Is it time we looked at the impact of languages in primary care research? Lessons from qualitative research with minority ethnic groups

Talk Code: 
7E.1
Presenter: 
Faraz Ahmed
Twitter: 
Co-authors: 
Jenni Burt, Cathy Lloyd
Author institutions: 
University of Cambridge, The Open University

Problem

The health of minority ethnic populations is an increasingly important focus in European and US policy and research arenas, particularly as these populations are both substantial and growing. An individual’s language is one of many dimensions of ethnicity, and one that can play an important part in conducting primary care research with minority ethnic groups. Language use/turns during an interview or focus group can emphasise the unequal balance of power existing in the researcher-participant or participant-participant relationship. Participants and researchers may actively use/switch between different languages to emphasise and convey important narratives. This presentation outlines the ways in which language can impact on primary care-based qualitative research with minority ethnic groups, and makes suggestions for those conducting research in this field.

Approach

We critically explore the way in which language may impact on study design, data collection and analyses, drawing on examples from three different primary care research studies:• Semi-structured interviews with Pakistani and Bangladeshi community members• Focus groups with Pakistani and Bangladeshi community members• Video elicitation-interviews with Pakistani patients in general practicesThe term ‘code-switching’ is used to describe instances of a speaker switching between two or more languages during a conversation or research encounter, and also a speaker switching between two or more styles of speech within the same language. Explorations of code-switching can help bring new insights to qualitative data analysis, for example by enabling a greater focus on aspects of researchers’ or participants’ behaviours, intentions, and meanings within an interview or focus group setting, or by considering new dimensions of communication behaviours in doctor-patient interactions. For example, Fisher and Groce's (1985) examination of doctor-patient interaction in relation to norms about female patients identified that doctors code-switched to a less formal and less ‘medical’ way of talking (i.e. 'ain't it') in certain interactions.

Findings

We will present findings relating to three major aspects of language use and impact:• Researchers’ language use during study design, and data collection• Participants’ language use during data collection• Role of code-switching and the implications of this for data analysis and interpretation

Consequences

The impact of language may be particularly pronounced when there is no agreed written form of a spoken language; for example, there is no agreed written form of the main language spoken by Pakistanis (Mirpuri) in the UK. Language use may impact in multiple ways on the power-dynamic between the researcher and interviewee, and on the construction and interpretation of qualitative data. Understanding and exploring language code-switching in the qualitative analysis process has the potential to provide greater depth and be a valuable data collection and analytical tool to explore interactions in interviews and focus groups with minority ethnic groups in primary care research.

Submitted by: 
Faraz Ahmed
Funding acknowledgement: 
This presentation covers a range of studies, and we would gratefully acknowledge the contributions made by all of the participants who took part in our studies. A special thanks to Professor Martin Roland and Professor Kamran Siddiqi for their support and guidance across the various projects. The studies included were supported by the Medical Research Council (MRC) and the National Institute for Health Research (NIHR). The support of the MRC and NIHR are gratefully acknowledged. The opinions expressed are those of the authors and not of the funder.