Culturally competent social work research: methodological considerations for research with language minorities.
Despite the growing number of language minorities, foreign-born
individuals with limited English proficiency, this population has been
largely left out of social work research, often due to methodological
challenges involved in conducting research with this population. Whereas
the professional standard calls for cultural competence, a discussion of
how to implement strategies for culturally competent research with
language nflnorities is regrettably limited in the social work
literature. This article is, to the authors' knowledge, one of the
first within the field of social work to tie together unique
methodological issues that may arise throughout the research
conceptualization, development, and implementation process with this
population. Strategies for how to overcome such issues are provided by
adapting and expanding on a conceptual framework by Meleis. The
incorporation of such research practices with language minorities has
the potential to enhance trust and, thus, improve the recruitment and
retention of this hard-to-reach population. More important, studies that
aim to include such culturally responsive criteria may produce results
that have improved validity and, thus, contribute to the advancement of
knowledge regarding this population.
KEY WORDS: culturally competent research; language minorities; limited English proficiency; translation
Social case work
English as a second language
Casado, Banghwa Lee
Negi, Nalini Junko
|Publication:||Name: Social Work Publisher: Oxford University Press Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2012 Oxford University Press ISSN: 0037-8046|
|Issue:||Date: Jan, 2012 Source Volume: 57 Source Issue: 1|
|Geographic:||Geographic Scope: United States Geographic Code: 1USA United States|
Due to the growing number of immigrants, foreign-born people in the
United States are increasing, and a vast majority (84 percent) of these
foreign-born people speak a language other than English (U.S. Census
Bureau, 2008). The Census Bureau's 2008 data indicated that 55.8
million people (or 20 percent of the total U.S. population) spoke a
language other than English, which marked a 25 percent increase since
2000, and more than one-third of these people did not speak English
well. In the United States, individuals who are not fluent in English
are referred to as "language minority" individuals (Li,
McCardle, Clark, Kinsella, & Berch, 2001).
Understanding the needs of this population is important, because the ability to speak English greatly affects how well people communicate with and navigate through social institutions. Well-documented evidence suggests that limited English proficiency often becomes a barrier to access and adherence to necessary treatments and services (Derose & Baker, 2000; Fiscella, Franks, Doescher, & Saver, 2002; Sentell, Shumway, & Snowden, 2007). Programming that does not incorporate the needs of language minorities can inadvertently contribute to poorer quality of care and, hence, lead to health disparities (Ponce, Hays, & Cunningham, 2006). Research that aims to understand the social and health service needs of this vulnerable population is then vital to the attempt to reduce the gap in access to and quality of services.
Unfortunately, research on language minorities is scant, perhaps due to the challenges involved in conducting research in other languages (Frayne, Bums, Hardt, Rosen, & Moskowitz, 1996), and the heterogeneity of this population requires researchers to design studies that are not only linguistically, but also culturally appropriate for each specific language group (Li et al., 2001). It is also possible that little publicity and lack of public outcry about this issue may lead to the unintended yet continued exclusion of this population from research studies (Frayne et al., 1996). To address growing concern about the exclusion of language minorities from national studies, a group of representatives from the National Institute on Aging and the National Institute of Child Health and Human Development conveyed a work group and issued a report, Diverse Voices (Li et al., 2001). This report urged researchers to overcome barriers that prevent the inclusion of language minorities in national studies. The group argued that lack of data on language minorities is problematic because both policymakers and service providers may not have the necessary information to meet the needs of this population.
Social work may be uniquely well positioned to meet this challenge as professional standard calls for cultural competence; however, the literature that specifically discusses language-related issues and culturally competent research methods with language minorities is regrettably limited in social work. In fact, an extensive search of the databases Academic Search Premier, Psychology and Behavioral Science Collection, Social Work Abstracts, and Soclndex with Full Text using the key words "language minority," "non-English speaking population," "limited English proficiency," and "cross-cultural" yielded no literature that explicitly discussed culturally responsive social work research methods specific to language minorities. A handful of social work articles have addressed cultural and methodological issues in research with minorities and vulnerable populations (Amador, Travis, McAuley, Bernard, & McCutcheon, 2006; Potocky & Rodgers-Farmer, 1998; Poupart, Baker, & Horse, 2009; Shams & Robinson, 2005), but none of these articles suggested or discussed strategies on how to include language minorities in research investigations.
Given the unique challenges of including language minorities in research, this article extends the literature by bringing together disparate research on language minorities to provide a conceptual framework for research with this population. Specifically, we adapt Meleis's (1996) conceptual framework for culturally competent scholarship to offer practical strategies to systematically include language minorities throughout the research process from problem formulation to dissemination. The tying together of extant research on language minorities to inform research methods can assist in bridging the gap between the call for knowledge regarding language minorities' service needs and the paucity of research.
CONCEPTUAL FRAMEWORK: MELEIS'S CULTURALLY COMPETENT SCHOLARSHIP
Meleis (1996) presented eight criteria of culturally competent scholarship:
1. contextuality, an understanding of the sociocultural, political, and historical context of where the study participants live;
2. relevance, research questions that address issues faced by the study population and serve interests in improving their lives;
3. communication style, an understanding of the preferred communication styles of the research participants and their communities and the subtleties and variations inherent in the language used;
4. awareness of identity and power differences, a cognizance of researcher-participant power differences, the establishment of credibility, and the development of more horizontal relationships;
5. disclosure, the avoidance of secrecy and the building of trust with the study population;
6. reciprocation, research that meets mutual goals and objectives of the researcher and the study population;
7. empowerment, a research process that contributes to empowering the study population; and
8. time, a flexible approach to time in the research process in terms of quantity and quality of time spent.
These criteria do not suggest independent qualities or a hierarchal order of competence; rather, they are interrelated, and all qualities are necessary for culturally competent research (see Figure 1).
To our knowledge, Meleis's framework (1996) is one of the few that has integrated the concept of cultural competence into research methods. The framework has been used to evaluate culturally competent knowledge development (Mendias & Guevara, 2001), culturally specific measurements (Im, Meleis, & Lee, 1999), and the evaluation of the rigor and credibility of research with diverse populations (Jacobson, Chu, Pascucci, & Gaskins, 2005; Mill & Ogilvie, 2003; Saltus, 2006). Although Meleis developed these criteria for nursing scholars, we believe them to be valid for culturally competent social work research because they focus on values relevant to social work practice, such as awareness of power differences and empowerment perspectives.
[FIGURE 1 OMITTED]
Although Meleis's (1996) original framework provided criteria for culturally competent scholarship, it offered no specific strategies to apply such criteria in research methods. We synthesized the literature on language minorities to expand and adapt Meleis's criteria to address specific methodological issues that are unique to this population. Furthermore, specific strategies for overcoming the challenges of including language minorities in research are provided. To this end, this article is organized by the following four methodological areas: (1) research problem formulation, (2) recruitment and retention, (3) measurement, and (4) dissemination (see Figure 2).
Research Problem Formulation
Research with language minorities calls for a consideration of the unique challenges faced by this population. Culturally responsive research problem formulation with this population, therefore, necessitates consideration of contexuality, relevance, reciprocation, and empowerment. An understanding of context includes knowledge regarding where the target population lives and a consideration of the environmental factors associated with the problems faced by the study population. Such understanding would provide the researcher with the requisite knowledge to effectively conduct research with this population. It may also equip the researcher to understand what problems are considered to be most salient, or relevant, by the study population. Investigating a research problem that is identified as an issue or a concern by the population of interest may, in turn, encourage reciprocation, whereby research results are considered to be mutually beneficial to both the researcher and the study population in addressing the problem, and this process will empower the study population.
Culturally competent research criteria compel researchers to develop strategies to identify and understand the unique issues faced by a target language population. To this end, due to the paucity of research with this population, a literature review alone may not be sufficient to develop contextually relevant research questions. One possible strategy includes conducting focus groups with community leaders and providers and enlisting a culturally and linguistically specific committee composed of community leaders to consult during the research development process (Han, Kang, Kim, Ryu, & Kim, 2007; Ogilvie, Burgess-Pinto, & Caufield, 20(18). Work with these community leaders can assist researchers in understanding the sociopolitical context of the community where the target language minority individuals live. Furthermore, it can help identify research problems that are a concern of and are relevant to the community.
[FIGURE 2 OMITTED]
Recruitment and Retention
Recruitment and retention of minority research participants has been a major challenge for scientific research. It is even more difficult to recruit and retain language minority individuals, because, as U.S. Census Bureau (2008) data indicate, many of these individuals do not speak English well and live in linguistically isolated households. Consequently, it requires considerable effort to reach out to language minority individuals and attain their interest, trust, and agreement to participate in research.
Culturally Competent Research Team.
Foremost, developing a culturally competent research team that can communicate effectively with the community is crucial for the recruitment and retention of language minorities. Such a research team usually requires bilingual/bicultural staff who can potentially take on the roles of interpreter and translator. It should be noted that although the literature routinely refers to bilingual staff as culturally and linguistically competent, being able to speak a language does not necessarily translate to cultural competence. Some research indicates that accessing language minorities is more difficult when researchers are considered to be "cultural outsiders" (that is, the researchers are from a different cultural background) (Phenice, Griffore, Hakoyama, & Silvey, 2(109). lt is often assumed that "insider" researchers are more capable and effective in research with ethnic minorities. In many cases, however, bilingual staff may differ greatly from the study population because of their varied socioeconomic backgrounds and immigration histories (Tsai et al., 2004). Therefore, some argue that cultural matching of researchers/staff and study participants does not necessarily ensure culturally competent research; rather, the most important characteristic m this relationship is the cultural responsiveness of the researchers (Sawyer et al., 1995).
Accordingly, in addition to linguistic competence, each research staff person also needs to possess competence in culturally sensitive commnication characterized by Meleis's criteria: Conmmnicating in a manner that is sincere and respectful (conmunication style), working as an equal partner (awareness of identify and power differences), and avoiding secrecy (disclosure) am all important qualities necessary for a culturally responsive research team. Researchers have reported that culturally appropriate and personal communications are particularly effective in recruiting and retaining immigrant study participants (Aroian, Katz, & Kulwicki, 2006; Maxwell, Bastani, Vida, & Warda, 2005; Taylor-Piliae, 2007). Adequate cultural sensitivity training for all bilingual staff is then essential, because bilingual research staff often play a pivotal role in communicating with the target community and potential study participants.
Community Relationship Building. Building supportive relationships with the target language minority community is crucial for the successful recruitment and retention of study participants. To this end, it is essential to understand that language minority communities often build and operate their own social support networks to support members who have limited ability to communicate with mainstream U.S. society. These social support networks may include religious organizations, community social service organizations, voluntary organizations, and interest groups. Researchers must then have buy-in from community leaders as they may be especially vital in the recruitment of minority individuals. In fact, this buy-in from community leaders will facilitate the recruitment of study participants. Consistent communication with and exposure to the community has been found to be an effective strategy for building trusting relationships with community leaders and securing their support (Han et al., 2007; Yancey, Ortega, & Kumanyike, 2005). Such relationship building requires additional time and effort both before and during research; therefore, researchers may need to build extra time and flexibility into their time table.
Culturally Sensitive Research Settings.
Culturally competent recruitment of study parti cipants requires that researchers be cognizant of researcher-participant power differences and disclose their positions. Consideration of these competency criteria can allow researchers to create a research environment that is culturally sensitive and appropriate for the target population. Because of their potentially fragile immigration status, for example, many language minorities may fear involvement in formal activities, such as research. Language minorities may then be reluctant to sign formal documents, even when these are translated into their language (Han et al., 2007), out of a fear of compromising their immigration status. For some immigrants, signing a technical form may also remind them of traumatic or difficult experiences in their home country (Yick & Berthold, 2005). This may create a challenge in obtaining signed informed consent. Although the informed consent process should not be compromised, some flexibility in requiring written informed consent may be needed with language minorities. Researchers may then need to act as "cultural brokers" between the ethnic minority community and the research establishment and may have to educate the institutional review board members regarding culturally responsive protocol that also meets the ethical standards of research (Norris & DeMarco, 2005).
Measurement issues have always been a central concern when conducting research with ethnic minorities. Consideration of measurement issues is especially important in research with language minorities because of cultural and linguistic differences in perceptions and expressions among each language minority group. Careful examination and understanding of such differences within the target population ensures use of valid measurements in research with the population.
Measurement Translation. Research with language minorities necessitates the use of measures in the language used by the target language population. Although it is most preferred to use translated versions of standardized instruments that have been tested and validated through rigorous research, it is often difficult to find such instruments in every language. For that reason, translation and subsequent analysis of the psychometric properties of a measure are often necessary in research with language minorities. Therefore, it is essential that researchers be knowledgeable about the issues involved in the translation of instruments (Carlson, 2000). The translation of measures require more than simple verbatim translation of words in one language to another language. It is an intricate process that requires an understanding of the context of the concept being studied. Specifically, an understanding of the cultural meaning of the concept of interest is vital to being able to convey the subtle meaning of the concept in the most accurate manner possible and, therefore, developing linguistic equivalency (van de Vijver & Leung, 1997).
With an increasing demand for linguistically and culturally valid instruments, a number of techniques and guidelines have been recommended for instrument translation (for example, Chavez & Canino, 2005; U.S. Census Bureau Methodology and Standards Council, 2004; van de Vijver & Leung, 1997; World Health Organization, 2009). The most widely used technique in these guidelines is the model proposed by Brislin (1970, 1980), which consists of a series of translations and back-translations of the original instrument by bilingual individuals. This technique involves four steps: (1) forward-translation of the English instrument into the target language by a bilingual individual, (2) back-translation of the translated instrument into English by another bilingual individual, (3) comparative review of the original English and back-translated English versions of the instrument for any inconsistencies, and (4) revision of the translated instrument through collaborative work by the bilingual translators (and possibly additional bilingual individuals). A recent review of instrument translation methods identified six types of translation approaches: (1) forward-only, (2) forward-only with testing, (3) back-translation only, (4) backtranslation with monolingual testing, (5) back-translation with bilingual testing, and (6) back-translation with both monolingual and bilingual testing (Maneesriwongul & Dixon, 2004). Another commonly used translational method is a committee approach in which a team of bilingual committee members translates the instrument as a group (van de Vijver & Leung, 1997). Researchers usually use these procedures in combination, followed by pretesting of the instrument and revisions as needed. It is likely that the selection of appropriate translation methods depends on the resources that the researcher has because some methods require more resources than do others. Nonetheless, it is essential that translation be conducted by at least two bilingual individuals who understand culturally specific language use and expressions in both English and the target language.
The foremost concern of instrument translation is ensuring measurement equivalence--that is, the translated version of the measure should work equivalently in the target population as the original measure does and measure the same construct it is designed to measure (Carlson, 2000). Although numerous types of equivalence have been suggested in ensuring the cross-cultural validity of measurement, equivalence essentially refers to ensuring the validity of a measure across culture (Chang, Chau, & Holroyd, 1999; Willgerodt, Kataoka-Yahiro, Kim, & Ceria, 2005). Measurement equivalence of the translated instruments should be examined through psychometric analysis before research hypotheses are tested, because the translation process inherently leads to changes in the psychometric properties of an instrument (Carlson, 2000; Hilton & Skrutkowski, 2002). Van de Vijver (2003) warned that absence of measurement equivalence indicates cross-cultural difference in the conceptualization of the measure or poor translation and, thus, should not be used to infer cross-cultural differences. For that reason, evaluation of the translated version of the instrument is a vital step in the development of a cross-culturally valid measure with each specific language population.
Qualitative Data. Culturally responsive data collection and interpretation of qualitative data require that researchers understand the preferred communication style of study participants and have knowledge and skills in contextualizing the meaning of the words and behaviors, and their subtleties and variations, exhibited by study participants. The translation and the interpretation of qualitative data collected from language minorities involve unique methodological issues that require special considerations. Researchers need to determine how data will be collected and in which language the data will be analyzed--in the language of the study population or in English.
It is essential that researchers collecting qualitative data carefully consider who collects the data. Bilingual researchers may be able to collect data on their own, but when researchers do not speak the language of the study population, they have to rely on bilingual interviewers for data collection. In such cases, one of the most important decisions that nonbilingual researchers need to make is whether they want to actively participate in data collection in real time when the bilingual interviewer collects data. One approach is to provide extensive training for bilingual interviewers, and then the trained bilingual interviewers can conduct data collection entirely without the participation of the nonbilingual researcher (for example, Quine, 1999; Wong, Yoo, & Stewart, 2005). Whereas this approach may be more time efficient, it limits the researcher's ability to control data collection beyond what was planned and what the bilingual interviewer was trained to do. An alternative approach that allows the nonbilingual researcher's real-time participation is the rapid bilingual appraisal model (Whelan, 2004), in which an interpreter interprets the proceedings to the researcher as the bilingual interviewer collects data. Adapting this model, Garrett, Dickson, Lis-Young, Whelm, and Roberto-Forero (2004) conducted focus groups with several language groups and reported that this approach allowed the nonbilingual researcher to fully engage in data collection while ensuring the natural flow of the focus group interview.
Unlike in the case of instrument translation, no methodologically rigorous standards for analyzing data collected in a language other than English (to be used for English language dissemination) exist (Lopez, Figueroa, Connor, & Maliski, 2008). In their review of the literature, Lopez et al. found that researchers commonly used a method wherein data is collected in the language of the study participants; this is then translated into English and transcribed for analysis. They warned that this method can create "the opportunity for interpreter bias" and proposed that a more accurate analysis can be obtained through adaptation of Brislin's (1970, 1980) process: verbatim transcription of the source language first, translation of the transcript, review of the two transcripts by multiple translators, and corrections if necessary.
Another important consideration is who translates and analyzes the data. Although insider researchers have the ability to potentially translate and analyze data on their own, which is advantageous, some warn of the threat of bias in this process and recommend the use of additional linguistically and culturally competent individuals to minimize bias (Squires, 2008). A recent study further suggested that having only insider researchers analyzing data may result in shortcomings. Specifically, Tsai et al. (2004) found that "outsider" coders tended to raise questions about the meanings of words, whereas insider coders did not. They suggested that insider coders may have been so well acquainted with the behaviors and concepts shared by participants that it prevented them from identifying relevant and unique cultural concepts. Subsequently, Tsai et al. recommended the use of both insider and outsider coders in qualitative data analysis with linguistic minorities.
Finally, as described earlier, the translation process for instruments and qualitative data consists of a series of repeated translation and review steps that is likely to require additional time. Because time is an important factor in implementation of the research project, researchers need to build adequate time for translation into a study's process design.
Dissemination of study findings is the goal of any scientific inquiry. Meleis (1996) stressed reciprocation and empowerment as essential criteria for culturally competent scholarship. These criteria call for the dissemination of findings for the purpose of advancing mutual goals and empowering the community for further improvement of the lives of its people. Dissemination of study findings is particularly important for research with ethnic minorities (Yick & Berthold, 2005). Lack of data on language minorities has resulted in such minorities' relative invisibility in both research and policy, which leads to the exclusion of this population's needs and problems in the development of policy, programs, and treatments (Li et al., 2001). Culturally responsive research demands that researchers bear the responsibility of disseminating study findings to address this gap in the knowledge base. In addition to scientific publication, it is important that study findings be disseminated to stakeholders at all levels. Researchers could use various dissemination strategies, such as press releases, summary reports, research brief brochures, policy briefs, study newsletters, community agency publications and Web sites, and local events and meetings (Community Alliance for Research and Engagement, 2009).
Dissemination of research findings to the community is crucial to the process of facilitating the use of evidence to ameliorate the consequences of social problems faced by the community (Papadopoulos & Lees, 2002). Researchers have long been criticized for their lack of long-term investment in the communities where they conduct their research (Gil & Bob, 1999; Pinto, McKay, & Escobar, 2008). Lack of follow-through in sharing of study results and long-term commitment from researchers can often result in distrust among community members, especially those who are socially isolated from mainstream establishments, such as language minorities. Consequently, language minorities may become cautious about participating in future studies or collaborating with researchers. Hence, it is imperative that researchers return to the community on completion of the study and disseminate key findings. The realization of such reciprocal opportunities allows for future research and collaborative opportunities to work toward the improvement of the community.
Underutilization of social and health care services among ethnic and racial minority populations compels the development of culturally responsive programming (Caldwell et al., 2008). Although limited English proficiency is known to be a barrier to the effective delivery of services (Furman et al., 2009), scant literature has focused on advancing the social work knowledge and skills needed for work with language minorities. Moreover, perhaps due to a presumption of social worker competence in dealing with language minorities, little discussion has appeared on the unique methodological challenges of and research strategies for working with language minorities, further hindering research in this area. The gap in the knowledge base regarding the distinct and diverse needs of language minorities has significant repercussions for our ability to conduct research with them. Perhaps this gap is partially attributable to the myriad challenges involved in including language minority participants in research studies. Regardless, research with these groups is essential for the development of culturally responsive health and social programming.
Social work researchers may be at an advantage to conduct research with language minorities because of the profession's traditional relationship with the community and prominent role in the human services sector. Furthermore, the profession's explicit focus on social justice charges social work researchers with the responsibility to contribute to the knowledge base on vulnerable populations. To this end, this is one of the first studies to offer a culturally responsive conceptual framework for research with language minorities. By expanding and adapting Meleis's (1996) criteria for culturally competent scholarship to include language minorities, this article offers practical strategies to effectively work with language minority communities throughout the research process. Specifically, this article's adaptation of Meleis's conceptual framework allows researchers to logically and systematically examine methodological issues in research with language minorities. The incorporation of such culturally responsive research practices with language minorities has the potential to enhance trust and, thus, improve the recruitment and retention of language minorities. In addition, the inclusion of culturally responsive criteria throughout the research process may generate results with improved validity (Jacobson et al., 2005) and, thus, further the knowledge base regarding language minorities. More important, the advancement of research with language minorities is an important step toward the improvement of health and social services access and quality of care among this group.
Original manuscript received November 17, 2009
Final revision received July 8, 2010
Accepted July 12, 2010
Advance Access Publication May 31, 2012
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Banghwa Lee Casado, PhD, and Nalini Junko Negi, PhD, are assistant professors, and Michin Hong, MSW, PhD, is an adjunct faculty member, School of Social Work, University of Maryland, Baltimore. An earlier version of this article was presented at the 2009 annual program meeting of the Council on Social Work Education, November 7, 2009, San Antonio, TX. Address correspondence to Banghwa Lee Casado, School of Social Work, University of Maryland, 525 West Redwood Street, Baltimore, MD 21201; e-mail: firstname.lastname@example.org.
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