ANAHEIM, CALIF. — There are limited standardized translations of the National Institutes of Health Stroke Scale (NIHSS) as well as several barriers to using interpreter services within medical institutions, according to new research presented at Physiatry ’23, the Association of Academic Physiatrists (AAP) annual meeting.
With over one million people of Haitian descent living in the U.S and Haiti having the highest incidence of stroke in the Americas, Haitian-Creole-speaking immigrants are at risk of receiving lower quality stroke care because of language barriers. To emphasize this need for translating the NIHSS into Haitian Creole and describe common challenges physicians face when utilizing interpreter services, a team of researchers at Albany Medical College in New York created a Qualtrics needs assessment survey and disseminated it to program coordinators across the U.S.
“This study is a passion project of mine that grew out of a gap I noticed in my second year of medical school, says Valerie Bresier, a medical student at Albany Medical College and the study’s presenting author. “We were in the midst of our second-year neurology course and one of our lectures included the NIHSS. The first thing I thought of when reviewing the scale was my grandmother who had two strokes and how this scale would have been administered to her. She spoke mainly Haitian Creole and I immediately thought of the language barriers between her and the physician administering the scale and how the scale is reflective of colloquial American English that does not translate smoothly to Haitian Creole.
“Upon further research, I noticed that not only was there not a scale available in Haitian Creole but there were very few NIH-validated scales available in other languages,” continues Bresier. “The translated scales that did exist stemmed from other independent research groups that created versions in their respective languages.”
The Qualtrics survey assessed physiatry and neurology residents’ demographics, barriers to using interpreter services and the need to adapt the NIHSS into Haitian Creole. To preserve participants’ anonymity, responses were collected over several months without program locations identified.
In data collected from 69 responses, more than 65% of physiatry and neurology residents had administered the NIHSS, while on a scale from 1-10 with 10 being the best quality in translation services, residents rated their respective institutions a 6.86 on average. The most frequent issues cited were time delays, having the interpreter physically present and connecting with technology. Residents rated the overall helpfulness of NIHSS standardized translations a 7.07 on average using a scale from 1-10, with 10 being very helpful. In addition, 16% of respondents reported needing an interpreter for Haitian Creole.
The findings demonstrate the need for standardized translations of the NIHSS, highlighted the researchers, noting that a minority of respondents required a Haitian Creole interpreter for the NIHSS, possibly due to responses from areas in which Haitian immigrants are not well-represented. The researchers also said that physiatry and neurology residents listed a variety of languages in which interpreters were needed showing an overall need for adaptations for patients with limited English proficiency.
“I want to raise awareness of the lack of translated versions of the NIHSS but ultimately discuss language barriers that exist in medicine,” says Bresier. “This project aims to provide insight into the challenges that residents face when working with patients with limited English proficiency and serves as a stepping stone for quality improvement projects anyone can take on at their respective institution. The NIHSS was simply the catalyst for the larger issue of addressing language barriers. My hope is that this begins a conversation around inclusivity of our patients with limited English proficiency, to serve as their allies in medicine, and to advocate for the improvement of interpreter services to ensure a quality patient care experience.”
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Physiatry ’23 is the Annual Meeting of the Association of Academic Physiatrists (AAP) which was held in Anaheim, California, from Feb 21 – 24, 2023. The Annual Meeting fosters lively discussions, collaborations, new ideas and unprecedented career growth with rehabilitation professionals and peers from all over the country. Immerse yourself in our diverse educational sessions that cover everything from COVID-19 rehabilitation to inclusive curriculums to even passing your Boards. You can view research contributed to Physiatry ’23 here. Remember to save the date today for Physiatry ’24.
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