Fairfield University assistant professor publishes first instrument for Spanish speakers that tests patient satisfaction with nursing care


Language barriers and cultural differences have caused Hispanic Americans, the fastest-growing ethnic population in the United States, to be underrepresented, and sometimes misrepresented, in health care research, said Jean W. Lange, RN, MN, Ph.D., an assistant professor in the School of Nursing at Fairfield University.

According to Dr. Lange's research, which has been published in the October edition of Research in Nursing & Health, the lack of Spanish-speaking researchers, a lack of Spanish testing instruments, and cultural differences, have all contributed to marginalization of Hispanics in healthcare research and sometimes accidentally biased results.

Dr. Lange has made a step forward in correcting that problem by translating a widely used patient satisfaction survey from English to Spanish. Her results on this effort were published in the December edition of the nursing journal.

Translating an English survey to Spanish isn't a simple matter of pulling out a bilingual dictionary. Often times, the wording of questions within a study can be misconstrued by Spanish-speakers because the original English wording may not be meaningful in Spanish. It is critical to learn whether what is being measured is defined the same way among Hispanic sub groups as it is among English speakers. This can become very complex because there are many different Hispanic cultures in the United States.

In many cases, traditional English response formats, such as "strongly agree, agree, disagree, strongly disagree," are often too vague and do not retain their different degrees of separation when translated. Such seemingly innocuous linguistic interpretations are actually major problems that skew responses from the Hispanic populace, Dr. Lange said.

Dr. Lange dealt with those problems in her Spanish translation of the 15-item LaMonica-Oberst Patient Satisfaction With Nursing Care Scale, which she tested on 64 Spanish-speaking patients. For example, an original item in the English version read "The nurse gives directions at just the right speed." However the English back translation of the line in Spanish she used to effectively convey that idea is: "The nurse gives precise instructions so that I can understand them." Another item changed from "the nurse sees that I get physical assistance when I need it," to "the nurse takes responsibility to find someone who can help me with my daily activities, such as bathing, feeding, etc."

"Nothing is ever perfect with research," said Dr. Lange, noting that her own translated measure still shows some skewing and needs further refinement. "While mine's not perfect, it's the only Spanish instrument out there right now to measure patient satisfaction with nursing care. This is very important because, as a key indicator of quality care, as defined by the Institute of Medicine, many researchers are interested in measuring this variable."

The Hispanic population in the United States has been projected to reach 15 percent of total population by the year 2020, according to recent data from the U.S. Census Bureau. Health care professionals seeking federal funding find themselves in need of reliable measures of satisfaction for Spanish-speakers because the National Institute of Health requires that grant applications provide adequate representation of all ethnic and racial groups. This requirement includes groups that may be marginalized due to language, socioeconomic status, or other reasons. Researchers are already turning to Dr. Lange's tool to include Hispanic patients in their studies.

Determining patient satisfaction with their health care experience has become even more crucial in today's cost-conscious environment, Dr. Lange said. Leaving a significant portion of the nation's citizenry out of studies on patient satisfaction is unacceptable, Dr. Lange said.

"The work that Jean is doing has implications for the health care of Hispanics not only in this country but internationally," said Jeanne M. Novotny, Ph.D., FAAN, dean of Fairfield University's School of Nursing. "Jean is one of the top researchers in this field, and her hard work reflects the School of Nursing's overall commitment to research."

Dr. Robin D. Froman, RN, FAAN, Associate Dean of Research in the School of Nursing at University of Texas Medical Branch in Galveston has commented on Dr. Lange's research.

"Jean Lange has provided an excellent model for our new researchers in healthcare," Dr. Froman said. "She has taken seriously the federal mandate that we improve representation of all segments of the population in research studies. Jean's work allows Spanish speakers a greater voice in research on satisfaction with health care services. I use her research as an example with my own doctoral students who are preparing to enter the arena of nursing research."

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Media Contact: Nancy Habetz, (203) 254-4000, ext. 2647, nhabetz@fairfield.edu

Posted on January 2, 2003

Vol. 35, No. 133