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      Overcoming language barriers in community-based research with refugee and migrant populations: options for using bilingual workers

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          Abstract

          Background

          Although the challenges of working with culturally and linguistically diverse groups can lead to the exclusion of some communities from research studies, cost effective strategies to encourage access and promote cross-cultural linkages between researchers and ethnic minority participants are essential to ensure their views are heard and their health needs identified. Using bilingual research assistants is one means to achieve this. In a study exploring alcohol and other drug service use by migrant women in Western Australia, bilingual workers were used to assist with participant recruitment and administration of a survey to 268 women who spoke more than 40 different languages.

          Discussion

          Professional interpreters, bilingual students, bilingual overseas-trained health professionals and community sector bilingual workers were used throughout the research project. For the initial qualitative phase, professional interpreters were used to conduct interviews and focus group sessions, however scheduling conflicts, inflexibility, their inability to help with recruitment and the expense prompted exploration of alternative options for interview interpreting in the quantitative component of the study. Bilingual mature-age students on work placement and overseas-trained health professionals provided good entry into their different community networks and successfully recruited and interviewed participants, often in languages with limited interpreter access. Although both groups required training and supervision, overseas-trained health professionals often had existing research skills, as well as understanding of key issues such as confidentiality and referral processes. Strategies to minimise social desirability bias and the need to set boundaries were discussed during regular debriefing sessions. Having a number of workers recruiting participants also helped minimise the potential for selection bias. The practical and educational experience gained by the bilingual workers was regarded as capacity building and a potentially valuable community resource for future health research projects.

          Summary

          The use of bilingual workers was key to the feasibility and success of the project. The most successful outcomes occurred with students and overseas-trained health professionals who had good community networks for recruitment and the required linguistic skills. By describing the advantages and disadvantages encountered when working with bilingual workers, we offer practical insights to assist other researchers working with linguistically diverse groups.

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          Most cited references29

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          Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study.

          What are the deleterious effects of mass trauma on the psychological wellbeing of refugees and other war-affected populations? Most epidemiological data are for short-to-medium term effects, leaving the possibility that early psychological reactions could reduce naturally over time. We aimed to assess the long-term effects of trauma on mental health and disability in Vietnamese refugees resettled in Australia. In a population-based study, we identified a community sample of 1413 adult Vietnamese from census collection areas in Sydney, Australia. Participants were interviewed by trained bilingual workers who administered questionnaires to assess the frequency of international classification of disease, version 10 (ICD-10) mental disorders in the 12 months before interview; psychiatric symptoms, by use of a culturally-sensitive symptom measure; exposure to psychologically traumatic events; disability and use of health services; and social, economic, and cultural factors since migration. We did multivariate analyses with adjustment for stressors since migration to establish the risk factors for mental illness. 1161 (82%) adults completed the interview. Mean length of residence in Australia was 11.2 years (SD 14.4) and mean time since the most severe traumatic event was 14.8 years (SD 10.8). 95 (8%) and 75 (7%) of participants had mental disorders defined by ICD-10 and the culturally-sensitive measure, respectively. Trauma exposure was the most important predictor of mental health status. Risk of mental illness fell consistently across time. However, people who had been exposed to more than three trauma events (199) had heightened risk of mental illness (23, [12%]) after 10 years compared with people with no trauma exposure (13, [3%]) (odds ratio 4.7, p<0.0001, 95% CI 2.3-9.5). Most Vietnamese refugees were free from overt mental ill health. Trauma-related mental illness seemed to reduce steadily over time, but a subgroup of people with a high degree of exposure to trauma had long-term psychiatric morbidity. Our findings support the need to develop specialised mental health services to reduce disability in refugees whose exposure to extreme trauma puts them at risk of chronic psychiatric disability.
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            Crossed wires: interpreters, translators, and bilingual workers in cross-language research.

            B. Temple (2002)
            Increasingly, researchers are undertaking studies involving people who do not speak the same language as they do. Sociologists have long argued that language constructs the social world at the same time as it describes it. However, the implications of this for cross-language research are rarely considered. Employing interpreters/translators and "cultural brokers" in research raises methodological issues around the meanings of concepts and how to convey difference. Using a project that employed two Asian mental health workers, the author teases out some of the implications for research of language difference. She focuses both on the value of a biographical approach and on the problems such an approach presents.
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              Multilingual translation issues in qualitative research: reflections on a metaphorical process.

              Focus on the translation and validation of measurement instruments has left a gap in the discussion on how to construct multilingual qualitative tools, such as interviews. Traditional methods of forward and backward translation have been criticized for weak conceptual equivalence, a crucial issue when multiple language interview methods are used. Through a creative arts metaphor of weaving, the authors describe an alternative process of multicentric translation used in the development of an interview guide designed to explore the impact of transition on palliative care patients in six European countries. Four identified core constructs illuminate this multicentric process: Cohesion, Congruence, Clarity, and Courtesy. Mutual reciprocity between researcher and translator offers greater possibility for construction of nuance and meaning, particularly where cultural parameters influence the collection and meaning of sensitive data from vulnerable populations. The translator therefore becomes a collaborator in the research process, which strengthens the rigor of language-based inquiry.
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                Author and article information

                Contributors
                Journal
                BMC Int Health Hum Rights
                BMC Int Health Hum Rights
                BMC International Health and Human Rights
                BioMed Central
                1472-698X
                2014
                12 April 2014
                : 14
                : 11
                Affiliations
                [1 ]Community Development Services Manager, Women’s Health and Family Services, Perth, Western Australia
                [2 ]Research Fellow, Combined Universities Centre for Rural Health, University of Western Australia, Perth, Western Australia
                [3 ]Winthrop Professor, Chair of Rural Health, University of Western Australia and Director, Combined Universities Centre for Rural Health, Geraldton, Western Australia
                Article
                1472-698X-14-11
                10.1186/1472-698X-14-11
                4016643
                24725431
                e45959ab-0f25-461a-b52a-e8b3c574f26d
                Copyright © 2014 Lee et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited.

                History
                : 22 May 2013
                : 2 April 2014
                Categories
                Correspondence

                Health & Social care
                bilingual workers,cross cultural research,migrants,refugees,communication,interpreting

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