Presentation on theme: "Www.psy.vanderbilt.edu Anghenion y claf dwyieithog: her i'r Gymraeg yn y gwasanaeth iechyd? Dr Enlli Thomas Cynhadledd y Gymraeg mewn Gofal Iechyd, Caerdydd."— Presentation transcript:
Anghenion y claf dwyieithog: her i'r Gymraeg yn y gwasanaeth iechyd? Dr Enlli Thomas Cynhadledd y Gymraeg mewn Gofal Iechyd, Caerdydd
Content Importance of language in health care Differences between monolinguals and bilinguals Implications of monolingual assessment, treatment, and care for bilingual patients Dealing with the Welsh challenge in the heath service: minimizing the effect
importance of language patient problem trafod discuss trafod discuss triniaeth treatment triniaeth treatment asesu assess asesu assess gofal care gofal care language
patient problem trafod discuss trafod discuss treatment assess care Altarriba & Santiago-Rivera (1994): Lack of knowledge of linguistic differences lead to inappropriate assessment importance of language
patient problem discuss treatment asesu assess asesu assess care Altarriba & Santiago-Rivera (1994): Wrong assessments lead to ineffective treatment and care importance of language
patient problem discus s triniaeth treatment triniaeth treatment assess gofal care gofal care Ineffective treatment and care doesn’t eliminate the core problem importance of language
Two main roles for language: A.Ensure fair assessment of a problem B.Ensure fair and purposeful treatment/care But does the health service succeed at doing this with its bilingual patients?
Major question in the field hosan ball Vihman (1985); Redlinger & Park (1980), Volterra & Taeschner, (1978); Grosjean, (1982), etc. Single, unitary system initially, separating around 2- 3 years?
hosan pêl sock ball (e.g., Meisel, 1989; De Houwer, 1990; Paradis & Genesee, 1996; Hulk & Müller, 2000; Döpke, 2000) Even if both languages are totally autonomous, they are likely to influence each other at some point in development Major question in the field
neurological cognitive linguistic
Differences between monolinguals and bilinguals: 1.Neurological 2.Cognitive 3.Linguistic
monolingual Language A
Simultaneous bilingual Language B Language A Lang A + B or Linguistic input never 100% in any language
L2/ late bilinguals Language A + new Language B
Successive bilingual Symmetrical bilingual Vertical bilingual Addaswyd y tabl o Wei (2000)
“Cultural sensitivity implies understanding an individual’s social values, beliefs, and customs as well as understanding the language in which these factors are expressed” (Altarribe & Santiago-Rivera, 1994: 389).
Types of problems 1.Problems with expression: If weaker language, attend to correctness of expression over relevance of content? For children, limited language? For older adults, status and prestige of majority language and expression of respect towards its speakers?
Types of problems 1.Problems with expression: If weaker language, lack of purposeful expressions to express a problem mae fy nghoes i’n cnoimae gen i boen yn fy mol is-my-leg-my-is-chewingis-have-I-pain-in-stomach “my leg is chewing” “I have a pain in my stomach” vs. vs. “my leg is aching/throbbing” “I have a stomach ache”
Types of problems 1.Problems with expression: If weaker language, lack of purposeful expressions to express a problem mae gen i bigyn yn fy nghlustmae gen i bigyn yn fy ochr is-have-I-thorn-in-my-earis-have-I-thorn-in-my-side “I have a thorn in my ear” “I have a thorn in my side” vs. “I have an ear ache” “I have a stitch”
Types of problems 1.Problems with expression: If weaker language, lack of purposeful expressions to express a problem O’n i yn sal...wedi troi fy ffêr was-I-is-illhas-turned-my-ankle “I was ill” “I have turned my ankle” vs. vs. “I was sick (vomiting)” “I have sprained my ankle”
Types of problems 2. No meaning overlap: Cross-language translations do not always correspond perfectly (Gathercole & Moawad, 2009) Gwddw = neck, throat Bawd = thumb, big toe Bysedd = fingers, toes Sal = ill, sick, vomit Poen = pain, ache, agony...
Types of problems 3. No translation equivalents: Lack of words in one or the other language, depending on the context of learning (cf. Distributed Characteristic – Oller, 2005; a Domain Specificity – Li, 1996) CymraegEnglish Clun = thighAnkle = migwrn Gwar = nape knuckles = migwrn, cwgn
Types of problems 3. No translation equivalents: Lack of words in one or the other language, depending on the context of learning (cf. Distributed Characteristic – Oller, 2005; a Domain Specificity – Li, 1996) CymraegSaesneg Y frech goch = measleswhooping cough = y pâs Eryr = shingles relapse = ailwaelu
4. / Problems displaying emotion and personality in L2 Speakers feel that it is easier to express aspects of their personality in their first language (Thomas & Gathercole, 2007) Difficulty expressing appropriate emotion when using L2 (Marcos, 1988) Types of problems
4. Problems displaying emotion and personality in L2 Context of learning L2 more neutral re. Emotion? (Bond & Lai, 1986) Motion mainly related to the main language when growing up (Guttfreund, 1990) Types of problems
4. Problems displaying emotion and personality in L2 Types of problems Harris et al., (2003): Participants: Turkish-English Task: Rating the pleasantness of words Words: taboo (e.g., swear words); reprimands (e.g., “Go to room!”); negative words (e.g., cancer); positive words (e.g.,joy); & neutral words (e.g., chair). Measures: pleasantness ratings (in Turkish & English) & skin activation
4. Problems displaying emotion and personality in L2 Types of problems Results: Skin activation: taboo > reprimands > negative words > positive words > neutral words Taboo words produced greater skin activation in L1 and L2 Reprimands produced greater activation in L1 than L2, especially if oral (not visual).
4. Problems displaying emotion and personality in L2 Types of problems Taboo words in the first language is associated with higher levels of anxiety, much higher than in an L2.
4. Problems displaying emotion and personality in L2 Types of problems Bilinguals prefer to discuss matters that cause embarrassment in their L2
4. Problems displaying emotion and personality in L2 Types of problems Some patients display higher levels of schizophrenic traits in their L2 than in their L1 (e.e., Marcos et al., 1973; Gomez, 1983). Others show less psychotic traits in their L2 than L1 (e.g., Price & Cuellar, 1981)
4. Problems displaying emotion and personality in L2 Types of problems The difference comes from differences in patients’ use of language: In Marcos et al. (1973): In their L2: slow speech with pauses = appears unwilling to converse Interpretation = depression and anxiety
4. Problems displaying emotion and personality in L2 Types of problems The difference comes from differences in patients’ use of language: In Price & Cuellar (1981): In their L2, showed less psychotic traits due to limited number of lexical items to express themselves verbally?
language an emotion Tehrani & Vaughan (2009) Language of context of given incident significant L1 increases the emotional link with the incident L2 a means of distancing the self from emotional turmoil Language mixing an effective therapy method Translating an incident doesn’t always express the full nature of the emotion attached.
Staff shortage Lack of awareness Lack of research Lack of appropriate measures/tests The challenge
Recruitment Raise awareness Fund research Develop new measures Solution
Staff recruitment Ideally, need to increase no of staff able to speak Welsh Need staff to conduct assessments bilingually. In Welsh Need staff able to interpret results of bilingual/Welsh assessments Need staff to offer treatment/therapy bilingually/ in Welsh Need staff to provide bilingual/Welsh medium care
Raising Awareness Training for: Nature of the bilingual patient Implications of assessing in one language Interpreting bilinguals’ results (i) when assessed in one language & (ii) when assessed in two languages Use of L1 vs. L2 vs. Mixing in therapy Bilingual patients’ care needs
Research Support Survey of patients’ language backgrounds Survey of staff language Survey of current assessments Survey of current therapy/treatment methods Research effectiveness of current assessment for bilinguals Research effectiveness of English/Welsh/bilingual therapy/treatment Patient views Carer/doctor’s views
Assessment Consider usefulness of current assessments Consider purpose of language in those assessments Consider translation possibilities Consider need for new developments Welsh or bilingual tests? Welsh norms? Bilingual norms? (e.g., Prawf Geirfa Cymraeg, Gathercole & Thomas, 2007)
Anghenion y claf dwyieithog: her i'r Gymraeg yn y gwasanaeth iechyd? Oes, mae yma her ond un nad yw’n amhosib ei datrys...