Introduction
The Afghan community in California experiences a variety of challenges with access to healthcare services. Factors such as English proficiency, level of education, financial stability, and health insurance status are significant determinants of healthcare access. It is estimated that 24.4% of Afghan households live in poverty, and 50.8% live in or near poverty (Camarota & Zeigler, 2021). In Northern California, most of the resident Afghans have moderate English ability while being male, employed, and having a high level of education is associated with improved access to healthcare (Alemi & Stempel, 2018). Inadequacies of interpreter services are directly linked to limited healthcare access. Afghan individuals seeking services often face difficulties communicating their problems to healthcare professionals. This makes medical appointments tedious and patients may get frustrated and dissatisfied (Reihani et al., 2021). The availability of translators is essential during medical appointments, given the fact that they facilitate the effective exchange of vital information necessary for the delivery of quality services.
Study Design and Rationale
A cross-sectional study is ideal because it facilitates the analysis of a health-related state and specific variables of interest in a target population at a specific point in time. It is an effective means of proving a snapshot of the frequency of health-linked characteristics in a chosen group of people (Kesmodel, 2018). In its analytic form, the study design effectively investigates the connection between a putative risk factor and a health outcome. It is the most efficient modality for the collection of prevalence data in a specific population. In addition, it allows for the evaluation of multiple outcomes and exposures in any given context. The objective, in this case, is to evaluate the degree to which the lack of interpretation services during medical appointments impacts the health of refugee communities in the State of California.
Methodology
A semi-structured interview approach will be adopted during the study. Each of the participants will be interviewed independently for 60-90 minutes. Each of the respondents will be provided with a detailed description of the study and reassured about adherence to ethical principles such as confidentiality and anonymity. This is critical because it allows participants to understand the interview expectations and increases the likelihood of honesty. The venue for the interviews will be free from distractions, and the locations that will be chosen will be the most ideal for the participants. The interviews comprise specific questions intended to define the areas of interest, such as the impact of language barriers on health access, while allowing participants to diverge to provide more detail (Gill et al., 2008). It is a particularly useful modality in healthcare contexts because it offers participants guidance on the nature of topics to explore, which is often immensely helpful. The flexibility associated with semi-structured interviews facilitates the exploration of important issues that may have been sidelined by the researchers.
The purpose of the interview process is to evaluate the experiences, perspectives, motivations, and beliefs that California’s Afghan community has about accessing healthcare services. Gill et al. (2008) note that qualitative approaches such as interviews provide an in-depth understanding of social phenomena than one would obtain from the application of purely quantitative approaches. It enables researchers to gain detailed insights into the translator challenges experienced in consultation rooms during clinical visits. The approach is also ideal for the exploration of sensitive topics, where a group environment is viewed as a breach of privacy, as is often the case with healthcare-associated concerns.
Sample Population
California is the basis for this study because it is home to the highest number of Afghan refugees in the United States. According to the Center for Immigrant Studies (CIS), approximately 133,000 foreign-born Afghans lived in the U.S. in 2019 (Camarota & Zeigler, 2021). The regions with the largest populations of Afghans are Texas at 10,000, Virginia at 24,000, and California at 54,000 (Camarota & Zeigler, 2021). Immigrant families face a variety of challenges associated with residence in a new country. Access to healthcare is determined in part by their ability to communicate (Kavukcu & Altlntaş, 2019). The fact that California has a high population of immigrant families makes it the most ideal location to investigate the impact of limited translator services on health access.
Local refugee resettlement agencies will be used to identify eligible individuals. The objective is to conduct 25 key informant interviews to explicate the impact of limited translator services on access to healthcare. The study will be focused on San Jose in Northern California. In addition to having a large Afghan population, previous studies have evaluated various health characteristics of the Afghan population in the region. Alemi and Stempel (2018) demonstrated that 25% of Northern California’s Afghan population had a bachelor’s degree, 13% attended a technical college, 29% had less than a diploma, and 32% did not complete a high school education. In addition, most of the surveyed individuals had moderate English ability. Therefore, Northern California’s Afghan population fits the criteria on which this research study is based, hence the choice of San Jose.
There are specific criteria that will be used to determine suitability for the study. Individuals that will be included are Afghan refugees that are eighteen years or older and have lived in California for a minimum of three years. In addition, they must have at least one living child who resides in the same state, should have attended at least one medical appointment with a healthcare practitioner, and have low English proficiency. Those that will be excluded from the study are individuals below the age of eighteen years, adults without children, individuals with a high proficiency in English, and individuals who have never had a clinical appointment. In addition, individuals who have resided in areas other than California will not be included in the study.
Instrumentation
The questions in the structured interviews are designed to evaluate the degree to which the lack of interpreters during clinic visits impacts access to healthcare among California’s Afghan population. The interviews incorporate a series of questions that help the researcher explore areas of interest, such as the impact of limited English proficiency and the lack of an interpreter on access to healthcare services in California. The prompts are designed to allow the participants to deviate from the stated topic to provide context or in-depth information whenever necessary. The instrument’s inherent flexibility allows participants to explore and highlight issues that the researcher may have overlooked. It also allows for the assessment of the target population’s experiences, motivations, and perspectives. In addition, the researcher gains an in-depth understanding of social phenomena, which would be impossible with strictly quantitative instruments. The questions in the structured interview are attached in the appendix.
A semi-structured interview is the most effective method of understanding the health-related challenges that Afghan refugees face in California. The questions serve as a guide to help elucidate specific elements that are relevant to the study. First, the interview questions help explicate the family dynamics and the impact of gender roles on health-seeking behavior. It is also important to establish how the participants are coping because there are significant cultural differences between California and Afghanistan. It is important to establish the frequency with which the study participant’s children have visited a doctor and the barriers they have encountered when accessing services. The quantification of the impact of language on access to care is integral to the study, which will ultimately be used to inform policies intended to improve healthcare service delivery in California.
Data Collection
The data for the interview will be collected through a face-to-face semi-structured interview that will take place with individual respondents. The researcher will include a translator when needed to conduct the interviews in a private room. It is important to provide a safe setting in a familiar environment as a way of prompting participants to express themselves freely. At the start of every interview, the participant information sheet will be read, the parameters of confidentiality will be explained and consent for audio recording will be sought. The participants will sign consent forms, and each of the interviews will be saved in encrypted USD devices.
Ethical Considerations
The protection of the rights, dignity, and well-being of study participants is an essential element of any research endeavor. The sensitivity of health-related issues demands the observance of moral principles that are designed to guarantee the objectivity of study findings. There are specific ethical considerations that must be observed during the interview. The facilitators must treat the study participants with respect and explain the nature of the research (United Nations Children’s Fund, n.d.). It is vital to allow respondents to ask questions before and during the interviews and must be allowed to stop their participation whenever they desire. Finally, the information provided must be kept confidential, unless the study participant agrees to its distribution (United Nations Children’s Fund, n.d.). The observance of ethical standards is essential when researching human populations.
Data Analysis
The analysis of the collected data will be conducted in a series of stages. First, it is essential to prepare and organize the information gathered from the respondents (Campus Labs, 2020). This will involve printing out transcripts and gathering notes and other materials used in the research exercise. The sources will be marked and any demographics collected will be logged and categorized. The second stage involves reviewing and exploring the collected data (Campus Labs, 2020). This will include reading the data several times to understand its key components while keeping notes on key ideas. The third step involves the creation of initial codes using highlighters and sticky notes to form connections in the data. It is important to review the identified codes and combine them into themes. The identified themes must then be presented cohesively.
Thematic analysis will be conducted using specific well-defined steps. Deductive thematic analysis will be employed to identify common themes that apply to the study sample. The transcripts will then be analyzed using an inductive approach that facilitates the identification of new themes and codes that were not identified in the initial evaluation. The reliability of the data will be guaranteed by ensuring that a different analyst reviews and assesses the data to check for compatibility with the researcher’s findings. It is vital to note that consensus on the final theme categorization will be reached as a team. Quotes to illustrate context and meanings as defined in the study results will be chosen at random from the identified themes and subthemes.
Conclusion
The Afghan community in California experiences a variety of challenges, such as limited English proficiency, low levels of education, financial instability, and limited health insurance, which impact access to healthcare services. California is the basis for this study because it is home to the highest number of Afghan refugees in the United States. A cross-sectional approach will be adopted because it facilitates the analysis of health-related issues and specific variables of interest in a target population at a specific point in time. A semi-structured interview approach will be adopted during the study as a means of evaluating the experiences, perspectives, motivations, and beliefs that California’s Afghan community has about accessing healthcare services. The facilitators will treat the study participants with respect and explain the nature of the research. The interview questions are designed to evaluate the degree to which the lack of interpreters during clinic visits impacts access to healthcare among California’s Afghan population. The data collected from the study will be analyzed to identify themes that define healthcare access in California’s Afghan community.
References
Alemi, Q., & Stempel, C. (2018). Discrimination and distress among Afghan refugees in northern California: The moderating role of pre-and post-migration factors. PLoS ONE, 13(5), 1–19.
Camarota, S. A., & Zeigler, K. (2021). Immigrants from Afghanistan: A profile of foreign-born Afghans. In Center for Immigration Studies. Web.
Campus Labs. (2020). How to analyze qualitative data. Web.
Gill, P., Stewart, K., Treasure, E., & Chadwick, B. (2008). Methods of data collection in qualitative research: Interviews and focus groups. British Dental Journal, 204(6), 291–295. Web.
Kavukcu, N., & Altlntaş, K. H. (2019). The challenges of the health care providers in refugee settings: A systematic review. Prehospital and Disaster Medicine, 34(2), 188–196. Web.
Kesmodel, U. S. (2018). Cross-sectional studies – what are they good for? Methodology in Clinical Epidemiological Research in Obstetrics and Gynecology, 97(4), 388–393. Web.
Reihani, A. R., Zimmerman, H. G., Fernando, N., Saunders, D. R., Edberg, M., Carter, E., Projects Manager, S., George, P., & Director, C. (2021). Barriers and facilitators to improving access to healthcare for recently resettled Afghan refugees: A transformative qualitative study. The Italian Journal for Interdisciplinary Health and Social Development, 6, 59–72. Web.
United Nations Children’s Fund. (n.d.). Communication for immunization: Key informant interview guidelines.
Appendix
Structured Interview Questions
- What is your biggest challenge with regard to healthcare access in California?
- Do you feel like all your health needs are met comprehensively? Why?
- What cultural differences have you noticed with regard to accessing healthcare services in California compared to Afghanistan?
- Please explain how frequently you have sought medical services in California.
- What challenges have you faced as an immigrant in California?
- Which aspect of the English language do you find the most challenging?
- Do you feel the presence of an interpreter during clinic visits is beneficial?
- Is there an instance in which a health practitioner failed to understand your complaints during a clinic visit? If so, please elaborate.
- Do you think health professionals understand the medical issues you communicate to them during clinical visits? Why?
- Do you feel health institutions are effectively prepared to address your language challenges? Please explain.