When COVID-19 threw Liv Dávila—and the rest of the world—for a loop in the spring of 2020, she was forced to make some major adjustments in her research methods.

Those adjustments led to a paper, “Immigrant Outreach and Language Access During First Year of the COVID-19 Pandemic,” published last summer in Applied Linguistics.

“I shifted from doing research in person, in schools, to conducting Zoom interviews with directors of two immigrant-serving organizations in the Midwest,” says Dávila, associate professor in Education Policy, Organization and Leadership in the College of Education. “I wanted to see how the organizations functioned to support immigrants during the early part of COVID.”

The organizations work with immigrants, particularly lower-income and undocumented people, providing a range of services, including healthcare access and mental health, legal, and translation services. They also offer tutoring and act as a liaison between the immigrant families and schools.

Dávila has spent 20 years researching and working with immigrant communities and community-based immigrant organizations. “It’s important to have a broader understanding of their lived experiences,” she says.

The need is certainly there: Illinois is home to 1.8 million immigrants. The U.S. has more than 46 million permanent residents who come from another country.

Scrambling to Meet Immigrant Needs

The organizations Dávila worked with in her study had to scramble during that first year of COVID to function well. “I looked at the effects of parents working remotely and the challenges of doing school remotely,” she says. “One of the organizations offered Zoom-based tutoring for kids. Many of the kids that are served by immigrant organizations live in communities with little or shaky access to Wi-Fi. So, the organizations were setting up mobile hotspots for the kids to access Wi-Fi—something that obviously the organizations weren’t trained to do.”

Dávila’s paper focused on how the organizations bridged the gaps between language and communication barriers when COVID first struck and everyone was isolated. Low-income migrant, immigrant, and refugee communities have faced disproportionate social and epidemiological impacts related to the pandemic, including loss of jobs or under-employment, food insecurity, and challenges associated with the abrupt transition to remote learning, Dávila notes in her paper.

“The immigrant-serving organizations that I worked with did a lot of work to make information available to their constituents, to translate materials and help people with immigration, legal documentation, and other issues, but then they had these additional layers of emergency relief, such as when someone can’t pay their rent because they were laid off because they can’t go to work,” she says.

Showcasing the Work of Immigrant-Serving Organizations

Dávila’s research shines a light where it is rarely shone. “Organizations like this are often unnoticed by the general population,” she says. “There’s a general awareness that they exist but not enough knowledge of what they really do day to day. It’s important to showcase how vital these organizations are, particularly in the US where we don’t have a solid social welfare system in place, especially for communities that are undocumented or are in other ways marginalized.”

Her study, she says, shows the complexity of school districts providing translation services for immigrant families and students.

“I think my findings build a general awareness of the challenges involved and hopefully can lead to some systematic changes, like making sure that translation services are available and well-funded by the state and integrated into the schools,” Dávila says. “The importance of immigrant-serving organizations in communicating, coordinating, and cooperating with schools is a prime takeaway.”

Communication Training in Medical School

Another project that stems from her work with immigrant and refugee communities has Dávila delving into the training that medical students undertake in communicating with patients—particularly those for whom English is not their first language. She has been affiliated with the Carle Illinois College of Medicine for the past two years.

“The nature of my research is to take a bottom-up approach to understand the context,” Dávila says. “So, I’ve sat in on several classes to see how students are being instructed in communication and working through language barriers.”

Dávila has interviewed many students and plans to interview more on how they are being prepared to communicate with patients. “I’ve also had some conversations with various faculty at the medical school about the curriculum,” she notes.

How medical students are trained to communicate with immigrants and refugees is critical, she says.

“If you’re working in a hospital, you’re going to be working with patients with a variety of linguistic, racial, and social class backgrounds,” Dávila explains. “What we know from research is that the populations that suffer the most from various medical challenges, that have the worst health outcomes, are those whose first language is not English. They are non-white, lower-income populations who may or may not have access to insurance. So that ability and understanding of how to communicate with them is vital.”

And it’s not just words that communicate, she adds.

“It’s body language as well,” she says. “You can operate very tacitly to alienate or exclude someone—or to invite them in. That also goes for medical professionals having conversations with each other.”

Need for Greater Integration

Dávila says there is some communication training in Illinois’ medical school. “A first-year foundations class has sessions on communicating with patients, on doing an intake, asking questions, communicating difficult news, that sort of thing,” she says. “The students practice on actor-patients, and they problem-solve in groups about how to communicate with a certain person. And that’s good—but what I’ve heard from students is they wish it were more integrated or a little more central to their curriculum, because what they learn in their first year often can play out very differently when it’s year three and they’re out in the field and confronted with these situations.”

To help meet that need, Dávila says, third- and fourth-year students have created a workshop for first-year students on various communication issues.

“Like how to use a translator, for example,” she says. “Using a translator or interpreter is very difficult from what I understand.”

Communicating with an ESL (English as a Second Language) population is included in the curriculum, but it’s not given a lot of time.

“I’m still focusing on this question of how medical students are trained in language and communication in a way that’s linguistically and culturally sensitive,” Dávila says.

Continuing Her Research

She is considering scaling her research, reaching out to colleagues across the country to expand to more quantitative research. “I could see doing a longitudinal study, following a medical student from year one to year four of their training,” she says. “I could also see expanding to the patient side, reinforcing or promoting health literacy among patients so that a visit to the doctor is more dialogical rather than the doctor just telling them what to do.”

In the best of all worlds, Dávila notes, medical education curricula would thoroughly and seamlessly integrate communication and language awareness and language equity throughout all four years.

“That’s the hoped-for outcome of this kind of research,” she says.