Study Notes on Language Anxiety in Neurosurgical Care

Language Anxiety in Neurosurgical Care: Exploring Foreign Language Anxiety in Hispanic Patients

Authors: Genaro E. Herrera Cano, Veronica Arroyo Rodriguez, Andrea Rodriguez Melendez, Ian Thomas McNeill

BACKGROUND

  • Globalization and immigration have led to increased language-discordant care.

  • Language discordance can adversely affect patient outcomes, particularly in health care settings.

  • Although research on Foreign Language Anxiety (FLA) is prevalent in education, it remains largely unexplored in health care.

  • FLA may hinder communication and clinical decision-making between patients and healthcare providers.

METHODS

  • A cross-sectional study conducted at a single institution with Hispanic outpatient neurosurgical patients aged 18 years and older.

  • Participants completed a survey evaluating their comfort with English and levels of FLA.

  • Survey prompts were based on the Foreign Language Anxiety in the Medical Office Scale (FLAMOS) and comfort reading/speaking English tools.

  • Responses were collected from May to December 2024.

  • Unadjusted t-tests and multiple linear regression were utilized to assess the relationships between English comfort and FLA, adjusting for sex, age, and educational level.

RESULTS

  • Total Surveys Collected: 102

  • Patients uncomfortable with English reported significantly higher FLA (mean ± SD: 3.23 ± 1.21) than those comfortable with English (2.10 ± 0.97).
      - Estimate (95% confidence interval): ‒1.12 (‒1.60 to ‒0.65), P < 0.0001.

  • Gender Differences: Females reported significantly higher FLA than males (estimate [95% CI]: ‒0.48 (‒0.95 to ‒0.01)).

CONCLUSIONS

  • There exists a significant correlation between discomfort with English and higher levels of FLA.

  • The study confirms the presence of FLA in neurosurgical outpatient care among Hispanic patients.

  • Recommendations for further research: Dive deeper into contributing factors to FLA, its impact on patient-physician interactions, and interventions to enhance communication in linguistically diverse populations.

INTRODUCTION

  • In the 21st century, globalization has increased international migration and the number of migrants worldwide grew from 173 million in 2010 to 258 million by 2017.

  • The U.S. saw an increase in linguistic diversity, with over 50 million residents (aged 5 and older) speaking a language other than English at home by 2015.
      - Notably, the Latino population is majorly represented amongst limited English proficient (LEP) individuals, with 62% categorized as LEP in 2015.
      - This population is projected to reach 111 million by 2060, accounting for 18.7% of the U.S. population.

  • Language discordance in healthcare is increasingly problematic as LEP Latinos face challenges in navigating an English-speaking healthcare system.
      - Limited English-speaking patients often interact with healthcare providers through limited English abilities, provider's Spanish skills, or family bilingual assistance.

KEYWORDS

  • Anxiety

  • Communication

  • Delivery of health care

  • FLA (Foreign Language Anxiety)

  • Hispanic or Latino

ABREVIATIONS AND ACRONYMS

  • CI: Confidence interval

  • FLA: Foreign language anxiety

  • LEP: Limited English proficient

  • FLAMOS: Foreign Language Anxiety Medical Office Scale

METHODS

  • The institutional review board (IRB) provided approval for the study.

  • Participants:
      - Adult Hispanic patients (18+ years) seeking outpatient neurosurgical care.
      - Participants completed a 5-minute written survey, available in both English and Spanish

  • Survey Design:
      - Collected demographics: age, sex, level of education, comfort in English, and FLA.
      - The survey comprised prompts rated on a Likert scale from 1 (totally disagree) to 5 (strongly agree).

  • The FLAMOS tool was selected as it best assessed FLA in the medical setting, concentrating on unease related to using English in the outpatient clinic.
      - Confusion was avoided with prompt wording specifying “English” alongside “foreign language.”

  • Identification of patients for the study occurred during check-in, inviting willing participants to complete the survey prior to their appointments.

  • Responses were stored securely until collected for analysis.

  • Participants were divided into groups based on English comfort level:
      - Comfortable with English Group: Average response > 3.
      - Uncomfortable with English Group: Average response ≤ 3.

  • Statistical analyses performed using JMP Student Edition version 18.2 for power analysis confirming sufficient sample size for significance testing.

RESULTS

  • Participant demographics:
      - Total participants: 102 (56 in Spanish, 46 in English)
      - Age range: 22 to 83 years (Median: 51)
      - Gender: 68 female (66.7%), 33 male (32.3%), 1 (1%) not reported
      - Education level: Majority reported having no college education

  • Findings by Group:
      - Uncomfortable with English: 3% of respondents skipped age questions.
      - Median age for Comfortable: 49 years; Uncomfortable: 53.5 years.
      - FLA averages were 2.10 (comfortable) and 3.23 (uncomfortable).
      - Statistical power of the study: 0.993.
      - Unadjusted t-tests confirmed significant differences in FLA averages between the two comfort categories (P < 0.0001).
      - Multiple regression analysis indicated lower FLA scores among those comfortable with English, significant at P < 0.0001.
      - Gender differences were statistically significant, with females experiencing higher FLA (P = 0.045).

DISCUSSION

  • This study underscores that FLA significantly affects Hispanic patients in neurosurgical settings, with uncomfortable patients reporting higher anxiety levels.

  • Language preference does not imply comfort; some respondents from the comfortable group chose to survey in Spanish.

  • Understanding FLA is essential for enhancing physician-patient communication and care for LEP individuals.

  • FLA Literature:
      - FLA has been globally studied since the 1970s mainly in educational settings, correlating negatively with communication willingness and positively with fear of making mistakes.
      - Factors such as language competence and duration of stay in the language-speaking country correlate with reduced FLA levels.

FLA in the Medical Context

  • FLA is less examined in healthcare than in educational settings.

  • Communication anxiety in native languages can similarly impair patient interactions.

  • Unique characteristics of FLA in healthcare, such as impacts on treatment adherence and diagnostic accuracy, differentiate it from other forms of communication anxiety.

  • Study Hypotheses: Zhao et al. showed that those from linguistic minorities face health-specific FLA, affecting their service usage.

EXPLORING FLA FACTORS

Potential Causes of FLA in Healthcare

  1. Limited vocabulary exacerbates FLA, especially with complex medical terminologies versus common words.

  2. Lack of oral comprehension arises from restricted exposure to the language, parallel to educational experiences of learners.

  3. Lower self-perception of language skills can heighten anxiety levels among patients.

Medical Interpreters' Role

  • Medical interpreting can mitigate barriers; however, variability in the interpreter's availability can complicate interactions.

  • Professional interpreters generally yield fewer errors than ad hoc interpreters.

  • However, patient satisfaction does not always improve with increased interpreter availability.

FLA and Demographic Factors

  • Only sex influenced FLA levels significantly, with females showing higher anxiety. Men may underreport anxiety due to societal stigma.

  • The study revealed no substantial links between FLA levels and age or education, potentially due to sampling biases from the low educational variability in respondents.

LIMITATIONS

  • Single-institution study limits generalizability.

  • Participant selection could introduce selection bias, focusing exclusively on a Hispanic demographic seeking neurosurgical care.

FUTURE DIRECTIONS

  • Recommendations for extending FLA studies: compare FLA across linguistic groups and settings, investigate the years spent in the U.S. impacting FLA, assess translation tools against interpreter services, and evaluate whether interpreters lessen FLA in LEP patients.

CONCLUSION

  • The study establishes the significance of FLA in Hispanic populations within healthcare contexts.

  • Clear communication strategies are necessary, particularly regarding complex medical issues, which can directly influence patient care and outcomes.

  • Recommendation: Utilize FLAMOS screening in initial neurosurgical visits to identify FLA in LEP patients.

CRediT AUTHORSHIP CONTRIBUTION STATEMENT

  • Contributions from all authors in writing, validating, reviewing and editing the study.

REFERENCES

  • Provided references at the end of the document covering various research studies related to the topic.