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The challenge

Overcoming language barriers in healthcare

When caring for patients from non-English speaking backgrounds, healthcare providers often require the services of an interpreter to help patients and their clinicians communicate.

But qualified interpreters are not always available, and clinicians' ability to adequately assess and respond to their non-English speaking patients' needs can be affected by how well they are able to communicate with one another.

Our response

We’ve developed a communication app to support the care of patients from non-English speaking backgrounds

Our researchers from the Australian eHealth Research Centre, together with Western Health, developed CALD Assist, an innovative app to help clinicians and patients from Culturally and Linguistically Diverse (CALD) backgrounds communicate when an interpreter is not available.

The CALD Assist™ app features more than 200 commonly used phrases professionally interpreted into ten languages.

CALD Assist now includes COVID-19 screening questions, making it easier for the community  to communicate with health professionals.

The CALD Assist app features

  • more than 200 commonly used phrases professionally interpreted into ten languages: Arabic, Cantonese, Croatian, Greek, Italian, Macedonian, Mandarin, Serbian, Spanish and Vietnamese
  • convenient language grouping into seven different disciplines: new COVID-19 screening questions, dietetics, speech pathology, podiatry, physiotherapy, occupational therapy and nursing
  • images, video and pre-recorded audio to further aid communication between clinician and patient
  • interactivity with 'Answer options' to help patients respond to common questions.

The results

CALD Assist effectively supports communication between clinicians and patients

We trialled the CALD Assist app with allied health clinicians and nursing staff at the Footscray, Sunshine and Williamstown Hospitals in Melbourne.

Images, video and pre-recorded audio helps clinicians and patients to interact with and understand each other.

Results from our trials indicated that:

  • staff believed the app was valuable and easy to use
  • the time required to complete allied health assessments with patients from non-English speaking backgrounds reduced when using the app
  • patients were satisfied with how the app supported their communication
  • clinician 'confidence' in the patient's level of understanding of instructions increased when using the app
  • clinicians reported 'success of the interaction' increased when using the app.

CALD Assist is now available for free download via the Apple App Store.

CALD Assist is now available for free download via the Google Play Store.

Images, video and pre-recorded audio further assists clinician and patient communication.

Since its inception in 2015, CALD Assist has received numerous awards:

  • 2018 iAwards Victoria Merit Certificate (Public Sector and Government)
  • 2018 iAwards Pitchfest winner
  • 2017 The Health Roundtable Innovations Award 'Improving the Continuum of Care'
  • 2015 Health Informatics Society Australia, Branko Cesnik Award for Best Academic/Scientific paper
  • 2015 Gold 'Improving health equality and closing the gap', Victorian Public Healthcare Awards

Courtney Pocock – Speech Pathologist & CALD Assist Project Manager

The CALD Assist app is really an innovative way of helping facilitate clinicians to communicate with patients from non-English speaking backgrounds when we can’t access an interpreter. So, it is a multimodal app, it includes eleven different languages and the nursing version includes over one hundred and fifty phrases and they are phrases that are really designed to help that basic interaction between nursing staff and patients.

The project came about when I had a referral from a patient who spoke Italian, from one of our acute wards. This patient was waiting for a swallow assessment because the nurses were not sure whether she could eat or drink safely. I was able to communicate some very very basic things with the patient and it was enough to engage her and so it got me thinking that perhaps if as clinicians we could learn some key words in different languages, we could go up and help that communication barrier when we couldn’t get an interpreter.

We were approached by CSIRO a few years ago who had heard about the project and were interested in collaborating with us to be able to develop a prototype app. From that prototype app our partnership with CSIRO has continued and with the added support from Better Care Victoria we’ve been able to develop the app into a fully functional app across allied health and then now nursing.

Lyn Bongiovanni – Manager Language Services

Well the app will be used for simple instructions for patients like “it’s time to have a shower”, “where are your dentures?”, “where are your glasses?” and then things like, “do you have pain?” for example, and where a quick response is needed.

The patient population at Western Health is very diverse. We have over 100 languages spoken. Our staff interpreters are very busy during the day and yes they will definitely respond but they might be a little while and if you want to know urgently that someone is in pain or if you want to take a patient to have a shower, things like that, you really don’t need an interpreter. The questions that we ask are culturally appropriate, they cannot be misunderstood, they’re clear, they’re simple. If an answer is longer than yes or no that’s when you need to call an interpreter. This app will benefit the interpreting service because we will be able to use our time where we are really needed in complex conversations.

Linda Pocock – Nurse Unit Manager

So, the staff are really excited to be able to use this app because it means that they don’t have to get an interpreter just for simple questions they can just go to the app, get the iPad, open it up, get the right language and then ask the patients the questions. We can use phrases that the patients can understand and there’s actually pictures involved so if sometimes they can’t read, it talks to the patient as well. The patients can point to the ticks or the crosses, they can see the pictures and then they can communicate back to the nurse.

Misa Rauza – Patient

There are many things to tell them. First of all when you come to the hospital they have to feed you, they have to show you what to do. They can’t find interpreter, they can’t find anybody to really speak English, you know. Some of them don’t know, don’t speak. It’s pretty hard because you can’t communicate properly.

Application: “Can you stand up?”

It’s a good idea, people will be happier and it’s going to be easier. Those who don’t speak English, it’s better for those people.

Courtney Pocock – Speech Pathologist & CALD Assist Project Manager

So, we are currently investigating sustainability and scalability. Looking at how we can implement this app, both across the organisation of Western Health, but more broadly so different health networks across Victoria and Australia.

CALD Assist: Designing technology to support timely nursing assessment of Culturally Aand Linguistically Diverse (CALD) patients

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