Editorial / Éditorial

The idea for this special issue developed from our own relatively recent entry into the area of language barriers in health care and the realization that this domain is both rich in research opportunity and filled with practical social significance. In recent decades, because of the ever-increasing needs of multicultural and multilingual societies, there has been an upsurge in interdisciplinary and intersectoral research addressing different aspects of communication. With regard to health care, there is new awareness among researchers and health care providers of the importance of understanding the obstacles to and facilitators of improved access to quality health care services. At the forefront of obstacles are language barriers. Martinez (2010) reports that an estimated 22 million individuals in the United States are affected by health care related language barriers every year; presumably, around the world hundreds of millions of people are similarly affected. Language discordant situations - when the patient and health care provider speak different first languages - can also raise stress levels and feelings of inadequacy among health care providers who are attempting to convey compassion, ensure understanding of diagnoses, or discuss the risks of medical procedures (Bowen, 2001). The six articles presented in this special issue provide only a taste of the range of theoretical and empirical issues that concern researchers at this time.

The first article, by Alison Wray, addresses the use of formulaic language - 'broadly defined as strings of words that have a particular holistic status' (Wray, 2002, p. 9) - by individuals with Alzheimer's disease (AD) and the barriers that this can create. Using a model of the mental lexicon that allows inclusion of individual morphemes, phrases, and formulaic expressions, she examines the use of formulaic language in AD and offers a novel perspective for studying how cognitive and social priorities can shape language learning and use and ultimately impact communication in language breakdown. An agenda for future research in this area is finally presented.

How to improve communication between patients and health providers, especially nurses, is the topic of the article by Nicholas Walker, Henrietta Cedergren, Pavel Trofimovich, and Elizabeth Gatbonton. They review computer-assisted language learning (CALL) applications and uses of automatic speech recognition in foreign and second language (L2) teaching, and they then describe an interactive automatic speech recognition system that simulates a nurse-patient interview. The system presented opens up new avenues for developing task-specific L2 speaking skills in the future, not only for nurses but also for other health care professionals.

Norman Segalowitz and Eva Kehayia present a position paper exploring the determinants of language barriers in health care. The aim is to promote interest in language barriers in health care among language scientists who may not have yet ventured into this field. They propose an interdisciplinary, theory-driven, programmatic, and problem-solving research agenda aimed at attracting general language researchers to this area.

Suzie Beaulieu explores the difficulties encountered by bilingual health care professionals and francophone patients in language-discordant situations within clinical environments. Working within a sociolinguistic framework, she exposes the difficulties encountered by francophones living in minority situations outside Quebec and proposes pedagogical recommendations to foster the development of sociolinguistic competence and the integration of stylistic variation phenomena that can be extrapolated to other language-discordant situations in health care.

Caroline Vickers and Ryan Goble explore the use of English discourse markers in medical consultations conducted in Spanish. Their United States-based study looked at Spanish-language clinical consultations and post-consultation interviews with patients and health care providers. They found that English-dominant medical providers made more frequent use of English discourse markers during consultations conducted in Spanish than their Spanish-speaking colleagues and patients. The authors interpreted this finding as a reflection of power relationships between health care providers and patients, even in the presence of good communication.

Bonny Norton, Shelley Jones, and Daniel Ahimbisibwe present a qualitative study that seeks to raise awareness through a digital literacy course about the causes, symptoms, and treatment of HIV/AIDS in sub-Saharan Africa. Aiming to improve young women's access to HIV/AIDS...