Advancing Concerns of Spanish-Speaking Physical Injury Survivors: Equitable Trauma Care System Service Delivery

Abstract

Objective: Few investigations have focused specifically on engaging Spanish-speaking patients in early post-injury comparative effectiveness trials. The goal of this study was to identify and categorize hospitalized Spanish-speaking injury survivors’ posttraumatic concerns. Method: A secondary analysis of baseline data collected as part of a larger randomized comparative effectiveness trial was conducted. Participants were 22 male and female Spanish, non-English, speaking survivors of intentional and unintentional injuries, ages ≥ 18. At baseline, while hospitalized, each patient was asked to describe the nature and severity of their post-injury concerns. Patient concern narratives were audio-recorded and later transcribed. Raters coded patients’ transcribed concerns into content domains. The associations between patient self-reported concern severity and posttraumatic stress disorder symptoms assessed with the PTSD Checklist and depressive symptoms assessed with the PHQ-9 were also ascertained. Results: The concerns of Spanish-speaking patients were reliably categorized into previously described content domains (i.e., work and finance, physical health, social, psychological, medical, and legal domains). The composite Kappa statistic across domains was 0.83 (95% Confidence Interval = 0.74, 0.92). Spanish-speaking patients also expressed novel concerns, including immigration, discriminatory experiences, and Coronavirus pandemic, related concerns. The number of severe patient concerns was highly correlated with PHQ-9 depressive symptom levels (r = 0.52, p < .05). Conclusions: The concerns of Spanish-speaking trauma survivors can be readily elicited and reliably interpreted. Future research could integrate concern narrative elicitation and amelioration into stepped care intervention procedures in order to engage diverse Spanish-speaking injury survivors and advance equitable trauma care system service delivery.

ACKNOWLEDGMENTS

The authors would like to acknowledge Cindy Martinez, Joan Russo, Allison Engstrom, Tanya Knutzen, Alice Lee, Jake Shoyer, Navneet Birk, Matt Iles-Shih, Eileen Bulger, Lauren Whiteside, Jin Wang, Lawrence Palinkas, and Ellie Oslin for their contributions to the development of the manuscript.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the author(s).

DATA AVAILABILITY STATEMENT

The data collection for the larger investigation is ongoing and is currently not being shared.

Additional information

Funding

This work was supported by the Patient-Centered Outcomes Research Institute (PCORI) Award under #IHS-2017C1-6151. The content is solely the responsibility of the authors and does not necessarily represent the official views of PCORI or its Board of Governors or Methodology Committee.

Notes on contributors

Alvaro La Rosa

Alvaro La Rosa is currently an Acting Assistant Professor in the Department of Psychiatry and Behavioral Sciences. His interests include consultation-liaison psychiatry and the development of intervention approaches for Spanish-speaking patients.

Khadija Abu

Khadija Abu is a Research Coordinator with the Trauma Survivors Outcome & Support study team in the Department of Psychiatry and Behavioral Sciences. She currently coordinates recruitment and follow up activities. She received her bachelor’s degree in Psychology from the University of Washington.

Alexandra Hernandez

Alexandra Hernandez is a Resident in the Department of Surgery at the University of Washington School of Medicine. She has research interests in qualitative research methods and the development of interventions for Spanish-speaking patients

Douglas Zatzick

Douglas Zatzick is a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. Dr. Zatzick’s research interests focus on pragmatically focused clinical trials targeting PTSD and related comorbidities in diverse traumatically injured populations.