Developing Digital Facilitation of Assessments in the Absence of an Interpreter: ParticipatoryDesign and Feasibility Evaluation with Allied Health Groups

Abstract

Background: To ensure appropriate and timely care, interpreters are often required to aid communication between clinicians and patients from non-English speaking backgrounds. In a hospital environment, where care is delivered 24 hours a day, interpreters are not always available. Subsequently, culturally and linguistically diverse (CALD) patients are sometimes unable to access timely assessment because of clinicians' inability to communicate directly with them. Objective: The aim of this study was to design and evaluate CALD Assist, a tablet app to assist communication between patients and allied health clinicians in the absence of an interpreter. CALD Assist uses key phrases translated into common languages and uses pictorial, written, and voice-over prompts to facilitate communication during basic patient assessment.Methods: CALD Assist's design, functionality,and contentwere determined through focus groups withclinicians and informed by interpreting and cultural services. An evaluation was conducted in a live trial phase on eight wards across 2 campusesof a hospital in Victoria, Australia.Results: A commercial grade CALD Assist mobile app for five disciplines within allied health was developed and evaluated. The app includes a total of 95 phrases in ten different languages to assist clinicians during theirinitial assessment. Evaluation results show that clinicians' confidence in their assessmentincreased with use of the CALD Assist app: clinicians' reports of "complete confidence"increased from 10%(3/30) to 42% (5/12), and assessment reports of "noconfidence"decreased from 57% (17/30) to 17% (2/12). Average time required to completean assessmentwith patients from non-English speaking backgrounds reduced from 42.0 to 15.6 min. Conclusions: Through the use of CALD Assist, clinician confidence in communicating with patients fromnon-Englishspeaking backgrounds in the absence ofan interpreter increased, providing patients fromnon-English speaking backgrounds with timely initial assessments and subsequent care in line with their Englishspeaking peers. Additionally, the inclusion of images and video demonstrations in CALDAssist increasedthe ability to communicate withpatients and overcome literacy-related barriers. Although a number of hurdles were faced, user uptake and satisfaction were positive, and the app isnow available in the Apple App Store.