Barriers, bridges and beyond : understanding perspectives in linguistically and culturally diverse clinical interactions

This study attempts to understand how monolingual English-speaking Speech-Language Pathologists (SLPs) and their Linguistically and Culturally Diverse (LCD) Indo-Canadian adult aphasic clients manage clinical interactions when they do not share the same language and/or culture. The specific objectives were to describe and explain participants' perspectives on the barriers they encountered, and the strategies they employed to overcome the barriers, and to develop a substantive theory that elucidates how SLPs manage such LCD clinical interactions. A symbolic interactionist theoretical perspective and grounded theory method were used to explore the clinical interaction experiences of eleven monolingual English-speaking SLPs, five adult Indo-Canadian aphasic clients, six family members, and five interpreters. Data were collected through interviews, observation, and field notes. Concurrent data collection and analysis was undertaken throughout the study. Constant comparative analysis, which included open, selective, and theoretical coding, was used to construct the substantive theory. The core category that emerged, 'coordinating communicative goals,' described the basic social process that was involved in clinician-client LCD interactions. This core category captured two stages and three conditions that participants encountered during clinical interactions. The two stages were 'encountering challenges in clinical interactions' and 'using strategies to overcome challenges.' The three conditions were 'linguistic barriers,' 'cultural barriers,' and 'involvement of family members and/or interpreters.' The two stages explained the processes used by participants during clinical interactions, and the three conditions were factors that impacted the stages. The findings indicate that participants coordinated their respective communicative goals in clinical interactions by going through an iterative process of confronting challenges and implementing strategies to overcome some of those challenges. The findings from this study have important implications for research, clinical practice, education, and policy aimed at helping SLPs provide linguistically and culturally appropriate services to LCD clients.Medicine, Faculty ofAudiology and Speech Sciences, School ofGraduat