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Strategies for overcoming language barriers in research

• Rory Meyers College of Nursing
• New York University
• Urban Initiative

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Aim: This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier. Design: Discussion paper. Data Sources: Research methods papers addressing cross-language research issues published between 2000–2017. Implications for Nursing: Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into “big data” systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. Conclusion: Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable, and valid cross-language research. Impact: This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The recommendations generated here have the potential to have an impact on the health and well-being of migrants around the world.

• asylum seeker
• language barrier
• translations
• undocumented immigrants

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• General Nursing

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• 10.1111/jan.14007

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• Language Medicine & Life Sciences 42%
• Healthcare Financing Medicine & Life Sciences 9%
• Data Science Medicine & Life Sciences 9%
• Big Data Medicine & Life Sciences 9%
• Data Systems Medicine & Life Sciences 8%
• Psychology Unconscious Medicine & Life Sciences 8%
• Patient Preference Medicine & Life Sciences 7%
• Data Accuracy Medicine & Life Sciences 7%

T1 - Strategies for overcoming language barriers in research

AU - Squires, Allison

AU - Sadarangani, Tina

AU - Jones, Simon

N1 - Funding Information: Funding information This paper was informed by research funded by the United States’ Agency for Health Care Research and Quality, R01HS23593. Publisher Copyright: © 2019 John Wiley & Sons Ltd

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Aim: This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier. Design: Discussion paper. Data Sources: Research methods papers addressing cross-language research issues published between 2000–2017. Implications for Nursing: Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into “big data” systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. Conclusion: Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable, and valid cross-language research. Impact: This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The recommendations generated here have the potential to have an impact on the health and well-being of migrants around the world.

AB - Aim: This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier. Design: Discussion paper. Data Sources: Research methods papers addressing cross-language research issues published between 2000–2017. Implications for Nursing: Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into “big data” systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. Conclusion: Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable, and valid cross-language research. Impact: This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The recommendations generated here have the potential to have an impact on the health and well-being of migrants around the world.

KW - asylum seeker

KW - immigrants

KW - language barrier

KW - methods

KW - nurses

KW - nursing

KW - refugee

KW - translations

KW - undocumented immigrants

UR - http://www.scopus.com/inward/record.url?scp=85067899110&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85067899110&partnerID=8YFLogxK

U2 - 10.1111/jan.14007

DO - 10.1111/jan.14007

M3 - Article

C2 - 30950104

AN - SCOPUS:85067899110

SN - 0309-2402

JO - Journal of Advanced Nursing

JF - Journal of Advanced Nursing

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Language and communication in international students’ adaptation: a bibliometric and content analysis review

• Open access
• Published: 12 July 2022
• Volume 85 , pages 1235–1256, ( 2023 )

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• Michał Wilczewski   ORCID: orcid.org/0000-0001-7650-5759 1 &
• Ilan Alon   ORCID: orcid.org/0000-0002-6927-593X 2 , 3  

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This article systematically reviews the literature (313 articles) on language and communication in international students’ cross-cultural adaptation in institutions of higher education for 1994–2021. We used bibliometric analysis to identify the most impactful journals and articles, and the intellectual structure of the field. We used content analysis to synthesize the results within each research stream and suggest future research directions. We established two major research streams: second-language proficiency and interactions in the host country. We found inconclusive results about the role of communication with co-nationals in students’ adaptation, which contradicts the major adaptation theories. New contextualized research and the use of other theories could help explain the contradictory results and develop the existing theories. Our review suggests the need to theoretically refine the interrelationships between the interactional variables and different adaptation domains. Moreover, to create a better fit between the empirical data and the adaptation models, research should test the mediating effects of second-language proficiency and the willingness to communicate with locals. Finally, research should focus on students in non-Anglophone countries and explore the effects of remote communication in online learning on students’ adaptation. We document the intellectual structure of the research on the role of language and communication in international students’ adaptation and suggest a future research agenda.

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Introduction

One of the consequences of globalization is the changing landscape of international higher education. Over the past two decades, there has been a major increase in the number of international students, that is, those who have crossed borders for the purpose of study (OECD, 2021a ), from 1.9 million in 1997 to over 6.1 million in 2019 (UIS Statistics, 2021 ). Even students who are motivated to develop intercultural competence by studying abroad (Jackson, 2015 ) face several challenges that prevent them from benefitting fully from that experience. Examples of these challenges include language and communication difficulties, cultural and educational obstacles affecting their adaptation, socialization, and learning experiences (Andrade, 2006 ), psychological distress (Smith & Khawaja, 2011 ), or social isolation and immigration and visa extension issues caused by Covid-19 travel restrictions (Hope, 2020 ).

Cross-cultural adaptation theories and empirical research (for reviews, see Andrade, 2006 ; Smith & Khawaja, 2011 ) confirm the critical importance of foreign-language and communication skills and transitioning to the host culture for a successful academic and social life. Improving our understanding of the role of foreign-language proficiency and communication in students’ adaptation is important as the number of international students in higher education worldwide is on the rise. This increase has been accompanied by a growing number of publications on this topic over the last decade (see Fig.  1 ). Previous reviews of the literature have identified foreign-language proficiency and communication as predictors of students’ adaptation and well-being in various countries (Smith & Khawaja, 2011 ). The most recent reviews (Jing et al., 2020 ) list second-language acquisition and cross-cultural adaptation as among the most commonly studied topics in international student research. However, to date, there are no studies specifically examining the role of language and communication in international students’ adaptation (henceforth “language and communication in student adaptation”). This gap is especially important given recent research promoting students’ self-formation (Marginson, 2014 ) and reciprocity between international and domestic students (Volet & Jones, 2012 ). The results challenge the traditional “adjustment to the host culture” paradigm whereby international students are treated as being out of sync with the host country’s norms (Marginson, 2014 ). Thus, this article differs from prior research by offering a systematic and in-depth review of the literature on language and communication in student adaptation using bibliometric co-citation analysis and qualitative content analysis. Our research has a methodological advantage in using various bibliometric tools, which should improve the validity of the results.

Source: HistCite). Note . TLC, total local citations received; TGC, total global citations received; Articles, number of articles published in the field; International Students, number (in millions) of international students worldwide (UIS Statistics, 2021 )

Yearly publication of articles on language and communication in student adaptation (

We focus on several questions:

What are the most impactful journals and articles about the role of language and communication in student adaptation?

What is the thematic structure of the research in the field?

What are the leading research streams investigating language and communication in student adaptation?

What are the effects of language and communication on student adaptation?

What are the future research directions?

After introducing the major concepts related to language and communication in student adaptation and the theoretical underpinnings of the field, we present our methodology. Using bibliometric and content analysis, we track the development of the field and identify the major themes, research streams, and studies that have shaped the state-of-the art and our current knowledge about the role of language and communication in student adaptation. Finally, we suggest avenues for future research.

Defining the concepts and theories related to language and communication in student adaptation

Concepts related to language and communication.

Culture is a socially constructed reality in which language and social practices interact to construct meanings (Burr, 2006 ). In this social constructionist perspective, language is viewed as a form of social action. Intertwined with culture, it allows individuals to communicate their knowledge about the world, as well as the assumptions, opinions, and viewpoints they share with other people (Kramsch, 1998 ). In this sense, people identify themselves and others through the use of language, which allows them to communicate their social and cultural identity (Kramsch, 1998 ).

Intercultural communication refers to the process of constructing shared meaning among individuals with diverse cultural backgrounds (Piller, 2007 ). Based on the research traditions in the language and communication in student adaptation research, we view foreign or second-language proficiency , that is, the skill allowing an individual to manage communication interactions in a second language successfully (Gallagher, 2013 ), as complementary to communication (Benzie, 2010 ).

Cross-cultural adaptation

The term adaptation is used in the literature interchangeably with acculturation , adjustment , assimilation , or integration . Understood as a state, cultural adaptation refers to the degree to which people fit into a new cultural environment (Gudykunst and Hammer, 1988 ), which is reflected in their psychological and emotional response to that environment (Black, 1990 ). In processual terms, adaptation is the process of responding to the new environment and developing the ability to function in it (Kim, 2001 ).

The literature on language and communication in student adaptation distinguishes between psychological, sociocultural, and academic adaptation. Psychological adaptation refers to people’s psychological well-being, reflected in their satisfaction with relationships with host nationals and their functioning in the new environment. Sociocultural adaptation is the individual’s ability to fit into the interactive aspects of the new cultural environment (Searle and Ward, 1990 ). Finally, academic adaptation refers to the ability to function in the new academic environment (Anderson, 1994 ). We will discuss the results of the research on language and communication in student adaptation with reference to these adaptation domains.

Theoretical underpinnings of language and communication in student adaptation

We will outline the major theories used in the research on international students and other sojourners, which has recognized foreign-language skills and interactions in the host country as critical for an individual’s adaptation and successful international experience.

The sojourner adjustment framework (Church, 1982 ) states that host-language proficiency allows one to establish and maintain interactions with host nationals, which contributes to one’s adaptation to the host country. In turn, social connectedness with host nationals protects one from psychological distress and facilitates cultural learning.

The cultural learning approach to acculturation (Ward et al., 2001 ) states that learning culture-specific skills allows people to handle sociocultural problems. The theory identifies foreign-language proficiency (including nonverbal communication), communication competence, and awareness of cultural differences as prerequisites for successful intercultural interactions and sociocultural adaptation (Ward et al., 2001 ). According to this approach, greater intercultural contact results in fewer sociocultural difficulties (Ward and Kennedy, 1993 ).

Acculturation theory (Berry, 1997 , 2005 ; Ward et al., 2001 ) identifies four acculturation practices when interacting with host nationals: assimilation (seeking interactions with hosts and not maintaining one’s cultural identity), integration (maintaining one’s home culture and seeking interactions with hosts), separation (maintaining one’s home culture and avoiding interactions with hosts), and marginalization (showing little interest in both maintaining one’s culture and interactions with others) (Berry, 1997 ). Acculturation theory postulates that host-language skills help establish supportive social and interpersonal relationships with host nationals and, thus, improve intercultural communication and sociocultural adjustment (Ward and Kennedy, 1993 ).

The anxiety/uncertainty management (AUM) theory (Gudykunst, 2005 ; Gudykunst and Hammer, 1988 ) states that intercultural adjustment is a function of one’s ability to cope with anxiety and uncertainty caused by interactions with hosts and situational processes. People’s ability to communicate effectively depends on their cognitive resources (e.g., cultural knowledge), which helps them respond to environmental demands and ease their anxiety.

The integrative theory of communication and cross-cultural adaptation (Kim, 2001 ) posits that people’s cultural adaptation is reflected in their functional fitness, meaning, the degree to which they have internalized the host culture’s meanings and communication symbols, their psychological well-being, and the development of a cultural identity (Kim, 2001 ). Communication with host nationals improves cultural adaptation by providing opportunities to learn about the host country’s society and culture, and developing intercultural communication competence that includes the ability to receive and interpret comprehensible messages in the host environment.

The intergroup contact theory (Allport, 1954 ; Pettigrew, 2008 ) states that contact between two distinct groups reduces mutual prejudice under certain conditions: when groups have common goals and equal status in the social interaction, exhibit intergroup cooperation, and have opportunities to become friends. Intercultural contact reduces prejudice toward and stereotypical views of the cultural other and provides opportunities for cultural learning (Allport, 1954 ).

These theories provide the theoretical framework guiding the discussion of the results synthesized through the content analysis of the most impactful articles in the field.

Methodology

Bibliometric and content analysis methods.

We used a mixed-method approach to review the research on language and communication in student adaptation for all of 1994–2021. This timeframe was informed by the data extraction process described in the next section. Specifically, we conducted quantitative bibliometric analyses such as co-citation analysis, keyword co-occurrence analysis, and conceptual thematic mapping, as well as qualitative content analysis to explore the research questions (Bretas & Alon, 2021 ).

Bibliometric methods use bibliographic data to identify the structures of scientific fields (Zupic and Čater, 2015 ). Using these methods, we can create an objective view of the literature by making the search and review process transparent and reproducible (Bretas and Alon, 2021 ). First, we measured the impact of the journals and articles by retrieving data from HistCite concerning the number of articles per journal and citations per article. We analyzed the number of total local citations (TLC) per year, that is, the number of times an article has been cited by other articles in the same literature (313 articles in our sample). We then analyzed the total global citations (TGC) each article received in the entire Web of Science (WoS) database. We also identified the trending articles in HistCite by calculating the total citation score (TLCe) at the end of the year covered in the study (mid-2021). This score rewards articles that received more citations within the last three years (i.e., up to the beginning of 2018). Using this technique, we can determine the emerging topics in the field because it considers not only articles with the highest number of citations received over a fixed period of time, but also those that have been cited most frequently in recent times (Alon et al., 2018 ).

Second, to establish a general conceptual structure of the field, we analyzed the co-occurrence of authors’ keywords using VOS software. Next, based on the authors’ keywords, we plotted a conceptual map using Biblioshiny (a tool for scientific mapping analysis that is part of the R bibliometrix-package) to identify motor, basic, niche, and emerging/declining themes in the field (Bretas and Alon, 2021 ).

Third, to determine specific research streams and map patterns within the field (Alon et al., 2018 ), we used the co-citation mapping techniques in HistCite that analyze and visualize citation linkages between articles (Garfield et al., 2006 ) over time.

Next, we used content analysis to synthesize the results from the 31 most impactful articles in the field. We analyzed the results within each research stream and discussed them in light of the major adaptation theories to suggest future research directions and trends within each research stream (Alon et al., 2018 ). Content analysis allows the researcher to identify the relatively objective characteristics of messages (Neuendorf, 2002 ). Thus, this technique enabled us to verify and refine the results produced by the bibliometric analysis, with the goal of improving their validity.

Data extraction

We extracted the bibliographic data from Clarivate Analytics’ WoS database that includes over 21,000 high-quality, peer-reviewed scholarly journals (as of July 2020 from clarivate.libguides.com). We adopted a two-stage data extraction approach (Alon et al., 2018 ; Bretas and Alon, 2021 ). Table 1 describes the data search and extraction processes.

First, in June 2021, we used keywords that would best cover the researched topic by searching for the following combinations of terms: (a) “international student*” OR “foreign student*” OR “overseas student*” OR “study* abroad” OR “international education”—to cover international students as a specific sojourner group; (b) “language*” and “communicat*”—to cover research on foreign-language proficiency as well as communication issues; and (c) “adapt*” OR “adjust*” OR “integrat*” OR “acculturat*”—to cover the adaptation aspects of the international students’ experience. However, given that cross-cultural adaptation is reflected in an individual’s functional fitness, psychological well-being, and development of a cultural identity (Kim, 2001 ), we included two additional terms in the search: “identit*” OR “satisf*”—to cover the literature on the students’ identity issues and satisfaction in the host country. Finally, based on a frequency analysis of our data extracted in step 2, we added “cultur* shock” in step 3 to cover important studies on culture shock as one of critical aspects of cross-cultural adaptation (Gudykunst, 2005 ; Pettigrew, 2008 ; Ward et al., 2001 ). After refining the search by limiting the data to articles published in English, the extraction process yielded 921 sources in WoS.

In the second stage, we refined the extraction further through a detailed examination of all 921 sources. We carefully read the articles’ abstracts to identify those suitable for further analysis. If the abstracts did not contain one or more of the three major aspects specified in the keyword search (i.e., international student, language and communication, adaptation), we studied the whole article to either include or exclude it. We did not identify any duplicates, but we removed book chapters and reviews of prior literature that were not filtered out by the search in WoS. Moreover, we excluded articles that (a) reported on students’ experiences outside of higher education contexts; (b) dealt with teaching portfolios, authors’ reflective inquiries, or anecdotal studies lacking a method section; (c) focused on the students’ experience outside the host country or on the experience of other stakeholders (e.g., students’ spouses, expatriate academics); (d) used the terms “adaptation,” “integration,” or “identity” in a sense different from cultural adaptation (e.g., adaptation of a syllabus/method/language instruction; integration of research/teaching methods/technology; “professional” but not “cultural” identity); or (e) used language/communication as a dependent rather than an independent variable. This process yielded 313 articles relevant to the topic. From them, we extracted the article’s title, author(s) names and affiliations, journal name, number, volume, page range, date of publication, abstract, and cited references for bibliometric analysis.

In a bibliometric analysis, the article is the unit of analysis. The goal of the analysis is to demonstrate interconnections among articles and research areas by measuring how many times the article is (co)cited by other articles (Bretas & Alon, 2021 ).

• Bibliometric analysis

Most relevant journals and articles

We addressed research question 1 regarding the most impactful journals and articles about the role of language and communication in student adaptation by identifying the most relevant journals and articles. Figure  2 lists the top 20 journals publishing in the field. The five most influential journals in terms of the number of local and global citations are as follows: International Journal of Intercultural Relations (79 and 695 citations, respectively), Journal of Studies in International Education (28 and 343 citations, respectively), Journal of Multilingual and Multicultural Development (14 and 105 citations, respectively), Journal of Cross-Cultural Psychology (13 and 302 citations, respectively), and Higher Education (11 and 114 citations, respectively),

Source: HistCite). Note . TLC, total local citations received; TLC/t, total local citations received per year; TGC, total global citations received; Articles, number of articles published in the field

Top 20 journals publishing on language and communication in student adaptation (

Table 2  lists the 20 most influential and trending articles as measured by, respectively, local citations (TLC) and trending local citations at the end of the period covered (TLCe), that is, mid-2021. The most locally cited article was a qualitative study of Asian students’ experiences in New Zealand by Campbell and Li ( 2008 ) (TLC = 12). That study, which linked host-language proficiency with student satisfaction and effective communication in academic contexts, also received the highest number of global citations per year (TGC/t = 7.86). The most influential article in terms of total local citations per year was a quantitative study by Akhtar and Kröner-Herwig ( 2015 ) (TLC/t = 1.00) who linked students’ host-language proficiency, prior international experience, and age with acculturative stress among students in Germany. Finally, Sam’s ( 2001 ) quantitative study, which found no relationship between host-language and English proficiency and having a local friend on students’ satisfaction with life in Norway, received the most global citations (TGC = 115).

The most trending article (TLCe = 7) was a quantitative study by Duru and Poyrazli ( 2011 ) who considered the role of social connectedness, perceived discrimination, and communication with locals and co-nationals in the sociocultural adaptation of Turkish students in the USA. The second article with the most trending local citations (TLCe = 5) was a qualitative study by Sawir et al. ( 2012 ) who focused on host-language proficiency as a barrier to sociocultural adaptation and communication in the experience of students in Anglophone countries.

Keyword co-occurrence analysis

We addressed research question 2 regarding the thematic structure of the research in the field by analyzing the authors’ keyword co-occurrences to establish the thematic structure of the field (Bretas and Alon, 2021 ; Donthu et al., 2020 ). Figure  3 depicts the network of keywords that occurred together in at least five articles between 1994 and 2021. The nodes represent keywords, the edges represent linkages among the keywords, and the proximity of the nodes and the thickness of the edges represent how frequently the keywords co-occurred (Donthu et al., 2020 ). The analysis yielded two even clusters with 17 keywords each. Cluster 1 represents the primary focus on the role of language proficiency in student adaptation. It includes keywords such as “language proficiency,” “adaptation,” “acculturative stress,” “culture shock,” and “challenges.” Cluster 2 represents the focus on the role of intercultural communication and competence in student adaptation. It includes keywords such as “intercultural communication,” “intercultural competence,” “academic/psychological/sociocultural adaptation,” and “transition.”

Source: VOS)

Authors’ keyword co-occurrence analysis (

Conceptual thematic map

Based on the authors’ keywords, we plotted a conceptual map (see Fig.  4 ) using two dimensions. The first is density , which indicates the degree of development of the themes as measured by the internal associations among the keywords. The second is centrality , which indicates the relevance of the themes as measured by the external associations among the keywords. The map shows four quadrants: (a) motor themes (high density and centrality), (b) basic themes (low density and high centrality), (c) niche themes (high density and low centrality), and (d) emerging/declining themes (low density and centrality) (Bretas & Alon, 2021 ). The analysis revealed that motor themes in the field are studies of Chinese students’ experiences and student integration. Unsurprisingly, the basic themes encompass most topics related to language in student adaptation. Research examining the perspective of the students’ parents with regard to their children’s overseas experience exemplifies a niche theme. Finally, “international medical students” and “learning environment” unfold as emerging/declining themes. To determine if the theme is emerging or declining, we analyzed bibliometric data on articles relating to medical students’ adaptation and students’ learning environment. We found that out of 19 articles on medical students published in 13 journals (10 medicine/public health-related), 15 (79%) articles were published over the last five years (2016–2021), which clearly suggests an emerging trend. The analysis of authors’ keywords yielded only three occurrences of the keyword “learning environment” in articles published in 2012, 2016, and 2020, which may suggest an emerging trend. To further validate this result, we searched for this keyword in titles and abstracts and identified eight relevant articles published between 2016 and 2020, which supports the emerging trend.

Source: Biblioshiny)

Conceptual thematic map (

Citation mapping: research streams

We addressed research question 3 regarding the leading research streams investigating language and communication in student adaptation by using co-citation mapping techniques to reveal how the articles in our dataset are co-cited over time. To produce meaningful results that would not trade depth for breadth in our large dataset (313 articles), we limited the search to articles with TGC ≥ 10 and TLC ≥ 3. These thresholds yielded the 31 articles (10% of the dataset) that are most frequently cited within and outside the dataset, indicating their driving force in the field. We analyzed these 31 articles further because their number corresponds with the suggested range of the most-cited core articles for mapping in HistCite (Garfield et al., 2006 ).

Figure  5 presents the citation mapping of these 31 articles. The vertical axis shows how the articles have been co-cited over time. Each node represents an article, the number in the box represents the location of the article in the entire dataset, and the size of the box indicates the article’s impact in terms of TLCs. The arrows indicate the citing direction between two articles. A closer distance between two nodes/articles indicates their similarity. Ten isolated articles in Fig.  5 have not been co-cited by other articles in the subsample of 31 articles.

Source: HistCite)

Citation mapping of articles on language and communication in student adaptation (

A content analysis of these 31 articles points to two major and quite even streams in the field: (a) “ second-language proficiency ” (16 articles) and (b) “ interactions in the host country ” involving second-language proficiency, communication competence, intercultural communication, and other factors (15 articles). We clustered the articles based on similar conceptualizations of language and communication and their role in student adaptation. As Fig.  5 illustrates, the articles formed distinct but interrelated clusters. The vertical axis indicates that while studies focusing solely on second-language proficiency and host-country interactions have developed relatively concurrently throughout the entire timespan, a particular interest in host-country interactions occurred in the second decade of research within the field (between 2009 and 2013). The ensuing sections present the results of the content analysis of the studies in each research stream, discussing the results in light of the major theories outlined before.

Content analysis

We sought to answer research question 4 regarding the effects of language and communication on student adaptation by synthesizing the literature within the previously established two research streams. The concept map in Fig.  6 illustrates the predictive effects of second-language proficiency and host-country interactions on various adaptation domains. Table 4 in the Appendix presents a detailed description of the synthesis and lists studies reporting these effects, underscoring inconclusive results.

A concept map synthesizing research on language and communication in student adaptation

Second-language proficiency

This research stream focuses on language barriers and the role of foreign-language proficiency in student adaptation. Having host-language proficiency predicts less acculturative stress (Akhtar and Kröner-Herwig, 2015 ), while limited host-language proficiency inhibits communication with locals and academic integration (Cao et al., 2016 ). These results are in line with the acculturation theory (Berry, 1997 , 2005 ; Ward et al., 2001 ) and the communication and cross-cultural adaptation theory (Kim, 2001 ). Cross ( 1995 ) suggested that social skills predict sociocultural rather than psychological (perceived stress, well-being) adaptation (Searle and Ward, 1990 ). Indeed, several qualitative studies have explained that the language barrier affects sociocultural adaptation by preventing students from establishing contacts with host nationals (Wang and Hannes, 2014 ), developing meaningful relationships (Sawir et al., 2012 ), and limiting occasions for cultural learning (Trentman, 2013 ), supporting the acculturation theory (Anderson, 1994 ; Church, 1982 ; Searle and Ward, 1990 ).

Moreover, insufficient host-language proficiency reduces students’ satisfaction by hampering their communication, socialization, and understanding of lectures in academic contexts (Campbell and Li, 2008 ). Similarly, language affects academic adaptation in students who have difficulty communicating with domestic students (Young and Schartner, 2014 ) or when used as a tool in power struggles, limiting students’ opportunities to speak up in class and participate in discussions or decision-making (Shi, 2011 ). Students who have limited host-language proficiency tend to interact with other international students, which exacerbates their separation from domestic students (Sawir et al., 2012 ). These findings again confirm the theories of acculturation (Berry, 1997 ; Ward et al., 2001 ) and communication and cross-cultural adaptation (Kim, 2001 ).

With regard to the acculturation theory (Berry, 1997 ; Ward and Kennedy, 1999 ), we found inconclusive results concerning the impact of foreign-language skills on students’ satisfaction and adaptation. Specifically, some studies (e.g., Sam, 2001 ; Ying and Liese, 1994 ) found this effect to be non-significant when tested in regression models. One explanation for this result might be the indirect effect of language on adaptation. For instance, Yang et al. ( 2006 ) established that host-language proficiency mediated the relationship between contact with host nationals and the psychological and sociocultural adjustment of students in Canada. Swami et al. ( 2010 ) reported that better host-language skills among Asian students in Britain predicted their adaptation partly because they had more contacts with host nationals. In turn, Meng et al. ( 2018 ) found that the relationship between foreign-language proficiency and social and academic adaptation was fully mediated by global competence (understood as “intercultural competence” or “global mindset”) in Chinese students in Belgium.

Interactions in the host country

The second research stream comprises studies taking a broader look at language and communication in student adaptation by considering both individual and social interaction contexts: second-language (host-language and English) proficiency; willingness to communicate in the second language; communication interactions with domestic and international students, host nationals, and co-nationals; social connectedness (i.e., a subjective awareness of being in a close relationship with the social world; Lee and Robbins, 1998 ; and integrative motivation (i.e., a positive affective disposition towards the host community; Yu, 2013 .

Host-language proficiency predicts academic (Hirai et al., 2015 ; Yu, 2013 ), psychological (Hirai et al., 2015 ; Rui and Wang, 2015 ), and sociocultural adaptation (Brown, 2009 ; Duru and Poyrazli, 2011 ), confirming the acculturation theory (Ward et al., 2001 ). However, although some studies (Hirai et al., 2015 ; Yu, 2013 ) confirmed the impact of host-language proficiency on academic adaptation, they found no such impact on sociocultural adaptation. Yu’s ( 2013 ) study reported that sociocultural adaptation depends on academic adaptation rather than on host-language proficiency. Moreover, host-language proficiency increases the students’ knowledge of the host culture, reduces their uncertainty, and promotes intercultural communication (Gallagher, 2013 ; Rui and Wang, 2015 ), supporting the central aspects of the AUM theory (Gudykunst, 2005 ).

In turn, by enabling communication with academics and peers, second-language proficiency promotes academic (Yu and Shen, 2012 ) and sociocultural adaptation, as well as social satisfaction (Perrucci and Hu, 1995 ). It also increases the students’ willingness to communicate in non-academic contexts. This willingness mediates the relationship between second-language proficiency and cross-cultural difficulties among Asian students in England (Gallagher, 2013 ). This finding may explain inconclusive results concerning the relationship between second-language proficiency and cultural adaptation. It appears that second-language proficiency alone is insufficient for successful adaptation. This proficiency should be coupled with the students’ willingness to initiate intercultural communication to cope with communication and cultural difficulties, which is compatible with both the AUM theory and Kim’s ( 2001 ) communication and cross-cultural adaptation theory.

As mentioned before, host-language proficiency facilitates adaptation through social interactions. Research demonstrates that communication with domestic students predicts academic satisfaction (Perrucci and Hu, 1995 ) and academic adaptation (Yu and Shen, 2012 ), confirming Kim’s ( 2001 ) theory. Moreover, the frequency of interaction (Zimmermann, 1995 ) and direct communication with host nationals (Rui and Wang, 2015 ) predict adaptation and reduce uncertainty, supporting the AUM theory. Zhang and Goodson ( 2011 ) found that social interactions with host nationals mediate the relationship between adherence to the host culture and sociocultural adaptation difficulties, confirming the acculturation theory (Berry, 1997 ), the intergroup contact theory (Allport, 1954 ; Pettigrew, 2008 ), and the culture learning approach in acculturation theory (Ward et al., 2001 ).

In line with the intergroup contact theory, social connectedness with host nationals predicts psychological and sociocultural adaptation (e.g., Hirai et al., 2015 ; Zhang and Goodson, 2011 ), confirming the sojourner adjustment framework (Church, 1982 ) and extending the acculturation framework (Ward and Kennedy, 1999 ) that recognizes the relevance of social connectedness for sociocultural adaptation only.

Research on interactions with co-nationals has produced inconclusive results. Some qualitative studies (Pitts, 2009 ) revealed that communication with co-nationals enhances students’ sociocultural adaptation and psychological and functional fitness for interacting with host nationals. Consistent with Kim’s ( 2001 ) theory, such communication may be a source of instrumental and emotional support for students when locals are not interested in contacts with them (Brown, 2009 ). Nonetheless, Pedersen et al. ( 2011 ) found that social interactions with co-nationals may cause psychological adjustment problems (e.g., homesickness), contradicting the acculturation theory (Ward and Kennedy, 1994 ), or increase their uncertainty (Rui and Wang, 2015 ), supporting the AUM theory.

Avenues for future research

We addressed research question 5 regarding future research directions through a content analysis of the 31 most impactful articles in the field. Importantly, all 20 trending articles listed in Table 1 were contained in the set of 31 articles. This outcome confirms the relevance of the results of the content analysis. We used these results as the basis for formulating the research questions we believe should be addressed within each of the two research streams. These questions are listed in Table 3 .

Research has focused primarily on the experience of Asian students in Anglophone countries (16 out of 31 most impactful articles), with Chinese students’ integration being the motor theme. This is not surprising given that Asian students account for 58% of all international students worldwide (OECD, 2021b ). In addition, Anglophone countries have been the top host destinations for the last two decades. The USA, the UK, and Australia hosted 49% of international students in 2000, while the USA, the UK, Canada, and Australia hosted 47% of international students in 2020 (Project Atlas, 2020 ). This fact raises the question of the generalizability of the research results across cultural contexts, especially given the previously identified cultural variation in student adaptation (Fritz et al., 2008 ). Thus, it is important to study the experiences of students in underexplored non-Anglophone host destinations that are currently gaining in popularity, such as China, hosting 9% of international students worldwide in 2019, France, Japan, or Spain (Project Atlas, 2020 ). Furthermore, future research in various non-Anglophone countries could precisely define the role of English as a lingua franca vs. host-language proficiency in international students’ experience.

The inconsistent results concerning the effects of communication with co-nationals on student adaptation (e.g., Pedersen et al., 2011 ; Pitts, 2009 ) indicate that more contextualized research is needed to determine if such communication is a product of or a precursor to adaptation difficulties (Pedersen et al., 2011 ). Given the lack of confirmation of the acculturation theory (Ward and Kennedy, 1994 ) or the communication and cross-cultural adaptation theory (Kim, 2001 ) in this regard, future research could cross-check the formation of students’ social networks with their adaptation trajectories, potentially using other theories such as social network theory to explain the contradictory results of empirical research.

Zhang and Goodson ( 2011 ) showed that social connectedness and social interaction with host nationals predict both psychological and sociocultural adaptation. In contrast, the sojourner adjustment framework (Ward and Kennedy, 1999 ) considered their impact on sociocultural adaptation only. Thus, future research should conceptualize the interrelationships among social interactions in the host country and various adaptation domains (psychological, sociocultural, and academic) more precisely.

Some studies (Brown, 2009 ; Gallagher, 2013 ; Rui and Wang, 2015 ) confirm all of the major adaptation theories in that host-language proficiency increases cultural knowledge and the acquisition of social skills, reduces uncertainty and facilitates intercultural communication. Nevertheless, the impact of language on sociocultural adaptation appears to be a complex issue. Our content analysis indicated that sociocultural adaptation may be impacted by academic adaptation (Yu, 2013 ) or does not occur when students do not engage in meaningful interactions with host nationals (Ortaçtepe, 2013 ). To better capture the positive sociocultural adaptation outcomes, researchers should take into account students’ communication motivations, together with other types of adaptation that may determine sociocultural adaptation.

Next, in view of some research suggesting the mediating role of second-language proficiency (Yang et al., 2006 ), contacts with host nationals (Swami et al., 2010 ), and students’ global competence (Meng et al., 2018 ) in their adaptation, future research should consider other non-language-related factors such as demographic, sociocultural, and personality characteristics in student adaptation models.

Finally, the conceptual map of the field established the experiences of medical students and the learning environment as an emerging research agenda. We expect that future research will focus on the experience of other types of students such as management or tourism students who combine studies with gaining professional experience in their fields. In terms of the learning environment and given the development and growing importance of online learning as a result of the Covid-19 pandemic, future research should explore the effects of remote communication, both synchronous and asynchronous, in online learning on students’ adaptation and well-being.

This article offers an objective approach to reviewing the current state of the literature on language and communication in student adaptation by conducting a bibliometric analysis of 313 articles and a content analysis of 31 articles identified as the driving force in the field. Only articles in English were included due to the authors’ inability to read the identified articles in Russian, Spanish, or Chinese. Future research could extend the data search to other languages.

This review found support for the effects of language of communication on student adaptation, confirming major adaptation theories. Nevertheless, it also identified inconsistent results concerning communication with co-nationals and the complex effects of communication with host nationals. Thus, we suggested that future research better captures the adaptation outcomes by conducting contextualized research in various cultural contexts, tracking the formation of students’ social networks, and precisely conceptualizing interrelations among social interactions in the host country and different adaptation domains. Researchers should also consider students’ communication motivations and the mediating role of non-language-related factors in student adaptation models.

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Acknowledgements

We thank the anonymous reviewers for their insightful comments and suggestions.

This research is supported by the Polish National Agency for Academic Exchange grant “Exploring international students’ experiences across European and non-European contexts” [grant number PPN/BEK/2019/1/00448/U/00001] to Michał Wilczewski.

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Wilczewski, M., Alon, I. Language and communication in international students’ adaptation: a bibliometric and content analysis review. High Educ 85 , 1235–1256 (2023). https://doi.org/10.1007/s10734-022-00888-8

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Implications of Language Barriers for Healthcare: A Systematic Review

Hilal al shamsi.

1 Director of Planning and Studies, Directorate General of Planning and Studies, Ministry of Health, Al Buraimi, Oman

Abdullah G. Almutairi

2 Director of Tumair Hospital, Ministry of Health, Riyadh, Saudi Arabia

Sulaiman Al Mashrafi

3 Directorate General of Planning and Studies, Department of Health Information and Statistics, Ministry of Health, Muscat, Oman

Talib Al Kalbani

4 Director of Pharmaceutical Care and Medical Stores, Directorate General of Health Services, Ministry of Health, Al Buraimi, Oman

Language barriers pose challenges in terms of achieving high levels of satisfaction among medical professionals and patients, providing high- quality healthcare and maintaining patient safety. To address these challenges, many larger healthcare institutions offer interpreter services to improve healthcare access, patient satisfaction, and communication. However, these services increase the cost and duration of treatment. The purpose of this review is to investigate the impact of language barriers on healthcare and to suggest solutions to address the challenges.

We identified published studies on the implications of language barriers in healthcare using two databases: PubMed and Medline. We included 14 studies that met the selection criteria. These studies were conducted in various countries, both developed and developing, though most came from the US. The 14 studies included 300 918 total participants, with participation in each study ranging from 21 to 22 353 people.

We found that language barriers in healthcare lead to miscommunication between the medical professional and patient, reducing both parties’ satisfaction and decreasing the quality of healthcare delivery and patient safety. In addition, the review found that interpreter services contribute indirectly to increased cost and the length of treatment visits. One study reported the implementation of online translation tools such as Google Translate and MediBabble in hospitals, which increased the satisfaction of both medical providers and patients (to 92%) and improved the quality of healthcare delivery and patient safety. Language barriers are responsible for reducing the satisfaction of medical providers and patients, as well as the quality of healthcare delivery and patient safety. Many healthcare institutions use interpreter services that increase the cost and length of treatment visits.

Conclusions

The results of our review suggest that implementing online translation tools such as Google Translate and MediBabble may improve the quality of healthcare and the level of satisfaction among both medical providers and patients.

Introduction

Language barriers have a major impact on the cost and quality of healthcare. They commonly occur between healthcare providers and patients when the two groups do not share a native language. 1 Regardless of language barriers, healthcare providers are required to deliver high-quality healthcare that adheres to the principles of human rights and equity to all their patients. 2

Health disparities such as unequal treatment related to language barriers are associated with unequal access to healthcare and unequal health outcomes. 3 For instance, a recent study demonstrated that patients who do not speak the local language are disadvantaged in terms of access to healthcare services. 4 Similarly, several studies have shown that patients who face language barriers have poorer health outcomes compared with patients who speak the local language. 5 , 6

Growing evidence documents the fact that language barriers indirectly impact the quality of the healthcare that patients receive. Language barriers contribute to reducing both patient and medical provider satisfaction, as well as communication between medical providers and patients. Patients who face language barriers are more likely to consume more healthcare services 2 and experience more adverse events. 7 A recent study conducted in six hospitals in the US found that adverse events occurred more frequently among patients with limited proficiency in English than among those who were proficient in English.

This review investigates the impact of language barriers on healthcare and suggests solutions to address the challenges.

We identified studies of the impact of language barriers on the delivery of healthcare by searching the PubMed and Medline databases using the keywords: ‘language barriers,’ ‘satisfaction,’ ‘healthcare,’ ‘limited English proficiency,’ ‘quality of care,’ ‘communication,’ and ‘access to health services’.

This review includes studies that address the impact of language barriers on the delivery of healthcare. It excludes studies into the impacts of communication barriers other than language barriers on the delivery of healthcare, studies that were not primarily conducted in healthcare organizations, and non-peer-reviewed articles. The search strategy was limited to articles published from 2000 to 2019 to find the most recent literature on the topic.

The extracted data are summarized in two tables. Table 1 outlines the general characteristics of the studies, including the country in which the study was done, the total number of organizations in which the sample was collected, the type of organization that conducted the study, the study type, the data collection method, the sample size, and the response rate. Table 2 presents the implication of language barriers on the delivery of healthcare in each study in the review.

*MOH: Ministry of Health; NA: not applicable; NR: not recorded.

Figure 1 shows the researcher’s method of selecting eligible studies for this review. Initially, the researcher’s search of the PubMed and Medline databases returned 2569 articles. After removing the duplicate articles, 1211 remained. Next, the researcher excluded the articles that were not mainly about language barriers (n = 605) and the non-peer-reviewed articles (n = 532). Then the researcher excluded those studies that were not primarily conducted in healthcare organizations (n = 60), leaving 14 articles to be included in this systematic review.

The process of selecting the included 14 studies in this review.

Table 1 presents a summary of the general characteristics of the 14 studies arranged by the authors’ names. Nine studies used a cross-sectional design, two used a prospective design, two used qualitative research, and one was a report. Five studies collected data from an interview survey, three used questionnaires, one used both an interview survey and questionnaires, three used hospital databases, and two used telephone and mail surveys. Five of the studies were conducted in the US, two in Saudi Arabia, two in Switzerland, and one each in Canada, Germany, England, Norway, and South Africa. The total number of participants in the 14 studies was 300 918, with the number of participants in each study ranging from 21 to 22 353.

Table 2 presents the most important findings of the 14 studies in this review. Seven of the studies focused on language barriers and patient satisfaction, two on the impact of language barriers on healthcare provider satisfaction, one on the impact of language barriers on both healthcare providers and patient satisfaction, two on the cost of interpretation services, one on the quality of interpretation services, and one on online translation tools. The findings of studies can be divided into three categories: the impact of language barriers on medical providers (such as physicians and nurses), patients, and the cost and quality of healthcare services.

Communication between patients and medical providers is at the heart of effective healthcare. In Pytel, 17 94.3% of nurses reported that it was very important for their work environment and communication to understand the language of their patients. Physicians also have difficulty understanding patients who do not speak their language, leading to wrong diagnosis and medications. 18 In Norway, medical providers reported that they had trouble understanding between 36% and 43% of the patients who do not speak the local language, necessitating interpreters. 15 Indeed, 37% of physicians indicated that they felt that patients hide some information because of language barriers. 15 In addition, all South African nurses in Saudi Arabia had difficulty communicating with patients and their family members, as well as nurses from other countries, because of language barriers. 19

Language barriers have negative implications for the delivery of healthcare and patient satisfaction. One study showed that among patients who received treatment from nurses who did not speak the local language, 30% had difficulty understanding medical instructions, 30% had a problem with the reliability of information, and 50% believed that the language barrier contributed to errors. 10 Other studies found that among patients who did not speak the local language, 49% had trouble understanding a medical situation, 34.7% were confused about how to use medication, 41.8% had trouble understanding a label on medication, 15.8% had a bad reaction to medication due to a problem understanding their healthcare provider’s instructions, 20 66.7% faced a barrier when accessing healthcare, and 20% did not seek healthcare services if these were not readily available for fear of not understanding their healthcare provider. 14 Furthermore, many patients with limited local language proficiency experienced adverse health events that resulted in detectable physical harm (49.1% of patients) or moderate temporary harm (46.8%) or experienced some failure in communication with medical providers (52.4%). 5 Patients with limited local language proficiency are also likely to miss medical appointments and have difficulties arranging appointments due to the language barrier. 9 Therefore, these patients have a poor level of satisfaction with their healthcare. 14 , 18

To increase patient satisfaction with healthcare, it is necessary to provide interpreter services. Two studies pointed out that medical providers needed interpreter services for 43.2% of their patients, and 21–76% of medical providers stated they had poor access to these services. 12 , 15 Moreover, 70.7% of limited English proficiency patients (LEPPs) reported limited availability of interpreter services, 13 , 14 and 26.4% reported that there were no interpreters in their healthcare institutions. 2 LEPPs also indirectly raise the cost of health services when they use interpreter services. 12 LEPPs who used interpreter services received more inpatient services and attended more office visits than those who did not. 11 The authors of this study estimated that interpreter services for Medicaid recipients at about $4.7 million annually. Some healthcare organizations use online translation tools such as Google Translate and MediBabble to address the challenges of language barriers. These tools are free and easy to access, and they contribute to improving healthcare delivery, patient safety, and increased (up to 92%) the satisfaction of both medical professionals and patients. 8

This review investigates the impact of language barriers on the delivery of healthcare and identifies possible solutions to the challenges posed by these language barriers. The first impact of language barriers is miscommunication between medical providers (physicians and nurses) and patients [ Table 2 ]. This miscommunication contributes to a reduction in the satisfaction of both medical providers and patients, the quality of healthcare delivery, and patient safety. The second impact is an increase in indirect healthcare costs. The final impact is the application of online translation tools to healthcare organizations, which improves the quality of healthcare delivery and patient safety and increases the satisfaction of both medical professionals and patients.

Language barriers are a key cause of miscommunication between medical providers and patients, and negatively affect the quality of healthcare services and patient satisfaction. Hospital medical professionals perceive language barriers to be a source of workplace stress and an impediment to the delivery of high-quality healthcare. 21 Much evidence shows a significant association between workplace stress and lower satisfaction among medical providers. 22 - 24 In addition, studies indicate that language barriers contribute to medical professionals’ incomplete understanding of patients’ situations, delayed treatment or misdiagnoses, poor patient assessment and incomplete prescribed treatment. 14 , 25

We also found that patients who do not speak the local language will have less satisfaction with their healthcare and less access to usual sources of healthcare. Even when patients with language barriers have access to healthcare, they have decreased satisfaction with that healthcare, decreased understanding of their diagnoses, and increased medication complications. 25 , 26 A study conducted in Saudi Arabia showed that 25% of foreign patients reported that they had difficulty communicating with medical professionals and decreased satisfaction with their healthcare; 20% of medical professionals reported that health outcomes (i.e., healthcare errors, understanding patient needs, feeling satisfaction, and trust in nursing care needs) were always affected by language barriers. 27 Interpreter services are necessary to solve the problem of language barriers in healthcare institutions and to increase the satisfaction of both medical professionals and patients.

To overcome language barriers, some healthcare institutions provide interpreter services; however, these services pose critical challenges in terms of access and financial burden. Previous studies have shown that most healthcare institutions have poor access to interpreter services or no services at all. 12 , 14 The use of interpreter services contributes to increased patient satisfaction and improved patient care among patients with language barriers. 28 Interpreter services have a significant association with increased physician visits, prescription drugs by physicians, and receipt of preventative services among patients. 29 However, providing interpreter services also increases the length and cost of physician visits.

MediBabble is an application created by medical students at the University of California, San Francisco, and released in 2011. Using advanced voice recognition software, it offers translations for thousands of medical instructions, as well as the questions for a standard medical history. 30 , 31 The application contains thousands of instructions and translated questions, organized by symptom. Most questions can be answered with ‘yes’ or ‘no’ gestures. 32 MediBabble can be used online or offline, and it allows physicians to take patient histories and make diagnoses when a language barrier exists. 32 However, the application translates only six languages: English, Spanish, Russian, Cantonese, Haitian Creole, and Mandarin. 32

A case study showed that medical professionals and patients were highly satisfied with MediBabble; they reported that the application was fast and easy in terms of translating and collecting information. 33 In a study done in Canada, MediBabble was used as one strategy to improve the delivery of healthcare for resettled Syrian refugees. It allowed medical professionals to take the refugees’ histories and also make diagnoses. 30 In brief, MediBabble shows success as a medical translator. Using both interpreter services and online translation tools may offer more opportunities to improve healthcare delivery and patient safety.

This review has some limitations. First, there are few existing studies on the application of online translation tools in healthcare to address the problem of language barriers. Second, there are few studies evaluating the challenges of language barriers in private healthcare organizations. The impact of language barriers must be evaluated in both the public and the private sectors to address this problem.

This review also has several strengths. First, studies included in the review were conducted in both developing and developed countries. Second, the response rate was 100% in six of the studies. Third, the studies focused on various aspects of language barriers in healthcare, which helped the researchers to evaluate the challenges from multiple angles and determine solutions.

Language barriers can make the delivery of high-quality healthcare very challenging. They have a negative impact on the quality of healthcare, patient safety, and the satisfaction of medical professionals and patients. While some health organizations provide interpreter services to address these problems, these services indirectly increase the cost of health services and increase the length of treatment visits. Online translation tools such as Google Translate and MediBabble present possible solutions for overcoming these challenges. Further studies on the implications of language barriers and the effectiveness of online translation tools are recommended. Furthermore, new updates with more medical phrases for Google Translate and with more languages included for MediBabble application are recommended.

The authors declared no conflicts of interest.

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Bachelor of Science in Nursing

The perceived effects of language barrier to academic performance of foreign students in De La Salle Medical and Health Sciences Institute

Christianne Jane Dela Cruz Angelica P. Gamilo Steven Bryan C. Zapata

Date of Completion

Document type, degree name.

language barrier, academic performance, foreign students

The study utilized the descriptive quantitative design. There were 27 respondents were chosen through purposive and snowball sampling. A self-made questionnaire composed of statements that represent situations related to academic performance and language barrier was prepared to determine difficulty in classroom and clinical settings. The statistical treatments used were frequency distribution, mean and standard deviation. The following conclusions were noted: 1) Majority of the respondents were 20 year old, female, came from America and had stayed in the Philippines for more than 5 1/2 years; 2) The respondents perceived that language barrier has an effect to their academic performance both in the classroom and in the clinical settings to a low extent; 3) There were no significant differences in the perceived effects of language barrier to the academic performance of foreign students at De La Salle Medical and Health Sciences Institute when grouped according to sex, age, country of origin and length of stay in the Philippines.

First Advisor

Julieta M. Damian

APA Citation

Dela Cruz, C. J., Gamilo, A., & Zapata, S. B. (2019). The perceived effects of language barrier to academic performance of foreign students in De La Salle Medical and Health Sciences Institute. [Bachelor's thesis, De La Salle Medical and Health Sciences Institute]. GreenPrints. https://greenprints.dlshsi.edu.ph/bsn/15/

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UNDERSTANDING BARRIERS AND FACILITATORS AFFECTING PARTICIPATION IN CANCER CLINICAL RESEARCH STUDIES FOR RACIALLY AND ETHNICALLY DIVERSE POPULATIONS IN RURAL NORTH CAROLINA

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• Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
• Increasing representation of minoritized racial and ethnic populations in cancer clinical research studies has been declared a priority in the US for many years. Additionally, it is widely recognized that people living in rural areas of the US have limited access to cancer clinical research studies, and solutions are needed to extend participation opportunities to rural patients with cancer. Underrepresentation of racial and ethnic minority populations and rural communities perpetuates health inequities, and solutions are needed to remove barriers and implement facilitators for participation. However, a review of existing literature found a lack of attention to understanding the needs and values of these populations in combination. This study employed a sequential mixed method, community engagement approach to explore the barriers and facilitators affecting participation in cancer clinical research from the perspectives of cancer survivors and their caregivers as well as cancer healthcare professionals. Existing publicly available data were used to identify and characterize four of the most rural, racially and ethnically diverse, and medically underserved counties in North Carolina. The principal investigator collaborated with cancer centers, churches, and American Indian Tribes to administer surveys to cancer survivors and caregivers to assess their beliefs and experiences regarding cancer clinical research. Eligible participants included persons who had been diagnosed with cancer or a caregiver of someone diagnosed with cancer. In addition, key informant interviews were conducted with cancer health care professionals providing cancer care in the selected counties. Survey and interview responses were analyzed with descriptive statistics. Forty-three cancer survivors/caregivers completed surveys and twenty-two cancer healthcare professionals completed semi-structured interviews. Cancer survivors and caregivers indicated lack of invitation to participate in cancer clinical research was their greatest barrier to participation, whereas cancer healthcare professionals cited lack of transportation as the greatest barrier for patients. Cancer survivors and caregivers and cancer healthcare professionals agreed that having support from clinical research personnel and research navigators would be amongst the most helpful facilitators, along with opportunities to participate in clinical research studies close to home. A plan for change was developed to address the barriers and promote the facilitators based on the study results.
• Public health
• https://doi.org/10.17615/r1cj-fw21
• Dissertation
• In Copyright - Educational Use Permitted
• Greene, Sandra
• Bell, Ronny
• Charlot, Marjory
• Dubé, Karine
• Spees, Lisa
• Doctor of Public Health
• University of North Carolina at Chapel Hill Graduate School

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