TableĀ 2.

Study Eligibility and Exclusion Criteria

Inclusion CriteriaExclusion Criteria
1. Studies were published from 1/1/1990 to 7/10/2018.1. Studies were published prior to 1990.
2. Studies are written in English.2. Studies are written in a language other than English.
3. The publication is peer-reviewed.3. The publication is not peer-reviewed or the information is from nonscholarly sources such as newspaper articles.
4. Full text is available.4. Full text is not available, only abstracts.
5. Studies have an adequate description of an accent intervention or strategy in a healthcare setting or a health education setting.a. Population: Study participants are healthcare professionals, health students, health educators, or patients/families/caregivers.b. Intervention: Programs (including tools or training) are provided to support clinicians/patients for the purpose of improving health communications, and one of the intervention's goals, explicitly or implicitly, is to mitigate the negative impact on communication quality due to accent or dialect. Such interventions may have a training element on pronunciation, tone, stress, colloquialism, or listening comprehension for culturally and linguistically diverse healthcare professionals/students.c. Comparison: Studies evaluated intervention effects by comparing with preintervention or no intervention. Other randomized/quasiexperimental designs and qualitative feedback by participants or trainers on communication skills improvement or on other intervention effects are acceptable.d. Outcome: Studies have objective and/or subjective measures to assess impact, efficacy, or cost-effectiveness of the intervention.e. Setting: Studies are conducted in healthcare delivery systems, community-based health programs, or health education programs.5. Studies have an insufficient description of the intervention, the intervention objectives do not include accent- or dialect-related communication improvement, or the intervention was not implemented in a healthcare delivery or health education setting.a. Population: Patient participants have specific communication disorders.b. Intervention: Treatment interventions are for specific communication disorders or interventions to improve English proficiency without addressing accent- or dialect-related issues. Studies that examined the effect of using interpreters, translators, or transcribers (human or technology-based) in healthcare delivery were also excluded.c. Comparison: Studies have no comparison and no demonstration of intervention effects but only report on personal experiences as a status snapshot (eg, a single survey on communication issues).d. Outcome: Studies do not have any specific outcome measures.e. Setting: Studies are conducted in preschool, primary, secondary, or tertiary classrooms that are not part of a health education program or in English as a second language training classrooms for non-healthcare professionals/students (eg, accent modification training programs for business school students). Studies to evaluate efficacy of accent interventions in the laboratory setting (eg, speech science research in a laboratory) were also excluded.
6. Studies have quantitative or qualitative outcome measures that rigorously assess the effect of the intervention. The direct intervention effect on the individual and organization and the indirect effect (eg, on patient outcome) are of interest in this review. The intervention effect in terms of communication quality, clinical performance, health outcome, and cognitive or behavioral change are to be considered.6. No specific outcome measures are reported, or the effect data are not analyzed using scientific methods.
7. English is the dominant language for communication in the clinical or academic setting.7. English is not the dominant language for communication in the study setting.
8. All study designs used to evaluate an individual intervention (eg, randomized controlled trials, other comparative studies, surveys, descriptive studies, etc) were included if they fit the criteria above.8. Expert opinions and review of studies were excluded.