back to news Oct. 23, 2014

$2.6 Million NIH Grant Funds New Language Teaching Model to Serve Spanish-speaking Chronic Care Patients

Glenn Martinez, professor and chair, Spanish and Portuguese; and Usha Menon, Ohio State Centennial Professor of Nursing, are co-principal investigators on a new grant designed to change the traditional way that Spanish for the health professions has been taught.

A new five-year National Institute of Health (NIH) Diabetes, Digestive and Kidney Disorders RO1 grant of $2.6 million dollars funds their innovative project, Integrated Second Language Learning for Chronic Care.

“Simply put,” Martinez said, “We are testing a model to train nurse practitioners to have the language and cultural skills to serve Hispanic patients with diabetes.

“The big idea is that when a student learns a language we should not only assess their performance in that language, but the impact of that performance on the person they’re speaking to.

“Unfortunately, the focus in language education has always been on the speaker never on the hearer.

“There are many programs out there that teach “medical Spanish” but none of them do what we’re doing. None have noticed that the models we have for teaching don’t fit the reality. And that’s the big innovation of this grant.”

“From the college of nursing perspective,” Menon said, “this study presents a unique opportunity to link academic curriculum to patient outcomes. For the most part, we educate nurses and advanced practice nurses, and the evaluation of their practice outcomes occur in separate settings.

“This study represents an innovative transdisciplinary partnership among departments and colleges that have not traditionally collaborated to merge educational outcomes with a direct impact on health.

“Few studies on health of patients in primary care settings make this link between education and patient outcomes — to that end, we are testing a unique model.

“Another exciting lesson learned is that boundaries between colleges and/or disciplines may only exist in our minds. Once we begin brainstorming and talking through interdisciplinary collaboration, really — the sky’s the limit — it’s made all those winter treks for meetings across campus so worth it!

“Faculty in the college of nursing are truly excited to model this framework for testing impact on health outcomes and transdisciplinary collaboration.”

The project gets underway next summer; it has a threshold proficiency level in Spanish that will allow its graduates to enter a nurse practitioner program.

It was designed specifically to train nurse practitioners due to a growing demand for health care and the expanded role of nurse practitioners in primary care.

“The Affordable Care Act will bring millions of new patients into the health care system; a large portion of those new patients are going to be Spanish speakers,” Martinez said.

“The people they will see are not physicians; they will be advanced practice nurses. The front line of primary care is nurse practitioners, so let’s be proactive in training them to serve this population.

“Current approaches to teaching Spanish for the health professions rarely offer a true clinical component. We need a new paradigm that includes and emphasizes clinical instruction. The use of language is integral to clinical practice, so how can we divorce language instruction from clinical contexts?

“To date, language is generally taught at a basic level — structured around a medical interview. Typical student-patient interactions consist of, ‘Where does it hurt?’ ‘When was the last time you ate?,’ etc.

“As a model for acute and episodic care for patients coming to the hospital who don’t speak English, this is a fine model.

“The fact, though, is that the Spanish speaking population in the United States is not primarily an acute care population — more than anything it’s a chronic care population with high rates of diabetes, hypertension, hyperlipidemia, obesity and depression — and these are things that require communication that goes far beyond what is required in acute and episodic care.

“For this, we need motivational interviewing; we need health care professionals to talk about lifestyle changes; to talk about setting goals. Clinical conversations with patients need to develop self-efficacy, their belief that they can ‘change.’”

To do that, this new three-phase program integrates language instruction and the development of Spanish language proficiency with health communication in a clinical setting. It starts with a seven-week student language classroom course during the summer that will integrate second language instruction with health communication training.

A nine-month clinical component follows, consisting of telephone health-coaching, pairing students with two or three diabetic patients, who they call every two weeks. Students ask about their diabetes control, any obstacles they’re facing in their diet or exercise routine, and talk about setting goals and how to meet those goals.

Finally, the students participate in an “immersion” component in Honduras, through the Global Health Initiative, a program offered by the College of Nursing.

The research components of the project include program level analysis, student level analysis, and patient level analysis.

“We want to know how a program like this functions in an academic structure like Ohio State’s College of Nursing," Martinez said. "Diane Birckbichler, director, Center for Languages, Literatures and Cultures, will evaluate this to see how this kind of educational intervention works within an academic setting."

At the student level, language proficiency will be measured at different points in the program to see which part raises proficiency more.

“We expect the greatest gains will be when the students are on the phone with the patients, and not necessarily when they are in the classroom,” Martinez said.

They will tape and analyze those interactions using Rotor Interaction Analysis System — an analytic tool used in health communication to determine effectiveness of patient- provider communication.

They will look at the quality of the conversations and how they change over time. As the practitioner and patient get to know each other and build rapport, they will be interested in seeing how those discourse features change.

Health outcomes will be measured at the patient level; the researchers hope to make the case that when put together, language, communication and clinical instruction have a positive impact on glycemic control, diabetes self-efficacy and depression.

ResearchProject co-investigators and consultants are Jennifer Moreland, Nationwide Children’s Hospital; Margaret Graham, vice dean, College of Nursing; Diane Birckbichler, director, Center for Languages, Literatures and Cultures; Laura Szalacha, research professor and statistician, nursing; Kathy Stone, professor emerita, nursing; and Alejandro Diez, clinical assistant professor of nephrology, College of Medicine.

—Sandi Rutkowski and Tan Nguyen