Handbook of Early Language Education pp 57–82 Cite as
Vocabulary Development in Early Language Education
- He Sun 2 &
- Bin Yin 3
- Reference work entry
- First Online: 31 March 2022
Part of the Springer International Handbooks of Education book series (SIHE)
Building lexical knowledge is one of the most fundamental developments in early childhood; as such development is associated with children’s later academic achievement and other language abilities. Both breadth (e.g., receptive vocabulary size) and depth (e.g., syntagmatic and paradigmatic knowledge) of lexical knowledge are vital, as the former indicates how much children know and the latter indicates how well they know it. Therefore, it would be crucial for any language program to provide qualified teaching for preschoolers to develop their lexical knowledge. The current review has synthesized findings published in recent years on preschoolers’ lexical development in early bilingual education programs, to explore the theoretical frameworks (e.g., the thresholds theory) and the effectiveness of these programs in improving bilingual children’s lexical breadth and depth in both first and second languages. Instructional strategies, such as shared book reading and multimodality, which have been proved to be effective in vocabulary teaching across various types of bilingual language programs, have been summarized. At the end of the chapter, future research directions of vocabulary development in early language programs have been proposed.
- Vocabulary breadth
- Vocabulary depth
- Early language education
- Strategies of vocabulary instruction
- Early bilingualism
This is a preview of subscription content, access via your institution .
- Available as PDF
- Read on any device
- Instant download
- Own it forever
- Available as EPUB and PDF
- Durable hardcover edition
- Dispatched in 3 to 5 business days
- Free shipping worldwide - see info
Tax calculation will be finalised at checkout
Purchases are for personal use only
Administration for Children and Families. (2007). Head Start programs. Retrieved March 2019 from https://eclkc.ohs.acf.hhs.gov/programs/article/head-start-programs
Akoğlu, G., & Yağmur, K. (2016). First-language skills of bilingual Turkish immigrant children growing up in a Dutch submersion context. International Journal of Bilingual Education and Bilingualism, 19 (6), 706–721. https://doi-org.libproxy.nie.edu.sg/10.1080/13670050.2016.1181605
Arnett, J. J. (2008). The neglected 95: Why American psychology needs to become less American. American Psychologist, 63 , 602–614. https://doi.org/10.1037/0003-066X.63.7.602 .
CrossRef Google Scholar
August, D., & Shanahan, T. (Eds.). (2006). Developing literacy in second-language learners: Report of the National Literacy Panel on language-minority children and youth . Mahwah: Lawrence Erlbaum.
Baker, C. (2001). Foundations of bilingual education and bilingualism . Clevedon/Buffalo: Multilingual Matters.
Barnett, W. S., Yarosz, D. J., Thomas, J. H., Jung, K., & Blanco, D. (2007). Two-way monolingual English immersion in preschool education: An experimental comparison. Early Childhood Research Quarterly, 22 , 277–293. https://doi.org/10.1016/j.ecresq.2007.03.003 .
Bates, E., Bretherton, I., & Snyder, L. (1988). From first words to grammar: Individual differences and dissociable mechanisms . Cambridge, UK: Cambridge University Press.
Beck, I. L., McKeown, M. G., & Kucan, L. (2002). Bringing words to life: Robust vocabulary instruction . New York: The Guilford Press.
Bergstrӧm, K., Klatte, M., Steinbrink, C., & Lachmann, T. (2016). First and second language acquisition in German children attending a kindergarten immersion program: A combined longitudinal and cross-sectional study. Language Learning, 66 (2), 386–418. https://doi.org/10.1111/lang.12162 .
Bialystok, E., Luk, G., Peets, K. F., & Yang, S. (2010). Receptive vocabulary differences in monolingual and bilingual children. Bilingualism: Language and Cognition, 13 , 525–531.
Brownell, R. (2010). Expressive one-word picture vocabulary test . San Antonio: Pearson.
Bruner, J. S. (1986). Actual minds, possible worlds . Cambridge: Harvard University Press.
Carlo, M. S., August, D., Mclaughlin, B., Snow, C. E., Dressler, C., Lippman, D. N., … White, C. E. (2004). Closing the gap: Addressing the vocabulary needs of English-language learners in bilingual and mainstream classrooms. Reading Research Quarterly, 39 (2), 188–215. https://doi.org/10.2307/4151671 .
Chapelle, C. (1998). Construct definition and validity inquiry in SLA research. In L. F. Bachman & A. D. Cohen (Eds.), Interface between second language acquisition and language testing research (pp. 32–70). Cambridge: Cambridge University Press.
Cobo-Lewis, A. B., Pearson, B. Z., Eilers, R. E., & Umbel, V. C. (2002). Effects of bilingualism and bilingual education on oral and written Spanish skills: A multifactor study of standardized test outcomes. In D. K. Oller & R. E. Eilers (Eds.), Language and literacy in bilingual children (pp. 98–117). Clevedon: Multilingual Matters.
Collins, M. (2010). ELL preschoolers’ English vocabulary acquisition from storybook reading. Early Childhood Research Quarterly, 25 , 84–97.
Collins, B. A. (2014). Dual language development of Latino children: Effect of instructional program type and the home and school language environment. Early Childhood Research Quarterly, 29 , 389–397. https://doi.org/10.1016/j.ecresq.2014.04.009 .
Conrad, N., Gong, Y., Sipp, L., & Wright, L. (2004). Using text talk as a gateway to culturally responsive teaching. Early Childhood Education Journal, 31 , 187–192. https://doi.org/10.1023/B:ECEJ.0000012137.43147.af .
Cruse, D. A. (1986). Lexical semantics . Cambridge: University Press.
Cummins, J. (1979). Cognitive/academic language proficiency, linguistic interdependence, the optimum age question. Working Papers on Bilingualism, 19 , 121–129.
Cummins, J. (1980). The construct of language proficiency in bilingual education. In J. E. Alatis (Ed.), Georgetown university round table on languages and linguistics 1980 . Washington, DC: Georgetown University Press.
Cummins, J. (1984). Bilingualism and special education: Issues in assessment and pedagogy . Clevedon: Multilingual Matters.
Cummins, J. (2000). Language, power and pedagogy: Bilingual children in the crossfire . Clevedon: Multilingual Matters.
De Groot, A. M. B. (2011). Language and cognition in bilinguals and multilinguals: An introduction . New York/Hove: Psychology Press.
De Groot, A. M. B., & Hoeks, J. C. C. (1995). The development of bilingual memory: Evidence from word translation by trilinguals. Language Learning, 45 (4), 683–724.
De Temple, J., & Snow, C. E. (2003). Learning words from books. In A. van Kleeck & S. A. Stahl (Eds.), On reading books to children: Parents and teachers . Mahwah: Erlbaum.
Dunn, L., & Dunn, L. (2007). Peabody picture vocabulary test (4th ed.). Circle Pines: American Guidance Service.
Durán, L., Roseth, C., & Hoffman, P. (2010). An experimental study comparing English-only and transitional bilingual education on Spanish-speaking preschoolers’ early literacy development. Early Childhood Research Quarterly, 25 , 207–217.
Ernst-Slavit, G., & Mulhern, M. (2003). Bilingual books: Promoting literacy and biliteracy in the second-language and mainstream classroom. Reading Online, 1. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&db=edb&AN=13515528&site=eds-live&scope=site
Espinosa, L. (2014). Getting it RIGHT for young children from diverse backgrounds: Applying research to improve practice with a focus on dual language learners (2nd ed.). Englewood Cliffs: Prentice Hall.
Farver, J., Lonigan, C., & Eppe, S. (2009). Effective early literacy skill development for young Spanish-speaking English language learners: An experimental study of two methods. Child Development, 80 , 703–719. https://doi.org/10.1111/j.1467-8624.2009.01292.x .
Freeman, Y., & Freeman, D. (2004). Connecting students to culturally relevant texts. Talking Points, 15 (2), 7–11.
Genesee, F., & Lindholm-Leary, K. (2008). Dual language education in Canada and the USA. In N. H. Hornberger (Ed.), Encyclopedia of language and education (pp. 1696–1706). Boston: Springer US.
Golberg, H., Paradis, J., & Crago, M. (2008). Lexical acquisition over time in minority first language children learning English as a second language. Applied PsychoLinguistics, 29 (1), 41–65. https://doi.org/10.1017/S014271640808003X .
Goodrich, J. M., & Lonigan, C. J. (2017). Language-independent and language-specific aspects of early literacy: An evaluation of the common underlying proficiency model. Journal of Educational Psychology, 109 (6), 782–793. https://doi.org/10.1037/edu0000179 .
Grosjean, F. (2008). Studying bilinguals . Oxford: Oxford University Press.
Gutiérrez-Clellen, V., Simon-Cereijido, G., & Restrepo, M. (2013). Improving the vocabulary and oral language skills of bilingual Latino preschoolers: An intervention for speech-language pathologists . San Diego: Plural.
Hadar, U., Teitelman, A., & Dar, R. (2001). Gesture during speech in first and second language: Implications for word retrieval. Gesture, 1 , 151–165.
Hammer, C. S., Davison, M. D., Lawrence, F. R., & Miccio, A. W. (2009). The effect of maternal language on bilingual children’s vocabulary and emergent literacy development during Head Start and kindergarten. Scientific Studies of Reading, 13 , 99–121. https://doi.org/10.1080/10888430902769541 .
Hammer, C. S., Hoff, E., Uchikoshi, Y., Gillanders, C., Castro, D. C., & Sandilos, L. E. (2014). The language and literacy development of young dual language learners: A critical review. Early Childhood Research Quarterly, 29 (4), 715–733. https://doi.org/10.1016/j.ecresq.2014.05.008 .
Hart, B., & Risley, T. R. (1995). Meaningful differences in the everyday experience of young American children . Baltimore: Brookes.
Hindman, A. H., & Wasik, B. A. (2015). Building vocabulary in two languages: An examination of Spanish-speaking dual language learners in Head Start. Early Childhood Research Quarterly, 31 , 19–33. https://doi.org/10.1016/j.ecresq.2014.12.006 .
Hoff, E., & McKay, J. (2005). Phonological memory skill in monolingual and bilingual 23-month-olds. In J. Cohen, K. McAlister, K. Rolstad, & J. MacSwan (Eds.), ISB4: Proceedings of the 4th international symposium on bilingualism (pp. 1041–1044). Somerville: Cascadilla Press.
Hoshino, N., & Thierry, G. (2011). Language selection in bilingual word production: Electrophysiological evidence for cross-language competition. Brain Research, 1371 , 100–109.
Jiménez, R. T. (1994). Understanding and promoting the reading comprehension of bilingual students. Bilingual Research Journal, 18 (1 & 2), 99–119.
King, K. A. (2011). Child language acquisition. In R. Fasold & J. Connor-Linton (Eds.), An introduction to language and linguistics (pp. 205–234). Cambridge: Cambridge University Press.
Kroll, J. F., & Stewart, E. (1994). Category interference in translation and picture naming: Evidence for asymmetric connections between bilingual memory representations. Journal of Memory and Language, 33 , 149–174.
Lee, J. (2011). Size matters: Early vocabulary as a predictor of language and literacy competence. Applied PsychoLinguistics, 32 , 69–92. https://doi.org/10.1017/S0142716410000299 .
Lervåg, A., & Aukrust, V. G. (2010). Vocabulary knowledge is a critical determinant of the difference in reading comprehension growth between first and second language learners. Journal of Child Psychology and Psychiatry, 51 , 612–620.
Leseman, P. (2000). Bilingual vocabulary development of Turkish preschoolers in the Netherlands. Journal of Multilingual and Multicultural Development, 21 , 93–112.
Lin, L. C., & Johnson, C. J. (2014). Mandarin-English bilingual vocabulary development in an English-immersion preschool: How does it compare with monolingual development? International Journal of Bilingualism, 20 (2), 173–189. https://doiorg.libproxy.nie.edu.sg/10.1177/1367006914547662
Lindholm-Leary, K. (2014). Bilingual and biliteracy skills in young Spanish-speaking low-SES children: Impact of instructional language and primary language proficiency. International Journal of Bilingual Education and Bilingualism, 17 (2), 144–159. https://doi.org/10.1080/13670050.2013.86662 .
Lindholm-Leary, K. (2018). Implications of research for dual language at the early childhood level. In M. B. Arias & M. Fee (Eds.), Profiles of dual language education in the 21st century . Avon: Multilingual Matters.
Lindholm-Leary, K., & Genesee, F. (2010). Alternative educational programs for English language learners. In California Department of Education (Ed.), Improving education for English learners: Research-based approaches (pp. 323–382). Sacramento: California Department of Education Press.
Lugo-Neris, M., Wood Jackson, C., & Goldstein, H. (2010). Facilitating vocabulary acquisition of young English language learners. Language, Speech, and Hearing Services in Schools, 41 , 314–327. https://doi.org/10.1044/0161-1461(2009/07-0082) .
Mancilla-Martinez, J., & Lesaux, N. K. (2011). Early home language use and later vocabulary development. Journal of Educational Psychology, 103 (3), 535–546. https://doi.org/10.1037/a0023655
Matthews, P. H. (2007). The concise Oxford dictionary of linguistics (2 ed.). Retrieved from https://doi.org/10.1093/acref/9780199202720.001.0001 .
Méndez, L. I., Crais, E. R., Castro, D. C., & Kainz, K. (2015). A culturally and linguistically responsive vocabulary approach for young Latino dual language learners. Journal of Speech Language and Hearing Research, 58 (1), 93–106. https://doi.org/10.1044/2014_JSLHR-L-12-0221 .
Méndez, L. I., Crais, E. R., & Kainz, K. (2018). The impact of individual differences on a bilingual vocabulary approach for Latino preschoolers. Journal of Speech, Language, and Hearing Research, 61 (4), 897–909. https://doiorg.libproxy.nie.edu.sg/10.1044/2018_JSLHR-L-17-0186
Moats, L. (2001). Overcoming the language gap. American Educator, 25 (2), 5–9.
Nagy, W. E., & Scott, J. A. (2000). Vocabulary processes. In P. D. Pearson & R. Barr (Eds.), Handbook of reading research (Vol. 3, pp. 269–284). Mahwah: Erlbaum.
Nation, I. S. P. (2001). Learning vocabulary in another language . Cambridge: Cambridge University Press.
Nicolay, A. C., & Poncelet, M. (2013). Cognitive abilities underlying second-language vocabulary acquisition in an early second-language immersion education context: A longitudinal study. Journal of Experimental Child Psychology, 115 , 655–671. https://doi.org/10.1016/j.jecp.2013.04.002 .
Oller, D. K. (2005). The distributed characteristic in bilingual learning. In J. Cohen, K. McAlister, K. Rolstad, & J. MacSwan (Eds.), ISB4: Proceedings of the 4th international symposium on bilingualism (pp. 1744–1750). Somerville: Cascadilla Press.
Oller, D. K., Pearson, B. Z., & Cobo-Lewis, A. B. (2007). Profile effects in early bilingual language and literacy. Applied PsychoLinguistics, 28 , 191–230.
Ordóñez, C. L., Carlo, M. S., Snow, C. E., & McLaughlin, B. (2002). Depth and breadth of vocabulary in two languages: Which vocabulary skills transfer? Journal of Educational Psychology, 94 (4), 719–728.
Paradis, J. (2009). Oral language development in French and English and the role of home input factors . Report for the Conseil scolaire centre-nord[north-central school board], Edmonton.
Parra, M., Hoff, E., & Core, C. (2011). Relations among language exposure, phonological memory, and language development in Spanish–English bilingually-developing two-year-olds. Journal of Experimental Child Psychology, 108 , 113–125. https://doi.org/10.1016/j.jecp.2010.07.011 .
Pearson, B. Z., Fernández, S., & Oller, D. K. (1995). Cross-language synonyms in the lexicons of bilingual infants: One language or two? Journal of Child Language, 22 (2), 345–368. https://doi.org/10.1017/S030500090000982X .
Pollard-Durodola, S. D., Gonzalez, J. E., Saenz, L., Resendez, N., Kwok, O., Zhu, L., & Davis, H. (2018). The effects of content-enriched shared book reading versus vocabulary-only discussions on the vocabulary outcomes of preschool dual language learners. Early Education and Development, 29 (2), 245–265.
Proctor, C. P., Uccelli, P., Dalton, B., & Snow, C. E. (2009). Understanding depth of vocabulary online with bilingual and monolingual children. Reading & Writing Quarterly, 25 (4), 311–333.
Reljić, G., Ferring, D., & Martin, R. (2015). A meta-analysis on the effectiveness of bilingual programs in Europe. Review of Educational Research, 85 (1), 92–128. https://doi.org/10.3102/0034654314548514 .
Restrepo, M., Morgan, G., & Thompson, M. (2013). The efficacy of a vocabulary intervention for dual-language learners with language impairment. Journal of Speech, Language, and Hearing Research, 56 , 748–765.
Rhys, M., & Thomas, E. M. (2013). Bilingual Welsh-English children’s acquisition of vocabulary and reading: Implications for bilingual education. International Journal of Bilingual Education and Bilingualism, 16 (6), 633–656.
Rolstad, K., Mahoney, K., & Glass, G. V. (2005). The big picture: A meta-analysis of program effectiveness research on English language learners. Educational Policy, 19 , 572–594.
Rom, A., Segal, M., & Zur, B. (2003). Child, what does he say? Tel-Aviv: Mofet.
Scheele, A. F., Leseman, P. P. M., & Mayo, A. Y. (2010). The home language environment of monolingual and bilingual children and their language profi- ciency. Applied PsychoLinguistics, 31 (1), 117–140. https://doi.org/10.1017/S0142716409990191 .
Schwartz, M. (2014). The impact of the first language first model on vocabulary development among preschool bilingual children. Reading and Writing, 27 , 709–732. https://doi.org/10.1007/s11145-013-9463-2 .
Schwartz, M., & Katzir, T. (2012). Depth of LK among bilingual children: The impact of schooling. Reading and Writing, 25 , 1947–1971.
Schwartz, M., Moin, V., & Leikin, M. (2012). Lexical knowledge development in first and second languages: A role of early bilingual education. Bilingualism and Bilingual Education, 15 (5), 549–571.
Sénéchal, M., Ouellette, G., & Rodney, D. (2006). The misunderstood giant: On the predictive role of early vocabulary to future reading. In D. K. Dickinson & S. B. Neuman (Eds.), Handbook of early literacy (pp. 173–182). New York: Guilford.
Silverman, R. D. (2007). Vocabulary development of English-language and English-only learners in kindergarten. The Elementary School Journal, 107 (4), 365–383.
Silverman, R. D., DiBara Crandell, J., & Carlis, L. (2013). Read alouds and beyond: The effects of read aloud extension activities on vocabulary in Head Start classrooms. Early Education and Development, 24 , 98–122. https://doi.org/10.1080/10409289.2011.649679 .
Smithson, L., Paradis, J., & Nicoladis, E. (2014). Bilingualism and receptive vocabulary achievement: Could sociocultural context make a difference? Bilingualism: Language and Cognition, 17 (4), 810–821. https://doi.org/10.1017/S1366728913000813 .
Sneddon, R. (2008). Magda and Albana: Learning to read with dual language books. Language and Education, 22 (2), 137–154.
Snow, C. E. (1990). The development of definition skill. Journal of Child Language, 17 , 697–710.
Spycher, P. (2009). Learning academic language through science in two linguistically diverse kindergarten classes. The Elementary School Journal, 109 (4), 359–379. https://doi.org/10.1086/593938 .
Starreveld, P. A., De Groot, A. M. B., Rossmark, B. M. M., & Van Hell, J. G. (2014). Parallel language activation during word processing in bilinguals: Evidence from word production in sentence context. Bilingualism: Language and Cognition, 17 (02), 258–276.
Steinlen, A., Neils, K., Piske, T., & Trumpp, C. (2010). SETK 3–5: A developmental language test on German for 3-to-5-year-old children. In K. Kersten, A. Rohde, C. Schelletter, & A. Steinlen (Eds.), Bilingual preschools: Learning and development (pp. 119–135). Trier: Wissenschaftlicher Verlag Trier.
Storch, A. S., & Whitehurst, J. G. (2002). Oral language and code-related precursors to reading: Evidence from a longitudinal structural model. Developmental Psychology, 38 , 934–947.
Sun, H. (2019). Bilingual children’s Mandarin language and literacy environment at home and their Mandarin language and social-emotional skills: One stone for two birds? Frontiers in Psychology, 16 , 1–13. https://doi.org/10.3389/fpsyg.2019.01640 .
Sun, H., Steinkrauss, R., Wieling, M., & de Bot, K. (2018a). Individual differences in very young Chinese children’s English vocabulary breadth and semantic depth: Internal and external factors. International Journal of Bilingual Education and Bilingualism, 21 (4), 405–425. https://doi.org/10.1080/13670050.2016.1178706 .
Sun, H., Yin, B., Amsah, F., & O’Brien, B. A. (2018b). Differential effects of internal and external factors in early bilingual vocabulary learning: The case of Singapore. Applied PsychoLinguistics, 39 (2), 383–411. https://doi.org/10.1017/S014271641700039X .
Sun, H., Loh, J. Y., & Charles, R. A. (2019). Motion and sound in animated storybooks for preschooler’s total fixation time and mandarin language learning: An eye-tracking study with Singaporean bilingual children. AERA Open, 5 , 1–18.
Sun, H., Ng, S. C., O’Brien, B. A., & Fritzsche, T. (2020a). Child, Family, and School Factors in Bilingual Preschoolers’ Vocabulary Development in Heritage Languages. Journal of Child Language, 47 (4), 817–843. https://doi.org/10.1017/S0305000919000904
Sun, H., Toh, W. M., & Steinkrauss, R. (2020b). Instructional strategies and linguistic features of kindergarten teachers’ shared book reading: the case of Singapore. Applied Psycholinguistics, 41 (2), 427–456. https://doi.org/10.1017/S0142716420000053
Van Wijnendaele, I., & Brysbaert, M. (2002). Visual word recognition in bilinguals: Phonological priming from the second to the first language. Journal of Experimental Psychology: Human Perception and Performance, 28 (3), 616–627.
Verhallen, M., & Schoonen, R. (1993). Lexical knowledge of monolingual and bilingual children. Applied Linguistics, 14 (4), 344–363.
Vermeer, A. (2001). Coming to grips with lexical richness in spontaneous speech data. Language Testing, 17 (1), 65–83.
Wesche, M., & Paribakht, T. S. (1996). Assessing second language vocabulary knowledge: Depth versus breadth. The Canadian Modern Language Review, 53 , 13–40.
West, J., Denton, K., & Reaney, L. (2001). The kindergarten year: Findings from the early childhood longitudinal study, kindergarten class of 1998–99 . Washington, DC: National Center for Education Statistics.
Authors and affiliations.
National Institute of Education, Nanyang Technological University, Singapore, Singapore
School of Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada
You can also search for this author in PubMed Google Scholar
Correspondence to He Sun .
Editors and affiliations.
Department of Research Authority, Oranim Academic College of Education, Kiryat Tiv’on, Israel
Rights and permissions
Reprints and Permissions
© 2022 Springer Nature Switzerland AG
About this entry
Cite this entry.
Sun, H., Yin, B. (2022). Vocabulary Development in Early Language Education. In: Schwartz, M. (eds) Handbook of Early Language Education. Springer International Handbooks of Education. Springer, Cham. https://doi.org/10.1007/978-3-030-91662-6_3
DOI : https://doi.org/10.1007/978-3-030-91662-6_3
Published : 31 March 2022
Publisher Name : Springer, Cham
Print ISBN : 978-3-030-91661-9
Online ISBN : 978-3-030-91662-6
eBook Packages : Education Reference Module Humanities and Social Sciences
Share this entry
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
- Find a journal
- Publish with us
Key Literacy Component: Vocabulary
On this page:, what skills do good readers have, what challenges do adolescent readers face with vocabulary, how can instruction help adolescent students with vocabulary, what do we still need to know, more key literacy components.
Vocabulary knowledge is important to reading because the oral and written use of words promotes comprehension and communication. The three primary types of vocabulary are oral vocabulary , which refers to words that are recognized and used in speaking; aural vocabulary , which refers to the collection of words a student understands when listening to others speak; and print vocabulary , which refers to words used in reading and writing. Print vocabulary is more difficult to attain than oral vocabulary because it relies upon quick, accurate, and automatic recognition of the written word. Furthermore, the words, figures of speech, syntax (the grammatical arrangement of words in sentences), and text structures of printed material are more complex and obscure than that of conversational language . A few studies have suggested that vocabulary instruction leads to improved comprehension .
In addition to distinctions between oral, aural, and print vocabulary, vocabulary is categorized according to whether it is typically used in an informal or formal setting. Vocabulary used in a formal, educational setting is referred to as academic vocabulary . Researchers who investigate academic vocabulary knowledge typically categorize words into three areas:
- high-frequency, everyday words (e.g., building, bus driver, eraser, etc.);
- non-specialized academic words that occur across content areas (e.g., examine, cause, formation); and
- specialized content-area words that are unique to specific disciplines (e.g., ecosystem, foreshadowing, octagon) .
Two important skills that are associated with vocabulary development are word identification and word analysis . Word identification or decoding refers to the ability to correctly decipher a particular word out of a group of letters.
Word analysis is defined as the process involved in understanding the letters, sounds, and roots, prefixes, and suffixes that make up words, to enable a student to understand and use those words . Word knowledge also includes syntactic awareness or awareness of the grammatical use of a word, such as the part of speech represented by a word . We assume that students successfully analyze a word when they articulate its meaning and use it correctly in sentences that indicate understanding of both the word’s meaning and correct syntactic usage.
Once words are recognized, students use pragmatic awareness , or sensitivity to how words are used to communicate, to understand the purposes of their use . All of these processes together constitute students’ vocabulary knowledge. Word identification or recognition without comprehension of the meaning and use of a word reveals a deficiency in vocabulary knowledge.
Good readers know a wide range of oral and print vocabulary. Typically, vocabulary knowledge results from extensive and repeated exposures to words through reading and speaking. One study estimated that good readers read approximately one million words per year . Good readers have superior vocabulary knowledge and possess the following characteristics.
Good readers have strong oral/aural vocabulary
A reader’s oral vocabulary is the collection of words used in speaking . Skilled readers are able to use grade-level words fluently and clearly in their speech and understand those words when used by others in their speech. Oral/aural vocabulary ability transfers to reading once the written word has been deciphered. A skilled reader can recognize that word again with little effort . To do this, readers must develop their decoding skills to the point that decoding occurs effortlessly.
Good readers have strong print vocabulary
Skilled readers are able to read words in written text at or above their grade level and use these words in written communication . When good readers encounter unfamiliar words, many translate this text into speech, either by decoding or getting help from someone else. Once the word is verbalized, good readers automatically recognize the word or engage in a self-regulated process to discover its meaning. This may include but is not limited to analyzing the word’s morphology (roots and affixes) and syntax (part of speech), searching for context clues, or looking up the word in the dictionary .
Because word identification is one of the foundational processes of reading, middle and high school students with poor or impaired word identification skills face serious challenges in their academic work. Some struggling adolescent readers have difficulty decoding and recognizing multi-syllabic words. For example, words such as “accomplishment” leave many struggling readers unsure about pronunciation or meaning. This is often the case not just because their vocabulary is limited, but also because they are unaware of or not proficient in word-learning strategies based on understanding the meanings and functions of affixes (e.g., prefixes and suffixes) and other word parts . In content areas in which text is more technical and abstract, insufficient vocabulary knowledge can become especially problematic for struggling readers. A major goal of vocabulary instruction is to facilitate students’ ability to comprehend text .
In addition, the meanings of many words vary from context to context and from subject to subject, making academic vocabulary especially difficult to acquire. For example, the word meter has distinct definitions in different content areas. In literature, a meter is a poetic rhythm and in math, it is a unit of measurement. In science, a meter is a device for measuring flow. Students may experience difficulty if they do not understand that words have multiple meanings .
Research findings suggest that there is not a single best way to teach vocabulary ; rather, using a variety of techniques that include repeated exposures to unknown word meanings produces the best results. Traditionally, independent word-learning strategies, such as the use of dictionaries and context clues, have been common strategies for teaching new vocabulary. Dictionary usage involves multiple skills, such as using guidewords, decoding, and discerning correct definitions . Using context clues involves integrating different types of information from text to figure out unknown vocabulary. These strategies are helpful after multiple encounters with a word but should be used in combination with other instructional practices .
The following vocabulary development strategies have been found to be effective in improving adolescent literacy levels.
Pre-teach difficult vocabulary
Pre-teaching vocabulary facilitates the reading of new text by giving students the meanings of the words before they encounter them. This practice reduces the number of unfamiliar words encountered and facilitates greater vocabulary acquisition and comprehension . Leaving students on their own to grasp the content material as well as to decode possibly unfamiliar vocabulary is setting them up for failure. Teachers can introduce both the more unfamiliar specialized academic words that will be used in the lesson as well as non-specialized academic words used when talking about the content.
When considering which non-specialized academic words to emphasize, teachers should consider the structure or structures used in the text. Text structures organize ideas and information according to certain patterns. For example, cause and effect patterns show the relationship between results and the events, people, or ideas that cause the results to occur. Common text structures include cause/effect, problem/solution, comparison/contrast, chronological order or sequence, concept idea with examples, proposition with support, analysis and evaluation of perspectives, arguments, and interpretations. Once the text structure or structures have been determined, teachers can identify non-specialized academic vocabulary words that help students talk about the content within a cause/effect text structure . Examples of non-specialized academic words that are commonly used when talking about cause/effect texts include recognize , analyze , result , impact , and relationship .
Teachers can use the following guidelines when selecting vocabulary to pre-teach:
- Importance of the word for understanding the text;
- Students’ prior knowledge of the word and the concept to which it relates;
- The existence of multiple meanings of the word (e.g., meter in poetry, mathematics, and science);
- Opportunities for grouping words together to enhance understanding a concept .
Once vocabulary words have been selected, teachers should consider how to make repeated exposures to the word or concept productive and enjoyable. For example, when introducing a particular word, pronounce it slowly to draw attention to each syllable, provide the word’s meaning, examine word parts (e.g., prefix, root, suffix), write the word on the board, use it in a sentence, and ask a question using the word.
After introducing all words, have students work in pairs or small teams to create groups of related words and to label these groups. Students can then take turns explaining to the class their reasons for grouping words in a particular manner. Students can also work in pairs to check each other’s understanding of the new words . Such activities provide multiple exposures to new words and can be structured in ways that are engaging and enjoyable for students.
Use direct, explicit, and systematic instruction to teach difficult vocabulary
Scientific research supports the use of direct, explicit, and systematic instruction for teaching vocabulary . Vocabulary lessons should be fast-paced, brief, multi-sensory, and interactive (i.e., allow students to see and write new words as well as to hear and speak these words) .
Explicit instruction of vocabulary involves the following steps:
- Explain word meanings and model usage of difficult content-area vocabulary in sentences that are relevant to the subject matter concepts that students are currently learning.
- Guide students to practice using the vocabulary in different sentences and contexts and provide corrective feedback.
- Provide time for independent practice with the vocabulary — peer tutoring, reciprocal teaching, and collaborative learning.
- Repeat these instructional steps until students are able to use the new vocabulary independently in their reading and writing .
Use students’ prior knowledge and provide opportunities for multiple exposures to new words
To learn and retain new words and concepts, students need to connect these words and concepts to what they already know. They also need repeated exposure to the words and concepts plus opportunities to practice using them in different contexts. Teachers can facilitate struggling readers’ learning and retention of new vocabulary in the following ways:
- Prior to pre-teaching vocabulary, elicit students’ prior knowledge of the content in which the new vocabulary is used and then relate their prior knowledge to the new vocabulary. It is also helpful to make a word map on the board, chart paper, or overhead to show the connections between students’ prior knowledge and the new vocabulary .
- Provide multiple repetitions of the words in different contexts . For example, within the context of explaining new concepts, giving directions, or summarizing ideas, use the new words repeatedly. You may also want to pronounce these words more slowly and pause after saying them to allow students time to identify and focus on the words.
- Point out that in academic settings certain non-specialized academic words are used when talking about content. Point out and model usage of these words and phrases. For example, when reading about or discussing the causes of the civil war, point out and model usage of such words as cause, consequence, relationship, etc. Guide students to use these words in their speech and writing.
- Provide students several opportunities to apply new word meanings across different situations . For example, place students in small groups to discuss their understandings of the new words. Have them develop their own word maps to show relationships among the new words and connections to the important concepts. A word map is a diagram used to help show the relationships of various topics or concepts to a chosen word or phrase. Have them write sentences using the new words in different ways, then share these orally with the class.
Even more repetition and time with new vocabulary should be allowed for students with learning disabilities. English language learners also require more exposure and practice with English vocabulary .
Use computer technology to help teach new vocabulary
Vocabulary instruction using computer technology can be particularly helpful to struggling readers who need additional practice with vocabulary skills . Computer technology allows for engaging formats, such as interfaces modeled on computer games. Hyperlinks that allow students to click on words and icons can add depth to word learning. Students may find online dictionaries more useful and accessible than print dictionaries. Computers also provide access to content-area-related websites hosted by such institutions as museums and libraries. Finally, computer program animation may hold students’ attention longer than plain text .
Research has yet to demonstrate the most effective types of professional development needed for teachers to become proficient in vocabulary instruction. Fully equipping the teachers to address adequately the issue of vocabulary in classrooms is an important step toward improving the vocabulary of adolescents. Another gap in the knowledge base is improved understanding of how vocabulary instruction should be integrated with comprehension instruction. We know that repetition and prior knowledge help familiarize adolescents with new vocabulary, but we need to determine what instructional techniques can help educators ensure that adolescents grasp the contextual meanings of vocabulary .
- Key Literacy Component: Morphology
- Key Literacy Component: Decoding
- Key Literacy Component: Fluency
- Key Literacy Component: Text Comprehension
- Key Literacy Component: Writing
Liked it? Share it!
Archer, A., M. Gleason, and V. Vachon, Decoding and fluency: Foundation skills for struggling older readers. Learning Disability Quarterly, 2003. 26: p. 89-101.
Bailey, A.L. and F.A. Butler, An evidentiary framework for operationalizing academic language for broad application to K-12 education: A design document. 2003, CRESST/University of California, Los Angeles: Los Angeles.
Bhattarya, A. and L. Ehri, Graphosyllabic analysis helps adolescent struggling readers read and spell words. Journal of Learning Disabilities, 2004. 37: p. 331-348.
Bryant, D., et al., Vocabulary instruction for students with learning disabilities: A review of the research. Learning Disability Quarterly, 2003. 26: p. 117-128.
Curtis, M.E., Adolescents who struggle with word identification: Research and practice, in Adolescent literacy research and practice, T.L. Jetton and J.A. Dole, Editors. 2004, The Guilford Press: New York. p. 119-134.
Kamil, M., Adolescents and literacy: Reading for the 21st century. 2003, Washington, DC: Alliance for Excellent Education.
Lehr, F., J. Osburn, and E.H. Hiebert, A focus on vocabulary. 2004, Regional Educational Laboratory at Pacific Resources for Education and Learning.
Mason, L., Introducing talk and writing for conceptual change: A classroom study. Learning and Instruction, 2001. 11: p. 305-329.
Medo, M. and R. Ryder, The effects of vocabulary instruction on readers’ ability to make causal connections. Reading Research and Instruction, 1993. 33(2): p. 119-134.
Moats, L.C., Efficacy of a structured, systematic language curriculum for adolescent poor readers. Reading and Writing Quarterly, 2004. 20(2): p. 145-159.
National Institute of Child Health and Human Development, Report of the National Reading Panel. Teaching children to read: An evidence-based assessment of the scientific research literature on reading and its implications for reading instruction. 2004, Government Printing Office: Washington, DC. http://www.nationalreadingpanel.org.
Nokes, J.D. and J.A. Dole, Helping adolescent readers through explicit strategy instruction, in Adolescent literacy research and practice, T.L. Jetton and J.A. Dole, Editors. 2004, The Guilford Press: New York. p. 162-182.
Santa, C.M., Project CRISS: Reading, writing, and learning in the content subjects, in Bridging the literacy achievement gap, grades 4-12, D.S. Strickland and D.E. Alvermann, Editors. 2004, Teachers College Press: New York. p. 183-199.
Schleppegrell, M., Linguistic features of the language of schooling. Linguistics and Education, 2001. 12(4): p. 431-459.
Scliar-Cabral, L., et al., The awareness of phonemes: So close-so far away. International Journal of Psycholinguistics, 1997. 13(38): p. 211-240.
Snow, C. and G. Biancarosa, Adolescent literacy and the achievement gap: What do we know and where do we go from here? 2003, Carnegie Corporation of New York: New York.
Visit our sister websites:
Reading rockets launching young readers, start with a book read. explore. learn, colorín colorado helping ells succeed, ld online all about learning disabilities, reading universe all about teaching reading and writing.
- Open access
- Published: 21 November 2023
Immigrant and ethnic minority patients` reported experiences in psychiatric care in Europe – a scoping review
- Marte Karoline Råberg Kjøllesdal 1 , 2 ,
- Hilde Hestad Iversen 3 ,
- Kjersti Eeg Skudal 3 &
- Lina Harvold Ellingsen-Dalskau 3
BMC Health Services Research volume 23 , Article number: 1281 ( 2023 ) Cite this article
There is little evidence on experiences in psychiatric care treatment among patients with immigrant or ethnic minority background. Knowledge about their experiences is crucial in the development of equal and high-quality services and is needed to validate instruments applied in national patient experience surveys in Norway. The aim of this scoping review is to assess and summarize current evidence on immigrant and ethnic minorities` experiences in psychiatric care treatment in Europe.
Guidelines from the Joanna Briggs Institute were followed and the research process adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. The literature search was carried out in Medline, Cinahl, Web of Science, Cochrane database of systematic reviews, Embase, and APA PsychInfo, up to Dec 2022, for articles on immigrant patients` experiences in psychiatric care. Reference lists of included articles were screened for additional relevant articles. Titles and abstracts were screened, and potentially relevant articles read in full-text, by two researchers. Evidence was extracted using an a priori extraction form and summarized in tables and text. Any disagreement between the reviewers regarding inclusion of articles or extracted information details were resolved through discussion between authors.
We included eight studies in the scoping review. Immigrant and ethnic minority background patients did not differ from the general population in quantitative satisfaction questionnaires. However, qualitative studies showed that they experience a lack of understanding and respect of own culture and related needs, and difficulties in communication, which do not seem to be captured in questionnaire-based studies.
Raising awareness about the importance of respect and understanding for patients` cultural background and communication needs for treatment satisfaction should be addressed in future quality improvement work.
Peer Review reports
Mental health issues represent a substantial share of contacts with health care services in Europe and is a major public health issue [ 1 ]. It`s prevalence is not evenly distributed across the population, and international studies [ 2 ], as well as studies from Norway [ 3 ], Sweden [ 4 ] and Denmark [ 5 ] find that both self-reported levels and risk of diagnoses are higher in some groups of immigrants than in the general population. Despite the elevated prevalence of mental health disorders among immigrants, the use of psychiatric care services is lower than in the majority population in Norway [ 6 , 7 ]. Reasons for differences in use of services by those with immigrant background may include practical barriers such as language, cultural barriers and stigma and low health literacy and knowledge of services, but also differences in quality of services and perceived benefit of treatment.
Patient experiences are an important aspect of quality of care and could inform service providers and policy makers of strengths, weaknesses and areas for improvement in the services [ 8 ]. Good patient experiences are related to improved communication, correct diagnoses and adherence to therapy and can promote service user participation in own care [ 8 ]. Studies assessing patient experiences with mental health care have measured experiences related to interpersonal relationships, respect and dignity, access and care coordination, drug therapy, information, psychological care and care environment [ 9 , 10 ]. Most studies on experiences in mental health care are carried out among patients from a majority background [ 11 ]. However, needs and expectations and thus the experiences and satisfaction of patients are influenced by a range of factors, including knowledge about care, values and culture and sociodemographic factors [ 11 ]. Some studies indicate that patients with an immigrant background have lower satisfaction with these services than others [ 11 ]. Migrant populations may have expectations of care and explanatory models of mental health which differ from those of majority populations, traumatic life-events, migration-related stress, experiences of discrimination, cultural preferences and limited proficiency in host language influencing their experiences in health care. The knowledge on immigrant patients` experiences in mental health care is fragmented and scarce. Knowledge about which elements immigrants regard as most important for the treatment to be useful and good for them is therefore needed to develop services which are equal and of high quality for all.
In Norway, continuous, electronical measurements of patient perceived quality in mental health services have been carried out since 2020, as part of the national quality monitoring and improvement of health services [ 12 ]. In developing these measurements further, one important aspect is to focus on experiences among immigrants. Specifically, this means to assess and include areas of special importance for immigrant patients in measurement tools, and to implement means to increase the response rate among immigrant patients (e.g. reduce the length of the questionnaire, offer translated versions). In a preliminary literature search we found no existing review on immigrant patients` experiences in mental health care. Thus, our objective was to synthesize evidence on experiences immigrant patients have in psychiatric care in Europe and provide an overview of areas of particular importance to validate instruments applied in national patient experience surveys in Norway. Our research questions are: Which experiences do patients with immigrant and ethnic minority background have in psychiatric care? Do their experiences differ from those of other patients? A scoping review is an evidence synthesis that identify and map the breadth of available evidence on a particular field and identifying key factors related to a concept [ 13 ]. This makes scoping review a suitable approach to our research questions, which best can be answered by synthesizing evidence from a range of studies, including both quantitative and qualitative. Results from quantitative studies will provide knowledge regarding experiences captured by existing questionnaires on patient reported experiences, whereas qualitative studies will inform us about experiences important to immigrants which are not captured by currently used questionnaires, but which should be considered included in future quantitative surveys.
The Joanna Briggs Institute`s methodology for scoping reviews was followed [ 14 ] and the research process reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews [ 15 ] (Appendix 1 ). The protocol for the scoping review was published in Open Science Framework ( http://osf.io/pce52/ ).
Our point of departure for this scoping review was a need to develop and improve questionnaires used to capture patient experiences both in psychiatric care and substance abuse treatment. The literature search thus entailed both psychiatric care and substance abuse treatment. Only one study on patient experiences among immigrant patients in substance abuse treatment was found, and this was carried out among men with co-occurring substance use- and mental health disorders. Thus, the focus of the final scoping review was on patient experiences in psychiatric care only.
A previous literature search carried out for patient experiences in substance abuse treatment was used as a starting point for developing the search strategy [ 16 ], and search words and terms related to psychiatric care and to immigrant status or being an ethnic minority were included. We included search terms related to both patient experiences and patient satisfaction. Patient satisfaction relates to a patient`s subjective evaluation of the service in general. Patient experiences focus more on factual information about processes and events, and its relation to patient satisfaction is dependent on a person`s standards and expectations [ 17 ]. Both types of measures reflect health care quality, but patient experiences may be more informative for quality development work. The search strategy was developed by the authors in close collaboration with an experienced librarian at the Norwegian Institute of Public Health. The search strategy, including all identified keywords and index terms, was adapted for each included database (Full search strategy included in Appendix 2 ). The search was carried out in Medline, Cinahl, Web of Science, Cochrane database of systematic reviews, Embase, APA PsychInfo, up to Dec 2022. The final search was carried out 15.12.2022. A starting date was not applied for our search, and it was limited to articles in English or a Scandinavian language, based on language competencies of the research team. Reference lists of included articles, as well as related reviews identified in the search, were screened for additional relevant studies.
All identified references were collated, uploaded into EndNote 20 and deduplicated. Titles and abstracts were screened by two of the authors (MKK, LED) for assessment against the inclusion criteria for the review. Potentially relevant articles were read in full text by the same two authors. Any disagreements between the reviewers at each stage of the selection process were resolved through discussion. The two authors agreed upon > 98% of the articles based on title/abstract screening and all the articles in the full text screening. The results of the search and the study inclusion process, including reasons for exclusion after full-text screening is reported in Fig. 1 and in Appendix 3 , Supplementary Table 1.
Flow diagram for included studies. *Reason for exclusion given in Appendix 3 , Supplementary Table 1
The scoping review includes peer-reviewed articles reporting from quantitative and qualitative studies on patient experiences and satisfaction in psychiatric care in Europe, and with a focus on patients with immigrant or ethnic minority background. We included studies both from inpatient and outpatient care and both former and current patients. In the protocol, we focused on experiences of immigrants in inpatient care. But as the number of articles reporting on this was low ( N = 3), we decided to widen our scope to include outpatient settings, and to also include ethnic minority patients with background from a country other than their country of residence (not indigenous people). Ethnic minorities may have lived in their country of residence for generations and do thus often not experience challenges related to being new in a country, such as language and lack of knowledge of the health systems. They may, however, face cultural differences in views of mental illness and treatment and discrimination based on their physical appearance or cultural traditions. A few references were focusing on differences by race in the US. As the sociocultural and historical context in Europe and the US is rather different, we have chosen to include only articles from Europe, and excluding those not from Europe. We included articles on patients 16 years or older, but not articles reporting experiences in children and adolescent mental health services. We excluded studies carried out in the general population and not focusing on specified service user groups.
All included articles were subjected to a data extraction procedure. We used an a priori extraction form, based on the JBI guidelines for scoping reviews [ 14 ] (Appendix 4 ), to systematically extract information from the studies. To ensure that all relevant information was extracted, two authors (MKK, LED) independently extracted information following the pre-defined categories; author, publication year, title, aim, country, context, participants, questionnaire applied (if relevant), domains of experiences assessed, results (main points). Any disagreement between the reviewers regarding extracted information details were resolved through authors discussing and agreeing upon what was of relevance for the scoping review. The extracted information was summarized in tables and a narrative synthesis.
A total of 1253 unique articles were identified through the database searches (Fig. 1 ). After screening of titles and abstracts, 23 articles were read in full-text and of those 4 were included in the scoping review. In addition, 4 eligible articles were identified through references screening and included, giving a total of 8 included studies. The included articles are presented with some selected descriptive details in Appendix 3 , Supplementary Table 2.
Description of included studies
Characteristics of the eight included articles in our scoping review are presented in Table 1 . Of the eight studies, five were quantitative [ 18 , 19 , 20 , 21 , 22 ] and three qualitative [ 23 , 24 , 25 ]. Three studies reported from an in-patient setting [ 18 , 19 , 21 ], four from both in-patient and out-patient settings [ 22 , 23 , 24 , 25 ] and one from out-patient setting only [ 20 ]. Four studies were from the UK [ 18 , 19 , 23 , 24 ], one from Denmark [ 20 ], one from Germany [ 22 ], one from Norway [ 25 ] and one reported from several countries [ 21 ]. The studies were published in the period 1999–2022, with more than half (5 articles) published from 2019 onwards. The studies from the UK reported on experiences among ethnic minorities, and the other studies among migrants. The quantitative studies included between 216 and 7302 participants, and four studies included patients both with and without a migrant/ethnic minority background [ 18 , 19 , 21 , 22 ], whereas one study included only immigrants [ 20 ]. Two of the qualitative studies conducted individual interviews only [ 24 , 25 ] and one did focus group sessions in addition to individual interviews [ 23 ]. The number of participants in the qualitative studies varied between 8 and 26, and all three studies included immigrants or ethnic minorities only [ 23 , 24 , 25 ]. The studies from UK focused on ethnic minorities [ 18 , 19 , 23 ], except one which focused on immigrants [ 24 ]. The other studies focused on immigrants [ 20 , 21 , 22 , 25 ], and the term immigrant most often included both immigrants and their descendants (first- and second-generation immigrants).
Among the quantitative studies, 4 used an existing questionnaire for measuring patient experiences and satisfaction [ 18 , 19 , 21 , 22 ] and one study used a new questionnaire that was developed based on the literature, other questionnaires and clinical experience [ 20 ]. Two studies included a question about satisfaction with mental health treatment in general [ 18 , 20 ], and four made a score of overall satisfaction based on questions on experiences and satisfaction in multiple domains of the treatment [ 18 , 19 , 21 , 22 ] (Table 2 ). Three studies specified satisfaction with medication and with other aspects of treatment [ 19 , 21 , 22 ]. All studies included questions on experiences with staff and their professional and interpersonal skills. Three studies included questions regarding helpfulness of treatment and feeling better after treatment [ 19 , 20 , 21 ]. Two studies included questions related to the ward and its social and physical qualities [ 18 , 19 ], and two included satisfaction with information given [ 20 , 22 ]. Only one study [ 22 ] included questions on relatives’ involvement, and two on cultural aspects related to treatment [ 19 , 20 ].
Among the qualitative studies, two assessed experiences with mental health services among patients with South Asian background in UK [ 23 , 24 ], and one assessed experiences among patients with an immigrant background (first and second generation) in Norway [ 25 ].
Synthesis of evidence
Comparison of satisfaction with services between patients with immigrant or ethnic minority background and majority background.
Two studies compared satisfaction with in-patient mental health treatment among White British patients and ethnic minority patients in UK [ 18 , 19 ]. One study found no ethnic differences in satisfaction with treatment, but that White patients reported more adverse events than others [ 18 ]. The other found no ethnic differences in most domains (16 of 21) of treatment, but that Black patients were less likely than White to perceive that they receive the right treatment or get the right medication [ 19 ]. Anderson et al. [ 21 ] and Gaigl et al. [ 22 ] compared experiences among mental health patients with and without a migration background, with diverging results. In a multisite study in both in- and out-patient settings across Germany, Italy, Poland, Belgium and UK, Anderson et al. found that migrants were less satisfied with their treatment than non-migrants. In an in-patient setting in Germany, patients with a migrant background had higher overall satisfaction with treatment and with involvement of relatives [ 22 ], and first-generation immigrants had higher satisfaction overall and with the professionals, efficacy and involvement of relatives compared to the second-generation immigrants and non-immigrants. There are no studies to assess differences in patient experiences in mental health care between various immigrant groups.
Domains of care highlighted as important by immigrants and ethnic minorities
Cultural understanding and communication.
In all the three qualitative studies, the importance of professionals understanding and respecting their cultural background was highlighted [ 23 , 24 , 25 ]. Participants expressed that this was not in place when they had received treatment, and that this led to a lack of connection to the professionals and lower satisfaction with services. Some said that having a professional of same, or at least a minority, background, could have helped. Participants in the Norwegian study made a point that their needs were different from those of patients with the same diagnoses from the host population, and that the services were not tailored to meet their needs [ 25 ]. They experienced to receive a large extent of the treatment in group settings, with no adjustment to their command of the Norwegian language or understanding or to their individual or cultural starting point to work with their disorder. In one quantitative study assessing experiences among patients of a non-Western refugee background in a competence centre for transcultural psychiatry [ 20 ], the satisfaction with the treatment was overall high, including the cultural understanding. The special setting could have helped to a high score on experiences with the professionals cultural understanding. Nevertheless, a perception of being met with respect for own culture was related to higher overall satisfaction, highlighting its importance for patients with an immigrant background. This dimension of care was not assessed in the other quantitative studies.
Patients of ethnic minority background in two qualitative studies expressed frustration related to communication, gaining a deep understanding of what was said, challenges in expressing themselves in the host language and the lack of interpreters [ 23 , 24 ]. Participants in one study also expressed a lack of information about diagnoses and treatment [ 24 ]. In the quantitative studies, three of them described that participants had to be able to communicate in the host language to participate [ 19 , 21 , 22 ], and one offered interpreters and translated questionnaires [ 20 ]. However, no questions on language and communication were included in questionnaires.
Relatives’ involvement and aftercare
In two of the qualitative studies, participants expressed that having relatives with them and supporting them was, or would have been helpful [ 24 , 25 ]. Participants also mentioned stigma related to mental illness in their communities and that raising awareness of these disorders and reducing stigma would help them seek treatment and benefit from it [ 23 , 25 ].
Practical issues and service development
Some participants in qualitative studies mentioned that they experienced practical barriers to practice religion when being in treatment, e.g., having a place to pray [ 23 ]. A concern was also raised that their voices were not heard in service development, which contributed to services less useful for them [ 23 ].
The limited number of quantitative studies comparing satisfaction scores between immigrant or ethnic minority patients and majority patients exhibit diverging methods and results, and do not provide evidence that immigrant or ethnic minority patients overall report poorer satisfaction with mental health treatment than the majority. However, evidence from qualitative studies suggests that immigrant patients experience a lack of understanding and respect of own culture and related needs, as well as difficulties in communication due to both cultural differences and language barriers. These issues were closely related to experiences of poorer satisfaction with mental health services. Importantly, these aspects were not captured in quantitative studies, except for one study from a competence centre for transcultural psychiatry [ 20 ].
Several of the aspects highlighted in the included studies, such as communication difficulties related to language and lack of insight, interest, and respect for the patient`s migration background by practitioners, have also been highlighted in studies conducted in general health care services [ 26 ]. Issues of discrimination and an expressed wish to be treated as a person have also been raised [ 26 ]. Thus, it seems that some of the areas of importance to immigrants in mental health care, also apply to other and more general parts of the health service system. Nevertheless, these are issues important to address in developing mental health care quality and in measuring perceived quality of this care. Overall satisfaction with primary health care services among immigrants vary across studies, like we have reported for mental health services in this scoping review. Some studies report lower satisfaction with primary health care services among immigrants than among others [ 27 ], whereas other studies report high satisfaction, including the perception of being met with respect for cultural background and own wishes [ 28 , 29 ]. Due to the heterogeneity and the relatively low number of included studies in this scoping review, it is not possible to draw any conclusions on differences in satisfaction with mental health services between immigrants and ethnic minorities. Potential differences could be due to differences in language proficiency, knowledge of the health care system and to expectations to the mental health care services.
Satisfaction is related to expectation. For example have Vietnamese immigrants in the UK been shown to report better satisfaction, but also lower expectations, to health care than others [ 30 ]. Some studies have suggested the presence of a “happy migrant effect”, describing immigrants rating the quality of services as good because they compare it to bad experiences in their country of origin or during the migration process, or because of a feeling that they should have been thankful or have a poor self-esteem arising from language challenges [ 20 ]. This could also be a current issue in mental health care, as immigrants come from very different health systems in their country of origin, sometimes non-existent in terms of mental health services. Our results did not show a consistently higher satisfaction among patients with an immigrant background. Therefore, it is not possible to draw any conclusions regarding how expectations may be influencing perceptions of the quality of mental health care.
It is generally expected that good patient experiences are associated with improved outcomes, as they contribute to a higher involvement of patients in own care through better communication, correct diagnoses and adherence to therapy. However, the included studies do not provide a clear confirmation of this relationship. One of the studies included objective measures of treatment outcomes [ 21 ], while another study relied on self-report data [ 20 ]. Anderson et al. [ 21 ] found that despite immigrants reporting a slightly lower satisfaction with mental health services, there were no differences between immigrants and others in objective outcomes including length of stay, rehospitalizations or number of untoward events. In fact, immigrants even had a lower rate of suicide than non-immigrants. In a competence center for transcultural psychiatry, patients who experienced a subjective improvement also reported better satisfaction scores [ 20 ].
Strengths and limitations
The strengths of this study were a thorough search in six databases covering medicine, mental health literature and social science. The authors have followed guidelines from the Joanna Briggs Institute and adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Review. We chose to include studies from Europe only, to limit the variation in political and social context, facilitating better generalization to the results to both the Norwegian and broader European context.
The studies from UK were rather old (1999, 2022, 2007, 2012) [ 18 , 19 , 23 , 24 ], whereas the other were of more recent (2019–2022) [ 20 , 21 , 22 , 25 ]. Knowledge and practice in the field may have developed over the last 20 years, but there was nothing that stood out as a difference between the results of the older and newer studies. Due to the lack of specific findings or conclusive evidence it was therefore difficult to make definitive statements about satisfaction with substance abuse treatment. Moreover, studies were carried out in both in-and out-patient settings, and each study had its own methodology and included questions. This further complicates drawing firm conclusion. Such variety, however, is part of the nature of scoping reviews. We included only scientific papers, and only papers published in English. By this, we may have lost relevant studies, but we assume that most relevant literature is published and available in English language. We did not perform a quality assessment of each paper, due to the broad nature of a scoping review and the varied nature of included studies.
Our rationale for carrying out this scoping review was to identify areas of special importance to patient satisfaction among immigrant patients in mental health care, to ensure that our measurement tools are relevant and covers important aspects of care, also for immigrants. Our review reveal that aspects related to cultural appropriateness of services, language barriers and perceived respect for patients` background are important for satisfaction with services among immigrants, and that these aspects should be included also in quantitative measurements of patient experience and satisfaction in the future. Research is needed on how these aspects best can be included in future surveys. Furthermore, these areas will be of importance in quality development of mental health services in an increasingly heterogenous Europe. In the literature search, no studies regarding patient experiences among immigrant in substance abuse treatment were found, except one among men with co-occurring substance abuse- and mental health disorders. This calls for research on how such health care services are experienced by patients with immigrant background.
Our scoping review highlights a need to raise awareness about the importance of respect and understanding for patients` cultural background and communication needs in improving mental health treatment given to patients with an immigrant or ethnic minority background. For immigrants` needs to be included in service quality improvement, these aspects should also be taken into quantitative and routine measures of patient experiences.
Availability of data and materials
The scoping review is based on articles available in the databases searched.
OECD/EU. Health at a Glance: Europe 2018. State of Health in the EU Cycle. Paris: OECD Publishing; 2018.
Close C, Kouvonen A, Bosqui T, Patel K, O’Reilly D, Donnelly M. The mental health and wellbeing of first generation migrants: a systematic-narrative review of reviews. Global Health. 2016;12(1):47.
Article PubMed PubMed Central Google Scholar
Abebe DS, Lien L, Hjelde KH. What we know and don’t know about mental health problems among immigrants in Norway. J Immigr Minor Health. 2014;16(1):60–7.
Article PubMed Google Scholar
Gilliver SC, Sundquist J, Li X, Sundquist K. Recent research on the mental health of immigrants to Sweden: a literature review. Eur J Pub Health. 2014;24:72–9.
Article Google Scholar
Norredam M, Garcia-Lopez A, Keiding N, Krasnik A. Risk of mental disorders in refugees and native Danes: a register-based retrospective cohort study. Soc Psychiatry Psychiatr Epidemiol. 2009;44(12):1023–9.
Berg JE. The level of non-Western immigrants’ use of acute psychiatric care compared with ethnic Norwegians over an 8-year period. Nord J Psychiatry. 2009;63(3):217–22.
Abebe DS, Lien L, Elstad JI. Immigrants’ utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway. Soc Psychiatry Psychiatr Epidemiol. 2017;52(6):679–87.
Doyle C, Lennox L, Bell D. A systematic review of evidence on the links between patient experience and clinical safety and effectiveness. BMJ Open. 2013;3(1):e001570.
Fernandes S, Fond G, Zendjidjian XY, Baumstarck K, Lançon C, Berna F, et al. Measuring the patient experience of mental health care: a systematic and critical review of patient-reported experience measures. Patient Prefer Adherence. 2020;14:2147–61.
Haugum M, Iversen HH, Helgeland J, Lindahl AK, Bjertnaes O. Patient experiences with interdisciplinary treatment for substance dependence: an assessment of quality indicators based on two national surveys in Norway. Patient Prefer Adherence. 2019;13:453–64.
Woodward S, Berry K, Bucci S. A systematic review of factors associated with service user satisfaction with psychiatric inpatient services. J Psychiatr Res. 2017;92:81–93.
Iversen HH, Haugum M, Bjertnaes O. Reliability and validity of the Psychiatric Inpatient Patient Experience Questionnaire - Continuous Electronic Measurement (PIPEQ-CEM). BMC Health Serv Res. 2022;22(1):897.
Munn Z, Pollock D, Khalil H, Alexander L, McLnerney P, Godfrey CM, et al. What are scoping reviews? Providing a formal definition of scoping reviews as a type of evidence synthesis. JBI Evid Synth. 2022;20(4):950–2.
Peters MD, Godfrey C, McInerney P, Munn Z, Tricco AC, Khalil H. Scoping reviews. In: Aromatis E MZ, editor. JBI Manual for Evidence Synthesis: Joanna Briggs Institute; 2020. 1–24.
Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Ann Intern Med. 2018;169(7):467–73.
Danielsen KGA, Kornør H. Måling av brukererfaringer med avhengighetsbehandling: En litteraturgjennomgang av validerte måleinstrumenter [Measuring patient experiences in substance abuse treatment. A review of literature on validated instruments]. Oslo: Nasjonalt kunnskapssenter for helsetjenesten; 2007.
Crow R, Gage H, Hampson S, Hart J, Kimber A, Storey L, Thomas H. The measurement of satisfaction with healthcare: implications for practice from a systematic review of the literature. Health Technol Assess. 2002;6(32):1–244.
Article CAS PubMed Google Scholar
Greenwood N, Key A, Burns T, Bristow M, Sedgwick P. Satisfaction with in-patient psychiatric services. Relationship to patient and treatment factors. Br J Psychiatry. 1999;174:159–63.
Boydell J, Morgan C, Dutta R, Jones B, Alemseged F, Dazzan P, et al. Satisfaction with inpatient treatment for first-episode psychosis among different ethnic groups: a report from the UK ÆSOP study. Int J Soc Psychiatry. 2012;58(1):98–105.
Lindberg LG, Mundy SS, Kristiansen M, Johansen KS, Carlsson J. Satisfaction with mental health treatment among patients with a non-Western migrant background: a survey in a Danish specialized outpatient mental health clinic. Eur J Pub Health. 2019;29(4):700–5.
Anderson K, Giacco D, Bird V, Bauer M, Pfennig A, Lasalvia A, et al. Do outcomes of psychiatric hospital treatment differ for migrants and non-migrants? Soc Psychiatry Psychiatr Epidemiol. 2021;56(11):1957–65.
Gaigl G, Täumer E, Allgöwer A, Becker T, Breilmann J, Falkai P, et al. The role of migration in mental healthcare: treatment satisfaction and utilization. BMC Psychiatry. 2022;22(1):1–13.
Bowl R. The need for change in UK mental health services: South Asian service users’ views. Ethn Health. 2007;12(1):1–19.
Bhui K, Chandran M, Sathyamoorthy G. Mental health assessment and south Asian men. Int Rev Psychiatry. 2002;14(1):52–9.
Kour P, Lien L, Kumar B, Biong S, Pettersen H. Treatment experiences with Norwegian health care among immigrant men living with co-occurring substance use-and mental health disorders. Subst Abuse. 2020;14:1178221820970929.
PubMed PubMed Central Google Scholar
Mangrio E, Sjögren FK. Refugees’ experiences of healthcare in the host country: a scoping review. BMC Health Serv Res. 2017;17(1):814.
Detollenaere J, Hanssens L, Schäfer W, Willems S. Can you recommend me a good GP? Describing social differences in patient satisfaction within 31 countries. Int J Qual Health Care. 2018;30(1):9–15.
Goetz K, Bungartz J, Szecsenyi J, Steinhaeuser J. How do patients with a Turkish background evaluate their medical care in Germany? An observational study in primary care. Patient Prefer Adherence. 2015;9:1573–9.
Wiking E, Saleh-Stattin N, Johansson SE, Sundquist J. Immigrant patients’ experiences and reflections pertaining to the consultation: a study on patients from Chile, Iran and Turkey in primary health care in Stockholm Sweden. Scand J Caring Sci. 2009;23(2):290–7.
Ogden J, Jain A. Patients’ experiences and expectations of general practice: a questionnaire study of differences by ethnic group. Br J Gen Pract. 2005;55(514):351–6.
We want to thank Ragnhild Agathe Tornes, librarian at the Norwegian Institute of Public Health, for valuable help with our search strategy.
Open access funding provided by Norwegian Institute of Public Health (FHI) This scoping review is part of the project `A new generation of Patient-Reported Quality Measurements in Mental health and Addiction Services (PRQMs-MAS)`, funded by the Norwegian Research Council (project number 331891).
Authors and affiliations.
Department of Public Health Science, Norwegian University of Life Sciences, Postboks 5003, 1433, Ås, Norway
Marte Karoline Råberg Kjøllesdal
Center for Evidence-Based Public Health: A Joanna Briggs Institute Affiliated Group, Ås, Norway
Norwegian Institute of Public Health, Health Services Research, Postboks 222 Skøyen, 0213, Oslo, Norway
Hilde Hestad Iversen, Kjersti Eeg Skudal & Lina Harvold Ellingsen-Dalskau
You can also search for this author in PubMed Google Scholar
H.H.I. and L.H.E-D. conceived the idea for the article, M.K.K. and L.H.E-D. did reference screening and data extraction, M.K.K. drafted the article and all authors (M.K.K., L.H.E-D., H.H.I., K.E.S.) contributed in revising the manuscript and interpreting the results.
Correspondence to Lina Harvold Ellingsen-Dalskau .
Ethics approval and consent to participate.
Consent for publication
The authors declare no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Additional file 1: appendix 1..
Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist.
Additional file 2: Appendix 2.
Additional file 3: Appendix 3.
Supplementary Table 1. List of articles excluded in full-text reading. Supplementary Table 2. Details of included studies.
Additional file 4: Appendix 4.
Data extraction form, modified from Peters et al, 2020*.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ . The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/ ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
Reprints and Permissions
About this article
Cite this article.
Kjøllesdal, M.K.R., Iversen, H.H., Skudal, K.E. et al. Immigrant and ethnic minority patients` reported experiences in psychiatric care in Europe – a scoping review. BMC Health Serv Res 23 , 1281 (2023). https://doi.org/10.1186/s12913-023-10312-1
Received : 30 August 2023
Accepted : 10 November 2023
Published : 21 November 2023
DOI : https://doi.org/10.1186/s12913-023-10312-1
Share this article
Anyone you share the following link with will be able to read this content:
Sorry, a shareable link is not currently available for this article.
Provided by the Springer Nature SharedIt content-sharing initiative
- Psychiatric care
- Patient experiences
- Ethnic minority
BMC Health Services Research