Can You Hear Us? Emerging Guidance for Cross-language Qualitative Pediatric Research: A Systematic Narrative Review

Background: One in 4 US children has a parent/caregiver with Limited English Proficiency (LEP), but individuals with LEP are excluded from participating in most qualitative research studies. We conducted a systematic review to examine published pediatric cross-language qualitative studies, analyzed the range of methods used in existing work to identify best practices, and developed guidelines for cross-language qualitative research in pediatric healthcare settings.

Methods: Two team members reviewed three databases (PubMed, CINAHL, and Sociological Abstracts) to identify cross-language pediatric research studies published between 1/2010 - 12/2020. We included studies (1) based in the US; (2) that included adult LEP parents/caregivers as informants who (3) discussed topics that impact the health of their child(ren). Two reviewers systematically abstracted information about procedures for each step of the research project (research team composition, interview guide development, data collection, analysis, and dissemination of findings). We performed critical synthesis of these papers to develop comprehensive best practice guidelines, incorporating previously published guidelines. We used a lens that included community-based participatory research to address power imbalances inherent in research with marginalized populations. The final guidelines were iteratively refined with qualitative experts and stakeholders working with LEP caregivers and children.

Results: We identified 20 studies that met our inclusion criteria, which used varying procedures to include LEP caregivers as subjects. No studies reported on known limitations of utilizing a translator or interpreter. The process and sequence of transcribing and translating interviews into English varied. One study included a research team member who identified as a native speaker from the population of interest. Only one study reported disseminating results with local community stakeholders and study participants. Our guidelines recommend adding a community partner as a member of the research team in a paid role to include the community voice in each step of study development, execution and disseminating findings back to the community.

Conclusion: This review identified important limitations in published qualitative cross-language pediatric research. It is imperative to incorporate community-engaged methods in future work. Including caregivers with LEP in cross-language qualitative research is critical to ensure their voices are heard.