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BackgroundPregnancy apps are a booming global industry, with most pregnant women in high-income countries now using them. From the perspective of health care and health information provision, this is both encouraging and unsettling; the demand indicates a clear direction for the development of future resources, but it also underscores the importance of processes ensuring access, reliability, and quality control. ObjectiveThis review provides an overview of current literature on pregnancy apps and aims at describing (1) the ways in which apps are used by women, in general, and by those of a culturally and linguistically diverse (CALD) background; (2) the utility and quality of information provided; and (3) areas where more research, development, and oversight are needed. MethodsWe chose a narrative review methodology for the study and performed a structured literature search including studies published between 2012 and 2017. Searches were performed using MEDLINE, EMBASE, and CINAHL databases. Studies were identified for inclusion using two separate search criteria and strategies: (1) studies on pregnancy apps and pregnant women’s use of these apps and (2) studies on CALD pregnant women and their use of technology for accessing information on and services for pregnancy. Overall, we selected 38 studies. ResultsWe found that pregnancy apps were principally used to access pregnancy health and fetal development information. Data storage capability, Web-based features or personalized tools, and social media features were also popular app features sought by women. Lower rates of the pregnancy app uptake were indicated among lower-income and non-English-speaking women. Preliminary evidence indicates that a combination of technological, health literacy, and language issues may result in lower uptake of pregnancy apps by these groups; however, further investigation is required. A marked limitation of the health app industry is lack of regulation in a commercially dominated field, making it difficult for users to assess the reliability of the information being presented. Health professionals and users alike indicate that given the choice, they would prefer using pregnancy apps that are relevant to their local health care context and come from a trusted source. Evidence indicates a need for greater health professional and institutional engagement in the app development, as well as awareness of and guidance for women’s use of these resources. ConclusionsThis is the first review of pregnancy app use, types of information provided, and features preferred by pregnant women in general and by those of a CALD background in particular. It indicates the demand for access to accurate information that is relevant to users, their community, and their associated health services. Given the popularity of pregnancy apps, such apps have enormous potential to be used for the provision of accurate, evidence-based health information.

Medical schools, programs and educators are increasingly expected to address medical student stress and wellbeing, yet also ensure student competence and fitness to practice. Educators play a central role in supporting students when evaluating a student's concerns and in deciding whether support and/or sanction should be offered. It is not known how educators approach or resolve such potentially contradictory responses. We conducted an interview study of 21 medical educators from a range of professional backgrounds across 11 on-campus and clinical teaching sites. Using Positioning Theory to inform our thematic analysis, we found that participants adopted an overarching position of Diagnostician, and at times, two alternative positions, the Judge and the Confidant when supporting students. In their narratives of support encounters, individual students were positioned as Good Students or Troubling Students. For most, educator positions were fluid and responsive to the storylines enacted in encounters. Rigidly adopting Judge or Confidant positions could lead to "failure to fail" and violations of professional boundaries. Positioning Theory locates student support in a moral space and helps explain the consternation experienced by educators when support is not effective. Positioning analysis offers a language, and metaphors which are meaningful to educators, for framing discussion and reviews of support practices and progression decisions. Such insights could encourage reflective practice and guide further research to inform practice when students with troubling concerns and persistently borderline performances require support.

The effectiveness of work performed through interprofessional practice is contingent on the nature and extent of communication between professionals. To date, there is little research exploring how the patterns of communication may impact interprofessional work. This study focused on communication during interprofessional meetings to better understand the interprofessional work performed through these encounters. Specifically, it examined how interactional discourse, that is, the patterns of language, influenced work performed during interprofessional meetings. A series of four interprofessional meetings in a rehabilitation unit were observed. Twenty-one participants were observed, including medical, nursing, allied health clinicians, and health professions students. Follow-up stimulated-recall interviews were conducted with five meeting participants. The data collection consisted of video and audio recordings and detailed field notes. Data were analyzed using a combination of genre analysis, a form of discourse analysis, and activity system analysis, drawing on Cultural Historical Activity Theory. This facilitated an in-depth examination of the structure of discourse and its influence on meeting outcomes. The meeting structure was defined and predictable. Two distinct forms of discourse were identified and labeled scripted and unscripted. Scripted discourse was prompted by standardized documents and facilitated the completion of organizational work. In contrast, unscripted discourse was spontaneous dialogue used to co-construct knowledge and contributed to collaboration. There was constant shifting between scripted and unscripted discourse throughout meetings which was orchestrated by experienced clinicians. Rather than fragmenting the discussion, this shifting enabled shared decision making. This research provides further insights into the interprofessional work performed during interprofessional meetings. The scripted discourse was highly influenced by artifacts (communication tools) in meetings, and these were used to ensure organizational imperatives were met. Unscripted discourse facilitated not only new insights and decisions but also social cohesion that may influence work within and outside the meeting. [ABSTRACT FROM AUTHOR]

Training in healthcare team communication has largely focused on strategies to improve information transfer with less focus on interpersonal dynamics and emotional aspects of communication. The Operating Room (OR) may be one of the most emotionally charged hospital environments, and is one requiring excellent team communications. We aimed to identify literature reporting on the emotional aspects of OR team communication. Our research questions were: what are the triggers in the environment that provoke an emotional response affecting communication, and what are the emotional responses to communication between OR team members; and how do these emotional aspects of communication affect the function of the OR team? We undertook a Scoping Review of literature across relevant databases following published guidelines, and narrative synthesis of the identified studies. From the 10 included studies we identified three themes: (1) Emotional experiences in the OR and their contributors; (2) Effects of emotional experiences on team communication; and (3) Solutions to manage the emotional experiences in the OR. Theme 1 sub-themes were: (1) Range of emotions experienced in the OR; (2) Hierarchical culture and (3) Leadership expectations as contributors to negative emotions. The OR is an emotionally charged environment. The hierarchical culture can inhibit staff from speaking up, and failure of leaders to meet team expectations, e.g., through appropriate and timely communication, may cause frustration and stress. The consequences of emotions include poor team dynamics, ineffective communication and potential negative impact on patient care. Few studies described strategies to manage emotions in the OR. The studies reviewed describe an environment where emotions can run high, affecting interpersonal communications, team function and patient care. The few identified studies relevant to our research questions demonstrate a need to better understand the emotional aspects of OR team communication and the effectiveness of interventions to improve these. [ABSTRACT FROM AUTHOR]

Background: Australia's overseas-born population continues to grow. This population is disproportionately affected by chronic, non-communicable diseases. Physical activity is the cornerstone of all chronic disease management. Engaging people from culturally and linguistically diverse (CALD) backgrounds in physical activity is an important public health objective. The purpose of this scoping review was to examine the factors that shape physical activity participation among people from CALD backgrounds in Australia. Methods: This scoping review followed Arksey and O'Malley's framework. Medline, Embase and CINAHL were searched with key words relating to 'physical activity', 'CALD' and 'Australia' in July 2021 and again in February 2022 for qualitative studies published in English since 2000. Exclusion criteria were: participants < 18 years old, studies specifically focusing on populations with health issues, pregnant or postpartum states. Methodological quality of included studies was evaluated using the Critical Appraisal Skills Programme with the purpose of informing future research. Data extracted from each study were analysed thematically and results were interpreted using Acculturation theory. Results: Of the 1130 studies, 17 met the inclusion criteria. Findings from each study were captured in three themes: Perceptions of physical activity; Acceptability and Appropriateness; and Access. Following migration, a decrease in physical activity, especially leisure-time activity, was reported. Common factors influencing physical activity engagement included perceptions of physical activity and wellbeing; language, financial and environmental barriers; as well as social, cultural, and religious considerations. Conclusion: This review identified several factors which may interact and contribute to the decline in self-reported physical activity upon migration. Findings from this review may be used to inform future health promotion initiatives targeting people from CALD backgrounds. Future research may benefit from devising a shared definition of physical activity and studying different CALD communities over time. [ABSTRACT FROM AUTHOR]

In many Western countries such as Australia, international medical graduates (IMGs) play a crucial role in meeting health workforce needs. For doctors for whom English is an additional language and who have received their medical education in non-Western settings, a challenge is the patient-centred approach to communication, which is well established in Western medical education as the optimal approach for safe and effective healthcare. It acknowledges the patient as an active participant in the healthcare interaction, and the importance of the psychosocial dimension of patient well-being. While there is a vast literature on doctor-patient discourse in the qualitative health literature, there is little in the medical education domain that systematically examines the linguistic patterns of doctors who are learning or are less familiar with patient-centred paradigms of communication. This article examines how IMG doctors manage patient-centred interviewing. The data are 15 video-taped 8-minute roleplay consultations of IMGs and simulated patients. Systemic functional linguistics and genre theory provided the theoretical framework and tools to analyse how the doctors realised the tasks of patient-centred communication as informed by the medical education literature, with a particular focus on the tasks of gathering information, providing information and decision-making. The findings suggest that the discourse patterns of doctor-patient communication demonstrated by the IMG doctors were towards a model of patient-centred communication; that is, aspects of the communication resonated with the features of patient-centred communication. However, valued aspects such as seeking patient perspectives and eliciting and validating patient emotions were either not given discursive prominence or were largely absent. Medicalised language featured in the doctor talk to explore sensitive behaviours or topics. The findings provide insights for medical educators into how IMG doctors from non-Western educational contexts might interpret the communication demands of patient-centred care.

The aim of this paper is to investigate from a discourse analytic perspective task authenticity in the speaking component of the Occupational English Test (OET), an English language screening test for clinicians designed to reflect the language demands of health professional-patient communication. The study compares the OET speaking sub-test roleplay performances of 12 doctors who were successful OET candidates with practice Objective Structured Clinical Examination (OSCE) roleplay performances of 12 international medical graduates (IMGs) preparing for the Australian Medical Council clinical examination. The premise for the comparison is that the OSCE roleplays can represent communication practices that are valued within the medical profession; therefore a finding of similarity in the discourse structure across the OET and the OSCE roleplays could be taken as supporting the validity of the OET as a tool for eliciting relevant communication skills in the medical profession. The study draws on genre theory as developed in Systemic Functional Linguistics (SFL) in order to compare the roleplay discourse structure and the linguistic realizations of the two tasks. In particular, it examines the role relationships of the participants (i.e. the tenor of the discourse), and the ways in which content is represented (i.e. the field of the discourse) by roleplay participants. The findings reveal some key similarities but also important differences. Although both tests inevitably fall short in terms of authentic representation of real world interactions, the findings suggest that the OET task, for a range of reasons including time allowances, training of test interlocutors, and the limits of contextual information provided to candidates, constrains candidate topic exploration and treatment negotiation, compared to the OSCE format. The paper concludes with proposals for mitigating these limitations in the interests of enhancing the OET's capacity to elicit more professionally relevant language and communication skills.

There is a growing demand for interpreter-mediated cognitive assessments for dementia. However, most interpreters lack specialist knowledge of dementia and cognitive assessment tools. This can negatively affect the way instructions and responses are conveyed between clinicians and patients, undermining clinicians' ability to accurately assess for cognitive impairment. This article reports on the co-design of an online dementia training package, MINDSET, which aims to address this gap. Two iterative online co-design workshops were conducted in October and November 2021, using a World Café approach. Sixteen clinicians, interpreters, and multilingual family carers of a person with dementia participated. Based on these workshops, training and assessment materials were developed and tested with 12 interpreters from April to June 2022. The training package comprises online modules: 1) Knowledge of Dementia and Australia's Aged Care System, 2) Briefings and Introductions, 3) Interpreting Skills, 4) Interpreting Ethics, and 5) Cross-cultural Communication. The codesign process highlighted divergent perspectives between clinicians and interpreters on an interpreter's role during a cognitive assessment, but it also facilitated negotiation and consensus building, which enriched the training content. The training is now developed and will be evaluated in a randomized control trial and subsequent implementation study. [ABSTRACT FROM AUTHOR]

Interprofessional communication (IPC) in rehabilitation is important for patient care yet it has been shown to be variable and challenging. Existing research does not address the complexity of IPC in this setting. Understanding the influence of contextual factors on IPC may guide improvements to increase the effectiveness of communication within interprofessional teams. From July 2020 to February 2021 semi-structured interviews were conducted with 24 healthcare professionals across Australia and New Zealand. Cultural Historical Activity Theory provided a guiding theoretical and analytical framework for this qualitative study. Participants described engaging in IPC through evolving interactions, piecing together information that underpinned patient care. Meetings occurred frequently, however communication extended well beyond formalised interactions, often requiring individuals to balance clinical workload with communication tasks. IPC reportedly relied on communication tools, however navigating information from multiple sources was demanding. Our results indicate that IPC contributes significantly to the workload of healthcare professionals in rehabilitation. IPC was integral in the provision of cohesive patient care, however it proved time consuming, effortful and at times frustrating and potentially erroneous. Our findings promote the need for rigorous examination of communication practices to ensure they are meeting the needs of an increasingly interprofessional workforce. Healthcare professionals should recognise that time spent communicating within their team is a legitimate and important part of patient care. Rehabilitation teams should consider how they allocate resources for communication tasks. Teams should reconsider how they can use communication more effectively to save time by reducing repetition and errors. [ABSTRACT FROM AUTHOR]

In parts 1 and 2 of this series, we highlighted the dominant impairment way of talking about osteoarthritis: talking that frames osteoarthritis as a disease of cartilage worsened by physical activity that can only be "cured" by replacing the joint. An alternative understanding that counters common misconceptions about osteoarthritis, and links physical activity and healthy lifestyles to improvements in symptoms is likely a prerequisite for sustainable behavior change. It is insufficient to tell people with osteoarthritis that regular physical activity is important; people need to understand and experience how physical activity can help. Here, we offer suggestions for how clinicians can shift from focusing on what people cannot do because of osteoarthritis, toward focusing on what people can do to improve their health and maintain "active bodies." [ABSTRACT FROM AUTHOR]

How people talk about osteoarthritis may impact outcomes, including uptake of guideline recommendations related to activity-based lifestyles and interventions. In this editorial, we describe 2 key ways of talking, based on findings from our systematic review of 62 qualitative studies exploring the perceptions of people with knee osteoarthritis (n = 1208), their carers (n = 28), and clinicians (n = 2403). Among raw quotes extracted from the studies, we observed a dominant impairment-based way of talking and a participatory based way of talking. These ways of talking form a novel framework to help clinicians understand what people think and do about osteoarthritis. [ABSTRACT FROM AUTHOR]

The gap between linguistic and professional criteria is a widely acknowledged but unresolved issue in the teaching and assessment of languages for specific purposes (LSP). In the teaching of professional writing, language experts and workplace professionals have been characterized as living worlds apart with respect to their views of communication. Likewise, in testing contexts, a number of studies have shown significant divergence in judgements between the language experts who traditionally assess performance on LSP tests and those with experience of the relevant professional context. It has been argued that if LSP tests are to act as proxies for the demands of communication faced by candidates entering the workforce, then the judgements of such professionals should not be ignored. The preliminary study reported in this article is part of a larger research project relating to a specific-purpose English language test for overseas-trained health professionals (HPs): the Occupational English Test (OET). The larger project is designed to validate both the criteria against which candidates are assessed on this test and the performance standards required for registration. The OET, a four-skill test, is recognized by 12 health professions as a mechanism for ensuring adequate language skills for nonnative-English-speaking applicants for entry to the profession. Test performances on the OET are currently rated against a common set of essentially linguistic criteria: (1) intelligibility; (2) fluency; (3) appropriateness of language; (4) resources of grammar and expression; and (5) overall communicative effectiveness. These criteria, although applied by highly trained language specialists, may nevertheless differ from those which HPs see as essential for effective healthcare communication. Moreover, the appropriateness of the passing standards on the OET required in terms of these criteria are the subject of ongoing debate, with concerns that HPs with a non-English-speaking background may pass the test but nevertheless struggle with interactions in the clinical setting. Tests like the OET thus bear a heavy burden of responsibility for making decisions affecting the careers of candidates and the people for whom they are subsequently responsible. Further investigation of the test's claim to form a valid basis for determining professional entry could therefore be seen as an ethical imperative. This report focuses on findings from the first phase of the project designed to probe views of spoken communication by three groups of HPs: (1) doctors; (2) nurses; and (3) physiotherapists. It elicits these views by analyzing clinical experts' (clinicians with an HP education role) feedback on instances of trainee-patient communication proffered "independently" of the test setting. (Contains 2 tables.)

The recently published article "English Proficiency Tests and Communication Skills Training for Overseas-Qualified Health Professionals in Australia and New Zealand" (Wette, 2011) aims to address perceived problems and misconceptions associated with the testing of English language skills and professional communicative competence of overseas-trained health professionals (HPs). In this response, the authors point to the questionable nature of a number of claims put forward by Wette. The main point that Wette seeks to make in her commentary is that the assessment of and support provided for overseas-qualified HPs is currently inadequate. Although the authors agree that support is often lacking, they suggest that her arguments regarding the assessment of overseas-qualified HPs warrant closer scrutiny. Wette asserts that registration bodies use language proficiency tests "as their sole measure of communicative ability and mastery of relevant professional discourses in healthcare contexts." The authors contend that this is not in fact the case. It would be more accurate to say that the registration bodies assess English language proficiency using recognised tests but that "mastery of relevant professional discourses in healthcare contexts" is not assessed by those tests. It is certainly a matter of concern if registration bodies presume that English proficiency tests are assessing the professional communication skills of their registrants, but the situation is complex. Language tests alone may well not provide sufficient evidence of HPs' work-readiness; however, this is not the remit of the tests, as they were neither designed for this purpose nor sanctioned for it by the registration bodies. The authors concur with Wette's conclusion that there may be a need for diagnostic assessment by both language and health specialists and for more ongoing training to help overseas-qualified HPs assimilate to the requirements of their new working environment, not only in the bridging program but also in the workplace. However, there is equally a need to retain English language proficiency tests to help to establish whether HPs entering such training have sufficient language skills to be able to derive benefits from it. It is essential in this cross-disciplinary field that there is recognition of the purpose and value of all the various elements of assessment and training required to promote the successful integration of overseas-qualified HPs into the Australian workplace.