Mobile Video interpretation to Optimize Communication Across Language barriers: mVOCAL

PROJECT SUMMARY Over 25 million people in the United States (US) have limited English proficiency (LEP). LEP populations face substantial challenges when interacting with the healthcare system, resulting in worse outcomes such as elevated risk for serious safety events, increased costs, and decreased comprehension, satisfaction, and adherence. Professional interpretation is an evidence-based practice to improve care and improve outcomes. However, its use remains persistently low despite legal and regulatory mandates. Previous strategies to improve use have mainly addressed intrapersonal determinants (provider knowledge and skills, via in-person education) or the system (simplifying telephone interpreter access). Educational strategies have improved provider knowledge with unknown effect on interpreter use; systems strategies have achieved modest improvements in use. However, these strategies have lacked clearly articulated mechanisms or causal pathways, often as part of expensive, multifaceted interventions that limit precise attribution and scalability. In this study, the investigators will compare two discrete implementation strategies for improving interpreter use, the first an enhanced education strategy targeting primarily intrapersonal determinants but delivered in a scalable format (interactive web-based educational modules), and the second targeting system determinants, with a novel focus on mobile video interpretation (mVI), accessible on providers’ own mobile devices. The study’s specific aims are: (1) Compare the effectiveness of two implementation strategies, alone and in combination, to improve use of interpretation and comprehension for LEP patients/parents seen in adult/pediatric primary care settings; (2) Explore mVI and education implementation strategies’ ability to activate putative provider-level mechanisms; and (3) Determine the incremental cost effectiveness from a healthcare organization perspective of each implementation strategy (mVI, education, both). To accomplish these aims, the investigators will conduct a Type III hybrid implementation-effectiveness study in 6 primary care clinics, using a Sequential Multiple Assignment Randomized Trial (SMART) design. Enrolled providers (total n=50) will be randomized to mVI or educational modules, in addition to standard interpreter access. After 9 months, providers with high interpreter use will continue as assigned; those with lower use will be randomized to continue as before or add the alternative implementation strategy. Providers will complete surveys and in-depth interviews to understand determinants of interpreter use, based on the Theoretical Domains Framework. LEP patients will be surveyed (n=648) and interviewed (n=75) following visits with enrolled providers to understand their experiences with communication and interpretation. Determining how these two scalable strategies, alone and in sequence, perform for improving interpreter use, how they do so, and at what cost, will provide critical insights for addressing a persistent cause of suboptimal healthcare outcomes.