Data collection
The research will take place at three hospitals located in the Metro South area of Brisbane, Australia: The Logan, Princess Alexandra and Queen Elizabeth II Hospitals. These hospitals were selected for their large size and comprehensive range of departments, and based on the demographic composition of their patient populations. Naturalistic conversations that occur between a patient and health practitioner, during an on-site hospital appointment, will be video recorded. These conversations will be obtained from a range of hospital in- and out-patient departments, in order to obtain a selection of health-related problems with different levels of patient risk. Departments considered appropriate for data collection include facilities for video recording in a quiet, private environment, as well as the ability to identify potential patient participants in advance (i.e. not those departments seeing or admitting emergency patients). The optimum length of appointment to obtain data appropriate for transcribing and analysing was determined as 15–20 min. Broad consultation with Directors of Nursing at each site, and with Nurse Unit Managers (NUMs), determined that the optimal process of initial patient and practitioner identification will be via the NUMs. An equivalent number of interactions will be recorded between participants who share the same L1, and those who do not share the same L1, in order to assess the effect of linguistic ability on the quality of the interaction and the communication of health-related information.
Participants
Patients and practitioners who speak either English or Chinese (Mandarin or Cantonese) as their L1 will be invited to participate, with initial recruitment facilitated by the NUMs. Chinese was chosen as the other language because it is the most common language spoken in South East Queensland after English. Depending on patient demographics, practitioners will be recorded in at least two interactions with patients. Patients will participate in one recorded interaction only. The patient cohort will comprise a minimum of 40 monolingual English and 40 bilingual (or polyglot) Chinese-English speakers. These patients will form dyads with 40 practitioners (20 monolingual English, 20 bilingual or polyglot Chinese-English), such that each practitioner will be recorded with at least two patients, one with whom they share an L1 (i.e. English L1 patient - English L1 practitioner or Mandarin L1 patient - Mandarin L1 practitioner) and one for whom the L1 is incongruent (i.e. English L1 practitioner - Mandarin L1 patient or English L1 patient - Mandarin L1 practitioner). We anticipate that most conversations will be in English. However, it is likely that practitioner and patient may resort to their common L1 (if not English) when that facilitates their communication. Conversations assisted by an interpreter will also be recorded. The practitioners will be recruited from multiple professions, including clinical nurses, midwives and pharmacists, thus allowing evaluation of a range of conversational dynamics.
Materials and procedure
Practitioners willing to participate in the research will be administered an information sheet and consent form, as well as a Language Background Questionnaire (LBQ), in advance of the video recording. Patients who are either language concordant or discrepant will be identified in a number of ways. First, NUMs will search the Queensland Health “Hibiscus” system (HBCIS: Hospital Based Corporate Information System) to identify patients with upcoming appointments who have identified themselves as Chinese, or requiring a Chinese interpreter, thus enabling the researchers to introduce themselves to the patient when they arrive for their appointment to seek their consent. Second, practitioners who have consented to take part will identify potential patients and contact the research team directly to inform them of a potential participant. Third, poster advertising will be used across the hospital and in local press to inform the public about the research and request that they get in touch should they be visiting the hospital as a patient and are interested in taking part in the study.
All information, consent and questionnaire forms will be available in a choice of English, Traditional Chinese or Simplified Chinese, allowing patients to select their preferred language. After providing informed consent, patients will participate in a video recording session during their hospital appointment. It should be noted that audio-only recording will be used if video recording is not possible. Basic language and L2 proficiency background information will be obtained using the LBQ (including self-rated proficiency for L1 and L2), for both patients and practitioners. This questionnaire was based on the work of two of the authors (RM and NS), described in [19] and adapted from [20]. In addition, patients will be asked to complete a short questionnaire to rate the perceived effectiveness of communication with the practitioner after their appointment has ended.
Exclusion and inclusion criteria
Patients and practitioners who speak more than two languages (e.g. Cantonese, Mandarin, and English) will be included in the study, as will those individuals (patients and practitioners) who identify English as their dominant language but who acquired Cantonese/Mandarin in childhood and speak it at home. Patients who are identified as having requested the assistance of an interpreter will be recorded, provided that they have consented to take part in the study. There will be no video recording of appointments where patients are expected to receive a physical examination by the practitioner.
Data analysis
All conversations will be transcribed in preparation for both qualitative and quantitative analyses. The transcripts will be analysed using Discursis [21], which will look at periods of engagement between patient and practitioner, with a focus on the extent to which communicative needs were met. In terms of communication content, Discursis will also allow us to investigate the extent to which expressions of likelihood and risk are used, and the extent to which they are linked to changes in convergence. Paralinguistic features such as tempo or pitch will also be available for analysis, for example convergence in register i.e. to what extent do patient and practitioner pitch their communication at the same level.
Data from the LBQ (e.g. L2 proficiency, language of training), as well as the practitioner/patient’s conversation, will be used to inform the metrics derived from the Discursis analysis. The metrics derived from these conversations can then be used to compare with the LBQ and the outcome measures from the post-appointment questionnaire for both qualitative and quantitative analyses. The qualitative analysis will look at accommodation, as well as target the occurrence of specific adverb phrases and how they operate in the context of discussing health risk.
Ethics
Ethical approval for the study has been granted from the Queensland University of Technology and University of Queensland Human Research Ethics Committees, and the Metro South Hospital Research Ethics Committee of the Queensland Government. Site specific approvals have been obtained for the Princess Alexandra, Queen Elizabeth II and Logan Hospitals.