IHP 410 Module 5 Final Project Milestone Three example

Milestone Three: Engaging and Communicating With Arab American Adults With Diabetes, Assessed Against the CLAS Standards

[Student Name]

Southern New Hampshire University

IHP 410: Population Health and Cultural Competence

Module Five Final Project Milestone Three

[Instructor Name]

[Date]

The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.

Milestone Three: Engaging and Communicating With Arab American Adults With Diabetes, Assessed Against the CLAS Standards

The Standard for Assessment

The federal CLAS standards contain 15 expectations for health care organizations in governance and leadership, communication and language assistance, and engagement, continuous improvement and accountability (U.S. Department of Health and Human Services, Office of Minority Health [OMH], 2013). They provide a practical yardstick for judging whether the composite health center's communication with Arabic-speaking patients is built into its systems. The table below assesses the center against seven standards most relevant to this population.

Table 1

Assessment of the Health Center Against Selected CLAS Standards

Barriers and Stakeholders

Barriers exist at three levels. For patients, they include limited English, work schedules, reliance on relatives to interpret and, for some older women, discomfort discussing health with male clinicians. For staff, they include time pressure that makes calling an interpreter feel burdensome and the habit of letting a bilingual relative interpret. At the organizational level, the center lacks translated materials, signage and ethnicity data, and has no formal link to community institutions. The recurring pattern is that the center relies on the goodwill and language skills of individual staff and families rather than on reliable systems.

Stakeholders who can address these barriers include patients and families, clinical and front desk staff, the center's leadership and patient-majority board, the telephone interpreter vendor, Medicaid managed care plans that pay for language services in some cases, and community organizations such as mosques and cultural associations.

Communication Strategies

Three communication strategies follow from the assessment. First, make professional interpretation the default. Staff should offer a qualified interpreter to every patient who prefers Arabic, and relatives, especially children, should not interpret clinical information except in emergencies. A systematic review found that professional interpreters are associated with better clinical care than ad hoc interpreters, bringing care for patients with limited English proficiency closer to that of patients without language barriers (Karliner et al., 2007). Signs in Arabic at every site should tell patients that interpretation is free.

Second, use teach-back at every diabetes visit. When researchers recorded primary care visits with diabetic patients who had low health literacy, physicians checked understanding of a new concept only one time in five, yet their patients whose understanding was checked were much more likely to have below-average A1c levels (Schillinger et al., 2003). Staff should be trained to ask patients to explain their medication plan or glucose targets in their own words, using an interpreter where needed.

Third, translate and simplify written materials. Diabetes education handouts, medication instructions and appointment reminders should be available in Arabic, written at a plain-language level, reviewed by community members, and supplemented with pictures for patients with limited literacy in any language.

Engagement Strategies

Communication tells patients what the center offers; engagement gives them a role in shaping it. The center should form an Arabic-speaking patient advisory group of eight to ten patients with diabetes, including women and older adults, that meets quarterly to review materials, class schedules and the pre-Ramadan program. It should formalize partnerships with two or three community institutions to host classes and screenings, and the community health worker proposed in Milestone Two should serve as a bridge, bringing patient concerns back to the care team. Patients should also be offered the option of a same-gender clinician when scheduling, recorded as a preference in the record so it does not depend on asking each time.

Staff Training

The strategies depend on staff, so the center should provide training on working with interpreters, teach-back and cultural and religious practices relevant to its patients, including Ramadan and gender preferences. Training should be practical, with role-plays using a telephone interpreter, and repeated annually. It should avoid stereotyping by presenting cultural information as common tendencies to explore with each patient rather than rules.

Measuring the Patient Experience of Communication

The center currently has no way of knowing how Arabic-speaking patients experience communication, because its satisfaction survey is offered only in English. A short survey in Arabic, administered by a staff member other than the treating clinician, should ask whether the patient understood the plan, whether an interpreter was offered, whether written materials were in a language the patient reads, and whether the patient felt respected. Results should be reported separately for Arabic-preferring and English-preferring patients so that gaps are visible, the same principle that exposed the diabetes outcome gap in Milestone One. The patient advisory group can help interpret the results and suggest changes, closing the loop between measurement and improvement that the accountability standards call for.

Linking Engagement to Evaluation

These strategies connect directly to measures the final proposal will track: the proportion of Arabic-preferring visits with a professional interpreter documented, the proportion of diabetes visits with teach-back recorded, attendance at Arabic-language classes, and patient-reported understanding and satisfaction, collected through a short survey in Arabic. Improvements in these process measures should precede changes in A1c and emergency visits, which will take longer to appear.

Conclusion

Assessed against the CLAS standards, the health center partly meets expectations for workforce and language assistance but falls short on signage, interpreter competence, translated materials and community partnership. Making professional interpretation the default, using teach-back, translating materials and giving patients a formal voice through an advisory group will move cultural competence from individual goodwill to reliable systems, which the final proposal will bring together with the strategies from Milestone Two.

References

Karliner, L. S., Jacobs, E. A., Chen, A. H., & Mutha, S. (2007). Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature. Health Services Research, 42(2), 727-754. https://doi.org/10.1111/j.1475-6773.2006.00629.x

Schillinger, D., Piette, J., Grumbach, K., Wang, F., Wilson, C., Daher, C., Leong-Grotz, K., Castro, C., & Bindman, A. B. (2003). Closing the loop: Physician communication with diabetic patients who have low health literacy. Archives of Internal Medicine, 163(1), 83-90. https://doi.org/10.1001/archinte.163.1.83

U.S. Department of Health and Human Services, Office of Minority Health. (2013). National standards for culturally and linguistically appropriate services in health and health care: A blueprint for advancing and sustaining CLAS policy and practice. https://thinkculturalhealth.hhs.gov/clas