Research Statement
This statement connects my research interests and work in sociocultural linguistics, medical and applied linguistics, Latinx studies, medical humanities, and pedagogy as related to Spanish for the Professions, and the development of virtual reality (VR) simulations for second language (L2) learners. This statement explores previous, current, and future research.
Introduction
The primary focus of my research is to bridge linguistics, humanities, and medicine. The fundamental question of my research centers on sociocultural linguistics with an emphasis on medical linguistics in Spanish-speaking populations to promote health equity among minority groups. This research stems from my work on Languages for Specific Purposes (LSP). As a field, LSP encompasses and combines many different areas, such as language, culture, sociocultural linguistics, perceptual dialectology, pedagogy, service-learning, etc. My work reflects the holistic approaches necessary to LSP and combines second language acquisition (SLA), Latinx studies, applied linguistics, health humanities, and pedagogy.
As the Spanish-speaking population in the United States (U.S.) continues to grow and is expected to reach roughly 30% of the U.S. population by 2060[1], it is important to understand the sociocultural effects on health and health-seeking behaviors to further promote health equity but also to better know how to train future health care providers (HCPs) in their language acquisition and intercultural competence development.
This line of research stems originally from my earlier work on motivation in which I connected theories from SLA, Achievement Goal Theory from education, and Goal Setting Theory from organizational psychology. In this research, I established a goal setting process specific to the L2 classroom, and the results showed that students who actively set a goal and followed the goal setting process had statistically significantly higher course grades and greater linguistic gains as compared to the control group. The results of this study have been published in Foreign Language Annals (Miller, 2019) and Hispania (Miller, 2020).
Applied linguistics with a focus on health and medicine
My recent work was inspired by my previous research and now focuses more specifically on the intersection of language, culture, and health particularly through the lens of sociocultural linguistics. To begin this multi-phase research, I formed an interdisciplinary, collaborative research group consisting of faculty and students from languages, nursing, biology, and allied health to investigate the effect of Latinx cultural constructs on health. First, our team focused on cultural ideologies and conducted two separate systematic reviews to understand previous literature. One review focused on the effects of machismo on health and stress in Latinx populations. The majority of the articles included in this review explored the relationship between machismo and men’s health and showed that increased levels of machismo were related to more binge drinking and higher psychological distress. This manuscript is currently under review at the Journal of Cross-Cultural Psychology (Miller De Rutté, White, & Delacroix). The other review explored the role of acculturation on diabetes in Latinx populations. Results were inconclusive due to the use of umbrella terms, such as Hispanic or Latino, and grouping ethnicities under one such term instead of describing groups based on their countries of origin as preferred by Spanish-speakers. These results have been published in Hispanic Health Care International (Miller De Rutté & Barrie, 2021). Based on information learned during these reviews, we designed an interview to investigate the role of cultural constructs on health in Spanish-speaking immigrants in Tampa, FL and native residents in the Dominican Republic (DR). We asked participants about their levels of machismo, marianismo, stress and other chronic health conditions. Results showed that Latinos with higher levels of machismo and marianismo had significantly higher rates of depression. These cultural constructs were found to be significantly higher in the DR population, but stress levels were significantly higher in the FL population. The results of this study are in preparation for submission to the International Journal of Public Health by December 2021. These particular studies served as the basis for internal grants from The University of Tampa, which totaled $12,289.
These results led us to the role of acculturation, acculturative stress, and health-seeking behaviors. First, we conducted a systematic review on acculturative stress and health to determine what previous studies had found. Results from this review indicated that the majority of previous research investigated the connection between acculturative stress and mental health with most studies concluding that increased acculturative stress had a significant relationship with greater mental health issues like depression and anxiety. This study has been published at the Hispanic Journal of Behavioral Studies (Miller De Rutté & Rubenstein, 2021). Taking the information gleaned in the systematic review, we devised a survey for Spanish-speakers in the U.S. Participants were of Hispanic/Latinx heritage currently living in the U.S. We had 351 respondents to our survey, and the data is currently being analyzed. Results indicated that pressure for English language competency significantly varied between countries of origin with Cubans and Hondurans feeling the most pressure. Health-seeking behaviors were also significantly associated with pressures to acculturate and against acculturation representing the unique and on-going battle that occurs as part of the acculturation process in general and when coupled with health care. The results of this study are under review at Journal of Latinx Psychology (Rubenstein, Miller De Rutté, & Paneru). These particular studies served as the basis for internal grants from The University of Tampa, which totaled $13,097.
My current research has also started to lay the groundwork for the linguistic and intercultural competence development of HCPs. Presently, we are interviewing HCPs to gauge their attitudes and perceptions towards the inclusion of medical Spanish curriculum during their training; their beliefs towards linguistic and intercultural competence development; and their thoughts about using an interpreter as part of the care they provide. Previous research has shown that physicians felt that the quality of care they provided to patients using an interpreter was limited and that there was a high potential for misunderstandings.[2] This study expands upon previous research by further exploring HCPs’ perspectives on interpreter-mediated care while also investigating their willingness to learn another language and culture in order to provide competent health care. We are in the data collection process and interviewing HCPs. We currently are planning to interview 50 participants, but this number will vary based on data saturation. Following Grounded Theory, during the data collection phase, we are also transcribing the interviews and coding the data line-by-line. We have begun looking for common words and phrases. We will then develop these commonalities into themes and categories. The data collection is expected to be finished by December 2021. Results pertaining to the linguistic and intercultural competence development of HCPs will be submitted to Studies in Second Language Learning and Teaching. Results on HCPs’ attitudes towards interpreter-mediated care will be submitted for publication to Medical Care. This study served as the basis for internal grants from The University of Tampa, which totaled $9,913.
Another study developed in parallel to the HCP study centers on the immigrant perspective of interpreter-mediated care and also dives into perceptual dialectology. Previous research has found that immigrants often worry about potential linguistic and cultural misunderstandings when visiting HCPs who have limited proficiency or cultural understanding in their language.[3] This project aims to study immigrants’ perceptions on interpreter-mediated care and investigates perceptual dialectology in health care settings from the Latinx patient perspective. In this study, we will be interviewing Spanish-speaking immigrants to understand their perspective using interpreters in health care settings but also to gauge their perceptions when being treated by an HCP who speaks a different Spanish dialect from themselves (including both native and non-native Spanish dialects). Data collection is expected to begin in January 2022. Results of this study will be submitted to the Journal of Health Communication. This study is also the basis for an internal grant at The University of Tampa, which is currently under review.
Future research in this area will explore discourse analysis and interactional linguistics in cross-cultural communication particularly through the lens of narrative medicine. I am currently planning a large-scale study on doctor-patient communication that crosses languages. Participants will be one of the following pairs: doctors and patients who speak the same primary language (such as English or Spanish); doctors and patients who do not speak the same primary language and/or are of low proficiency in the other language (such as a doctor who only speaks English, and a patient who primarily speaks Spanish with some English and does not use an interpreter); or doctors and patients who communicate through interpreters. The participants in the first group will be used to determine a baseline, and the other groups will be compared to that baseline. Data collection will be the observation and recording of naturally occurring conversations, and data will be analyzed using tenets of critical discourse analysis, conversation analysis, and interactional sociolinguistics along with the narrative medical approach to inform both the SLA and medical fields.
Virtual reality and technology in research and teaching
Another line of research is finding ways to incorporate research results and new pedagogies in the classroom. We conducted a study on the incorporation of Facebook and Twitter into language classes and found that students perceived that they had gains in reading and writing. This study was published in Tech Trends (Miller, Morgan, & Koronkiewicz, 2018).
Technology is ever-changing, and one of the “newer” trends is the use of virtual reality (VR) in L2 classes. VR simulations allow students to practice their L2 and enhance language acquisition in low-stakes and low-pressure environments while still using real-world language in real-world scenarios. I received an internal grant at The University of Tampa ($20,000) to develop and deploy VR simulations in Spanish for use in health care settings. As previous research has shown that VR promotes the development of linguistic skills and cross-cultural awareness in L2 learners,[4] my team and I created scenarios in which students studying Spanish can practice conversations, Translanguaging[5], and patient-provider skills with Spanish-speaking patients. The project is being submitted as a report to Second Language Research and Practice. We are currently collecting data from the implementation of the VR scenarios in a course on Medical Spanish. Data collection includes VR integration, language acquisition, and Zoltan Dornyei’s (2009) L2 Motivational Self System. Data analysis is expected to begin in January 2022. Results from this study will be submitted to Language, Learning, and Technology. This project also serves as the basis for a proposal (in preparation) to the National Institute of Health’s Research Enhancement Award Program (PAR-19-134), where I am the Principal Investigator (PI). Of particular interest with the future of this project is bridging VR simulations, the narrative medical approach, and interactional linguistics.
Research with the National Association of Medical Spanish
I serve as the Co-Director of the Pre-Health Medical Spanish Working Group as part of the National Association of Medical Spanish (NAMS). This group is charged with developing undergraduate, pre-health medical Spanish education, curriculum, assessment, standardization, teaching methodology, research methodology, etc. As part of this group, we conducted a review of online medical Spanish resources that have been marketed to HCPs. Our interdisciplinary group of both language and medical professionals screened 465 resources and selected eight for review based on inclusion and exclusion criteria. Results of this study found that no resource met suitability criteria for pre-determined medical Spanish learner competencies or cultural elements. This study has been published in Teaching and Learning in Medicine (Ortega, Hardin, Pérez-Cordón, Cox, Truesdale, Chang, Martínez, Miller De Rutté, Pérez-Muñoz, Rolón, & Shin, 2021).
Furthermore, I am leading a research team conducting a scoping review on undergraduate, pre-health medical Spanish to systematically determine what areas, such as empirical research, assessment, curriculum, etc., are lacking in development. This project has two aims. The first is to lay the groundwork for future studies in this area of LSP especially as this field has gained popularity as the importance of proper linguistic and intercultural communication between patients and providers has become more emphasized. The second is to disseminate the results to both Spanish and medical professionals alike. The review is ongoing and is expected to be finished by March 2022 with submissions to Hispania and Perspectives on Medical Education.
Another project currently underway is one that concentrates on determining the state of undergraduate, pre-health medical Spanish education in the U.S. To do so, we have developed a survey that will be sent out to a randomized sample of universities in the U.S. who offer medical Spanish programs, certificates, or courses. The survey asks questions about program size, types of medical Spanish offerings, learning goals and objectives, course content, etc. with the purpose of using the results to inform the development of learning objectives for undergraduate, pre-health medical Spanish curriculum. This project has received Institutional Review Board approval, and data collection is expected to begin January 2022. Once we have further established the above-mentioned projects, it is our goal to develop a research and teaching methodology for LSP as current methods do not account for the particulars required for this field.
[1]U.S. Census Bureau. (2018). Hispanic population to reach 111 million by 2060. National Population Projects and Vintage 2017 Population Estimates.
[2]Ahmed, S., Lee, S., Shommu., N., Rumana, N., & Turin, T. (2017). Experiences of communication barriers between physicians and immigrant patients: A systematic review and thematic synthesis. Patient Experience Journal, 4(1), 122-140.
[3]Alegria, M., Sribney, W., Perez, D., Laderman, M., & Keefe, K. (2009). The role of patient activation on patient-provider communication and quality of care for US and foreign-born Latino patients. Journal of General Internal Medicine, 24(Supp 3), 534-541.
[4]Lan, Y. (2020). Immersion, interaction, and experience-oriented learning: Bringing virtual reality into FL learning. Language, Learning and Technology, 24(1), 1-15.
[5]Wei, L. (2018). Translanguaging as a practical theory of language. Applied Linguistics, 39(1), 9-30.
This statement connects my research interests and work in sociocultural linguistics, medical and applied linguistics, Latinx studies, medical humanities, and pedagogy as related to Spanish for the Professions, and the development of virtual reality (VR) simulations for second language (L2) learners. This statement explores previous, current, and future research.
Introduction
The primary focus of my research is to bridge linguistics, humanities, and medicine. The fundamental question of my research centers on sociocultural linguistics with an emphasis on medical linguistics in Spanish-speaking populations to promote health equity among minority groups. This research stems from my work on Languages for Specific Purposes (LSP). As a field, LSP encompasses and combines many different areas, such as language, culture, sociocultural linguistics, perceptual dialectology, pedagogy, service-learning, etc. My work reflects the holistic approaches necessary to LSP and combines second language acquisition (SLA), Latinx studies, applied linguistics, health humanities, and pedagogy.
As the Spanish-speaking population in the United States (U.S.) continues to grow and is expected to reach roughly 30% of the U.S. population by 2060[1], it is important to understand the sociocultural effects on health and health-seeking behaviors to further promote health equity but also to better know how to train future health care providers (HCPs) in their language acquisition and intercultural competence development.
This line of research stems originally from my earlier work on motivation in which I connected theories from SLA, Achievement Goal Theory from education, and Goal Setting Theory from organizational psychology. In this research, I established a goal setting process specific to the L2 classroom, and the results showed that students who actively set a goal and followed the goal setting process had statistically significantly higher course grades and greater linguistic gains as compared to the control group. The results of this study have been published in Foreign Language Annals (Miller, 2019) and Hispania (Miller, 2020).
Applied linguistics with a focus on health and medicine
My recent work was inspired by my previous research and now focuses more specifically on the intersection of language, culture, and health particularly through the lens of sociocultural linguistics. To begin this multi-phase research, I formed an interdisciplinary, collaborative research group consisting of faculty and students from languages, nursing, biology, and allied health to investigate the effect of Latinx cultural constructs on health. First, our team focused on cultural ideologies and conducted two separate systematic reviews to understand previous literature. One review focused on the effects of machismo on health and stress in Latinx populations. The majority of the articles included in this review explored the relationship between machismo and men’s health and showed that increased levels of machismo were related to more binge drinking and higher psychological distress. This manuscript is currently under review at the Journal of Cross-Cultural Psychology (Miller De Rutté, White, & Delacroix). The other review explored the role of acculturation on diabetes in Latinx populations. Results were inconclusive due to the use of umbrella terms, such as Hispanic or Latino, and grouping ethnicities under one such term instead of describing groups based on their countries of origin as preferred by Spanish-speakers. These results have been published in Hispanic Health Care International (Miller De Rutté & Barrie, 2021). Based on information learned during these reviews, we designed an interview to investigate the role of cultural constructs on health in Spanish-speaking immigrants in Tampa, FL and native residents in the Dominican Republic (DR). We asked participants about their levels of machismo, marianismo, stress and other chronic health conditions. Results showed that Latinos with higher levels of machismo and marianismo had significantly higher rates of depression. These cultural constructs were found to be significantly higher in the DR population, but stress levels were significantly higher in the FL population. The results of this study are in preparation for submission to the International Journal of Public Health by December 2021. These particular studies served as the basis for internal grants from The University of Tampa, which totaled $12,289.
These results led us to the role of acculturation, acculturative stress, and health-seeking behaviors. First, we conducted a systematic review on acculturative stress and health to determine what previous studies had found. Results from this review indicated that the majority of previous research investigated the connection between acculturative stress and mental health with most studies concluding that increased acculturative stress had a significant relationship with greater mental health issues like depression and anxiety. This study has been published at the Hispanic Journal of Behavioral Studies (Miller De Rutté & Rubenstein, 2021). Taking the information gleaned in the systematic review, we devised a survey for Spanish-speakers in the U.S. Participants were of Hispanic/Latinx heritage currently living in the U.S. We had 351 respondents to our survey, and the data is currently being analyzed. Results indicated that pressure for English language competency significantly varied between countries of origin with Cubans and Hondurans feeling the most pressure. Health-seeking behaviors were also significantly associated with pressures to acculturate and against acculturation representing the unique and on-going battle that occurs as part of the acculturation process in general and when coupled with health care. The results of this study are under review at Journal of Latinx Psychology (Rubenstein, Miller De Rutté, & Paneru). These particular studies served as the basis for internal grants from The University of Tampa, which totaled $13,097.
My current research has also started to lay the groundwork for the linguistic and intercultural competence development of HCPs. Presently, we are interviewing HCPs to gauge their attitudes and perceptions towards the inclusion of medical Spanish curriculum during their training; their beliefs towards linguistic and intercultural competence development; and their thoughts about using an interpreter as part of the care they provide. Previous research has shown that physicians felt that the quality of care they provided to patients using an interpreter was limited and that there was a high potential for misunderstandings.[2] This study expands upon previous research by further exploring HCPs’ perspectives on interpreter-mediated care while also investigating their willingness to learn another language and culture in order to provide competent health care. We are in the data collection process and interviewing HCPs. We currently are planning to interview 50 participants, but this number will vary based on data saturation. Following Grounded Theory, during the data collection phase, we are also transcribing the interviews and coding the data line-by-line. We have begun looking for common words and phrases. We will then develop these commonalities into themes and categories. The data collection is expected to be finished by December 2021. Results pertaining to the linguistic and intercultural competence development of HCPs will be submitted to Studies in Second Language Learning and Teaching. Results on HCPs’ attitudes towards interpreter-mediated care will be submitted for publication to Medical Care. This study served as the basis for internal grants from The University of Tampa, which totaled $9,913.
Another study developed in parallel to the HCP study centers on the immigrant perspective of interpreter-mediated care and also dives into perceptual dialectology. Previous research has found that immigrants often worry about potential linguistic and cultural misunderstandings when visiting HCPs who have limited proficiency or cultural understanding in their language.[3] This project aims to study immigrants’ perceptions on interpreter-mediated care and investigates perceptual dialectology in health care settings from the Latinx patient perspective. In this study, we will be interviewing Spanish-speaking immigrants to understand their perspective using interpreters in health care settings but also to gauge their perceptions when being treated by an HCP who speaks a different Spanish dialect from themselves (including both native and non-native Spanish dialects). Data collection is expected to begin in January 2022. Results of this study will be submitted to the Journal of Health Communication. This study is also the basis for an internal grant at The University of Tampa, which is currently under review.
Future research in this area will explore discourse analysis and interactional linguistics in cross-cultural communication particularly through the lens of narrative medicine. I am currently planning a large-scale study on doctor-patient communication that crosses languages. Participants will be one of the following pairs: doctors and patients who speak the same primary language (such as English or Spanish); doctors and patients who do not speak the same primary language and/or are of low proficiency in the other language (such as a doctor who only speaks English, and a patient who primarily speaks Spanish with some English and does not use an interpreter); or doctors and patients who communicate through interpreters. The participants in the first group will be used to determine a baseline, and the other groups will be compared to that baseline. Data collection will be the observation and recording of naturally occurring conversations, and data will be analyzed using tenets of critical discourse analysis, conversation analysis, and interactional sociolinguistics along with the narrative medical approach to inform both the SLA and medical fields.
Virtual reality and technology in research and teaching
Another line of research is finding ways to incorporate research results and new pedagogies in the classroom. We conducted a study on the incorporation of Facebook and Twitter into language classes and found that students perceived that they had gains in reading and writing. This study was published in Tech Trends (Miller, Morgan, & Koronkiewicz, 2018).
Technology is ever-changing, and one of the “newer” trends is the use of virtual reality (VR) in L2 classes. VR simulations allow students to practice their L2 and enhance language acquisition in low-stakes and low-pressure environments while still using real-world language in real-world scenarios. I received an internal grant at The University of Tampa ($20,000) to develop and deploy VR simulations in Spanish for use in health care settings. As previous research has shown that VR promotes the development of linguistic skills and cross-cultural awareness in L2 learners,[4] my team and I created scenarios in which students studying Spanish can practice conversations, Translanguaging[5], and patient-provider skills with Spanish-speaking patients. The project is being submitted as a report to Second Language Research and Practice. We are currently collecting data from the implementation of the VR scenarios in a course on Medical Spanish. Data collection includes VR integration, language acquisition, and Zoltan Dornyei’s (2009) L2 Motivational Self System. Data analysis is expected to begin in January 2022. Results from this study will be submitted to Language, Learning, and Technology. This project also serves as the basis for a proposal (in preparation) to the National Institute of Health’s Research Enhancement Award Program (PAR-19-134), where I am the Principal Investigator (PI). Of particular interest with the future of this project is bridging VR simulations, the narrative medical approach, and interactional linguistics.
Research with the National Association of Medical Spanish
I serve as the Co-Director of the Pre-Health Medical Spanish Working Group as part of the National Association of Medical Spanish (NAMS). This group is charged with developing undergraduate, pre-health medical Spanish education, curriculum, assessment, standardization, teaching methodology, research methodology, etc. As part of this group, we conducted a review of online medical Spanish resources that have been marketed to HCPs. Our interdisciplinary group of both language and medical professionals screened 465 resources and selected eight for review based on inclusion and exclusion criteria. Results of this study found that no resource met suitability criteria for pre-determined medical Spanish learner competencies or cultural elements. This study has been published in Teaching and Learning in Medicine (Ortega, Hardin, Pérez-Cordón, Cox, Truesdale, Chang, Martínez, Miller De Rutté, Pérez-Muñoz, Rolón, & Shin, 2021).
Furthermore, I am leading a research team conducting a scoping review on undergraduate, pre-health medical Spanish to systematically determine what areas, such as empirical research, assessment, curriculum, etc., are lacking in development. This project has two aims. The first is to lay the groundwork for future studies in this area of LSP especially as this field has gained popularity as the importance of proper linguistic and intercultural communication between patients and providers has become more emphasized. The second is to disseminate the results to both Spanish and medical professionals alike. The review is ongoing and is expected to be finished by March 2022 with submissions to Hispania and Perspectives on Medical Education.
Another project currently underway is one that concentrates on determining the state of undergraduate, pre-health medical Spanish education in the U.S. To do so, we have developed a survey that will be sent out to a randomized sample of universities in the U.S. who offer medical Spanish programs, certificates, or courses. The survey asks questions about program size, types of medical Spanish offerings, learning goals and objectives, course content, etc. with the purpose of using the results to inform the development of learning objectives for undergraduate, pre-health medical Spanish curriculum. This project has received Institutional Review Board approval, and data collection is expected to begin January 2022. Once we have further established the above-mentioned projects, it is our goal to develop a research and teaching methodology for LSP as current methods do not account for the particulars required for this field.
[1]U.S. Census Bureau. (2018). Hispanic population to reach 111 million by 2060. National Population Projects and Vintage 2017 Population Estimates.
[2]Ahmed, S., Lee, S., Shommu., N., Rumana, N., & Turin, T. (2017). Experiences of communication barriers between physicians and immigrant patients: A systematic review and thematic synthesis. Patient Experience Journal, 4(1), 122-140.
[3]Alegria, M., Sribney, W., Perez, D., Laderman, M., & Keefe, K. (2009). The role of patient activation on patient-provider communication and quality of care for US and foreign-born Latino patients. Journal of General Internal Medicine, 24(Supp 3), 534-541.
[4]Lan, Y. (2020). Immersion, interaction, and experience-oriented learning: Bringing virtual reality into FL learning. Language, Learning and Technology, 24(1), 1-15.
[5]Wei, L. (2018). Translanguaging as a practical theory of language. Applied Linguistics, 39(1), 9-30.