Health Communication in Home Care for Elders in Hawai‘i

Abstract

The COVID-19 pandemic highlighted both the vulnerability of elders in institutional care and the essential multilingual caregiver workforce. Currently, the U.S. does not have standardized competencies for care worker training (Browne & Braune, 2008). Nor does the patient-centered model account for intercultural communication competency needed for inferences in multicultural interactions. This Mixed Methods Research (MMR) (Johnson et al., 2007) explored various stakeholder perceptions of (un)successful communication of multilingual care workers with elders and their families. Qualitative results of the first stages of sequential exploratory MM examined (a) forty semi-structured interviews, (b) four home observations of interaction between care workers and older adults, and (c) four stimulated recalls with multilingual caregivers with thematic content analysis and discourse analysis. Triangulation of qualitative data within and across groups showed that successful multilingual care workers used sociopragmatic strategies in activities of daily living (ADLs) to (a) manage rapport (Spencer-Oatey, 2008) with older adults and (b) navigate the local cultural order (Holmes, 2020) by using the insider language, Pidgin. Moreover, analysis of observation data revealed that while some care workers used prosodic and lexical features common to elderspeak, a register that some researchers identify as socializing elders into dependence, care workers were building solidarity for more effective outcomes (Marsden & Holmes 2014). From these results, the six constructs: (a) care, (b) appropriate assessment, (c) professional competency, (d) managing rapport, (e) cross-cultural communication, and (f) language choice / prosody guided item creation for Survey 1 (S1), to identify salient communicative activities of for Survey 2’s (S2) videos. Quantitative analysis clarified the underlying structure of care through S1’s Exploratory Factor Analysis (EFA) (n=50) and the extent of (dis)agreement on constructs of care through stakeholders’ assessments (n=45) of S2 videos. The integration of qualitative and quantitative procedures throughout research stages added to the validity of designing two quantitative instruments in home care and the triangulation of how stakeholders co-construct care in ADLs with older adults. This research adds to the sparse amount of research on therapeutic communication in home care as multilingual care workers and older adults orient to multiple levels of context to co-construct care in activities of daily living. Results imply that involving expertise of stakeholders at every stage of instrument development increases the relevance of items. Instructors and curriculum designers in English for Medical Purposes should also consider domain experts when creating language program goals and materials.