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7. Which research methodologies are useful for promoting bilingual and cultural competencies in public health?

The choice of a specific research strategy is highly dependent on the aim of the study. There are innumerable strategies that may vary on a continuum, depending on the level of (political) action, and the importance attached to changing the situation. On this ‘high action’ end of the continuum the focus is more on giving a contribution to the empowerment of people, to consciousness- raising. In that sense it shows overlap with political and or educational aims: the basis is one of a normative action, or of a certain policy. On the other end of the continuum, the emphasis is just on the “gathering of information” in a systematic way, which seems to be more neutral, with aims like “to gain insight into...”, e.g. the percentage of informal interpreters use in health care. This information may be used to change a situation, but from a research perspective this is not the first aim. The presented list of strategies doe not pretend to be exhaustive nor are the listed strategies mutually exclusive. Along the continuum there are countless combinations possible. The list is just meant to give an idea which strategies might be relevant for BICOM.

1. Action research
is based on Kurt Lewin’s field theory: insight is gained by changing the situation. If you change the situation, the problem becomes visible (e.g. women’s refugee houses, emergency telephone-line for children). If the policy in hospitals for interpreter services is changed, we can observe and describe the experiences and opinions of the several groups involved (professionals, patients, (in)formal interpreters).

2. Theatre forms
(like forum theatre or role playing) enable us to explore complex social situations, and to give voice to individuals who lack power in such situations (see chapters about Forum Theatre Chapter 5, Chapter 6). It can contribute to empowerment and consciousness- raising of people.

3. Process evaluation
is based on different data gathering methods, with the aim of giving a convincing description of ‘good practices’. These may be educational tools and methods, a new treatment, etc. The process of the treatment or methods is described in detail, and from different perspectives.

4. Intervention studies
are aimed to demonstrate an effect of a training or treatment. E.g. what is the effect of training in bilingual or intercultural competencies of health care providers on the level of mutual understanding between provider and patient? For example:

Harmsen, H. et al. (2005). The effect of an educational intervention on intercultural communication: Results of a randomised controlled trial. British Journal of General Practice, 55, 343-350.

5. Interviews
(group, individual) are meant to study opinions, attitudes and behaviour, and they may contribute to change these opinions etc. as well. By applying group interviews (focus groups, Delphi method), the participants may learn from each other. At the same time, relevant information in gathered. For example

Green, J. et al. (2005). Translators and mediators: Bilingual young people’s accounts of their interpreting work in health care. Social Science and Medicine, 60, 2097-110.
Greenhalgh, T., et al. (2006). Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective. Social Science and Medicine, 63, 1170-87.

6. Field work, participant observation
makes also use of different gathering methods, but the researcher just describes what he/she observes. Fieldwork is frequently used in anthropology for performing site studies.

7. Observation studies
are also descriptive and based on discourse analysis, conversation analysis. Audio- or video recordings, and transcripts of natural conversation are used to detect specific communication patterns, e.g. in intercultural and or bilingual settings. For example, to give a description of linguistic misunderstandings or to describe differences in communication patterns between different ethnic groups. Examples include:

Bürhig, K., & Meyer, B. (2004). Ad hoc interpreting and achievement of communicative purposes in briefings for informed consent. In J. House and J. Rehbein (eds.), Multilingual communication (pp. 43-62). Amsterdam: Benjamins.
Meeuwesen, L., Harmsen, H., Bernsen, R., & Bruijnzeels, M. Do Dutch doctors communicate differently with immigrant patients than with Dutch patients? Social Science and Medicine, 63, 2407-2417.

8. Survey research/ questionnaires
are meant to gather information, to show different pattern in behaviour, to develop questionnaires, e.g. on cultural views, or to evaluate the quality of health care services regarding migrant issues (communication, interpreter use, prejudice treatment expectations, etc., cultural knowledge).

Harmsen, J.A.M. et al. (2006). Cultural dissimilarities in general practice: Development and validation of a patient’s cultural background scale. Journal of Immigrant and Minority Health, 8, 115-124.

9. Epidemiology
generates data of large groups showing trends (linguistic competencies; education, work; subjective health; diseases etc.). Epidemiology refers to the story of the statistics. These data may be relevant to support health policy. For example: the percentage of immigrants taking their own interpreter with them is very high– which is contrary to public health policy (the right to make use of public interpreter services).

10. Review studies
present the state of the art regarding a specific issue, perform a meta-analysis, give an inventory of knowledge.

Mayhew, L., Eversley, J., & Harper, G. (2007). Neighbourhood knowledge management pilot project: Making neighbourhood knowledge accessible. London: ppre Ltd, Mayhew Associates and London Borough of Tower Hamlets.
Schouten, B.C., & Meeuwesen, L. (2006). Culture and medical communication: A review of the literature. Patient Education and Counselling, 64(1-3), 21-34.
Flores, G. (2005). The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review, 62, 255-99.

For the purpose of promoting bilingual and cultural competencies, the strategies most applicable seem to be to ones grouped on the “action” end of the continuum, especially process evaluation (description of best practice), and consciousness raising forms such as focus interviews or forms of theatre. However, also the other strategies may be very useful too. As always it will depend on the aim of the project.

L. Meeuwesen, Utrecht, May 16, 2007