Mobile Video Interpretation for Limited English Proficiency

(mVOCAL Trial)

Overseen By Casey Lion, MD, MPH

Age: Any Age

Sex: Any

Trial Phase: Academic

Sponsor: Seattle Children's Hospital

Disqualifiers: English speakers, ASL users, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

6669 Participants Needed

Trial Summary

What is the purpose of this trial?

Patients and families with limited English proficiency (LEP) and/or who use a language other than English for medical care (LOE) experience substantial barriers to communication in the healthcare setting, leading to medical care that is less safe, less efficient, less effective, and inequitable. Professional interpreter use has repeatedly been shown to improve outcomes and reduce disparities, yet it remains widely underused. This study will test two discrete, scalable implementation strategies for improving professional interpreter use in primary care, while collecting detailed information about mechanisms of action and costs that will be applicable to many sites of care and contribute meaningfully to the goal of reducing communication-based disparities. The investigators hypothesize that improving provider knowledge, confidence, and interpreter access will change behavior under real-world conditions.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Mobile Video Interpretation, Web-based Educational Modules?

Research shows that video interpretation is rated highly for quality and satisfaction compared to using untrained interpreters, and it increases access to professional interpretation without compromising quality. Additionally, video interpretation is seen as user-friendly and cost-effective, with 88% of users rating it as very good or good. ^{1 2 3 4 5}

How does mobile video interpretation differ from other treatments for limited English proficiency?

Mobile video interpretation is unique because it allows for real-time communication with patients who have limited English proficiency through video, which can be more effective than telephone interpretation by providing visual cues and a more personal interaction. ^{2 3 6 7 8}

Eligibility Criteria

This trial is for patients and families who prefer to communicate in a language other than English or sign language during medical care. They must visit a participating clinic, have an acute concern like a sore throat, and if under 18, be with a parent or guardian. Providers need to work at least 40% full-time and require interpretation often.

Inclusion Criteria

Providers: Primary clinical site at a participating clinic needing interpretation for at least 7 visits per month

I prefer a language other than sign language and will visit the clinic with an enrolled provider. If I'm under 18, I'll be with a parent or guardian.

My preferred language is one of the top 7 non-English languages, and I visited the clinic for an acute issue.

Timeline

Phase 0

Enrollment of primary care providers and baseline data collection

15 months

Baseline survey and interview

Phase 1

Randomization and implementation of strategies with data collection

9 months

Weekly and monthly follow-ups

Phase 2

Continuation and adjustment of strategies with ongoing data collection

9 months

Regular check-ins and interviews

Phase 3

Final data collection and development of sustainment plans

9 months

Final survey and interviews

Phase 4

Analysis and dissemination of results

18 months

Treatment Details

Interventions

• Mobile Video Interpretation
• Web-based Educational Modules

Trial Overview The study tests two strategies: web-based educational modules for providers and mobile video interpreting (mVI) access for non-English speakers. It aims to improve the use of professional interpreters in primary care, hoping this will lead to safer and more equitable healthcare.

Participant Groups

Group I: Mobile video interpreting access (mVI) Experimental Treatment 1 Intervention

This strategy will involve giving assigned providers access to mobile video interpreting (mVI) on a personal device, installation and support as needed, a tip sheet, and an extra charger, optional shock-resistant case, disposable antimicrobial sleeves, and a positioning stand to support use of their personal device for clinical care. mVI-assigned providers can opt for a study-issued smartphone in lieu of using their own. Access to mVI is achieved by downloading the application from the relevant location (e.g., Apple App Store), then entering an access code that links to a billing account. The study staff would then demonstrate use and answer questions. Technical support will be offered in-person following randomization; we will then email mVI-assigned providers weekly for the first month, then monthly, to offer additional support. A tip-sheet will be sent via email during the first week of the study that will include mVI instructions and best-practices.

Group II: Web based educational modules Active Control 1 Intervention

This strategy will consist of 6 web-based modules, clinic-specific interpreter access information, and 4 booster modules, all delivered via the internet. The online modules will cover 5 topics: 1) the importance and fundamentals of good communication; 2) the importance of professional interpreter use and disparities for LEP populations; 3) how to use an interpreter effectively; 4) what to do when the encounter is not going well; and 5) special challenges and solutions related to remote interpreter use. Modules will be interactive, with tailoring to the learner, and each will be \<15 minutes long. All modules will be available at once, but assigned providers will be prompted to view a new one each week. Every month for months 3-6 after randomization, a booster module will be released. The brief (\<10 min) boosters will review crucial points from initial modules and feature video vignettes. Providers will be reminded to view these weekly until they are complete.

Who Is Running the Clinical Trial?

Seattle Children's Hospital

Lead Sponsor

Trials

319

Recruited

5,232,000+

Findings from Research

In a study involving 241 Spanish-speaking patients and 24 health providers, in-person medical interpretation was rated significantly higher by providers and interpreters compared to remote methods, although patients rated all methods equally.

Providers and interpreters preferred video conferencing over telephone interpretation for remote services, highlighting potential concerns about miscommunication in phone interviews due to the lack of visual cues.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparing in-person, video, and telephonic medical interpretation. Locatis, C., Williamson, D., Gould-Kabler, C., et al.[2022]

References

1. Austria pubmed.ncbi.nlm.nih.gov

Enhancing patient safety through the quality assured use of a low-tech video interpreting system to overcome language barriers in healthcare settings. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

Comparing in-person, video, and telephonic medical interpretation. [2022]

3. United States pubmed.ncbi.nlm.nih.gov

Effect of Telephone vs Video Interpretation on Parent Comprehension, Communication, and Utilization in the Pediatric Emergency Department: A Randomized Clinical Trial. [2021]

4. United States pubmed.ncbi.nlm.nih.gov

Clinician ratings of interpreter mediated visits in underserved primary care settings with ad hoc, in-person professional, and video conferencing modes. [2021]

5. United States pubmed.ncbi.nlm.nih.gov

Performance of an online translation tool when applied to patient educational material. [2019]

6. United States pubmed.ncbi.nlm.nih.gov

Accessing university education: perceptions, preferences, and expectations for interpreting by deaf students. [2013]

7. Sweden pubmed.ncbi.nlm.nih.gov

Attitudes to and implementation of video interpretation in a Danish hospital: A cross-sectional study. [2018]

8. United States pubmed.ncbi.nlm.nih.gov

Classroom Discourse: What Is Conveyed Through Educational Interpretation. [2023]