6100 Discussion 2

Culturally Competent Social Work Research:

Methodological Considerations for Research with Language Minorities Banghwa Lee Casado, Nalini Junko Negi, and Michin Hong Despite the growing number of language minorities, foreign-bom individuals with limited English proficiency, this population has been largely left out of social work research, often due to methodological challenges involved in conducting research with this population. Whereas the professional standard calls for cultural competence, a discus- sion of how to implement strategies for culturally competent research with language mi- norities is regrettably limited in the social work literature. This article is, to the authors' knowledge, one of the first within the field of social work to tie together unique meth- odological issues that may arise throughout the research conceptualization, developrnent, and itnplementation process with this population. Strategies for how to overcome such issues are provided by adapting and expanding on a conceptual framework by Meléis. The incorporation of such research practices with language minorities has the potential to enhance trust and, thus, improve the recruitment and retention of this hard-to-reach population. More important, studies that aim to include such culturally responsive criteria may produce results that have improved validity and, thus, contribute to the advancement of knowledge regarding this population.

KEY WORDS; culturally competent research; language minorities; limited English proficiency; translation D ue to the growing number of immi- grants, foreign-bom people in the United States are increasing, and a vast majority (84 percent) of these foreign-bom people speak a language other than English (U.S.

Census Bureau, 2008). The Census Bureau's 2008 data indicated that 55.8 million people (or 20 percent of the total U.S. population) spoke a lan- guage other than English, lA^hich marked a 25 percent increase since 2000, and more than one-third of these people did not speak English well. In the United States, individuals who are not fluent in English are referred to as "language minority" individuals (Li, McCardle, Clark, Kinsella, & Berch, 2001).

Understanding the needs of this population is important, because the ability to speak English greatly affects bow well people communicate with and navigate through social institutions.

Well-documented evidence suggests that limited English proficiency often becomes a barrier to access and adherence to necessary treatments and services (Derose & Baker, 2000; FisceUa, Franks, Doescher, & Saver, 2002; Sentell, Shumway, & Snowden, 2007). Programming that does not in- corporate the needs of language minorities can in- advertently contribute to poorer quality of care and, hence, lead to health disparities (Ponce, Hays, & Cunningham, 2006). Research that aims to understand the social and health service needs of this vulnerable population is then vital to the attempt to reduce tbe gap in access to and quality of services.

Unfortunately, research on language minorities is scant, perhaps due to the challenges involved in conducting research in other languages (Frayne, Bums, Hardt, Rosen, & Moskowitz, 1996), and the heterogeneity of this population requires researchers to design studies that are not only lin- guistically, but also culturally appropriate for each specific language group (Li et al., 2001). It is also possible that little publicity and lack of public outcry about this issue may lead to the unintend- ed yet continued exclusion of this population from research studies (Frayne et al., 1996). To address growing concem about the exclusion of language minorities fi-om national studies, a group of representatives firom the National Institute on doi:

10.1093/sw/swr002 O 2012 National Association of Social Workers Aging and the National Institute of Child Health and Human Development conveyed a work group and issued a report.

Diverse Voices (Li et al., 2001). This report urged researchers to overcome barriers that prevent the inclusion of language mi- norities in national studies. The group argued that lack of data on language minorities is problematic because both policymakers and service providers may not have the necessary information to meet the needs of this population.

Social work may he uniquely well positioned to meet this challenge as professional standard calls for cultural competence; however, the literature that specifically discusses language-related issues and culturally competent research methods with language m^inorities is regrettably limited in social work.

In fact, an extensive search of the databases Academic Search Premier, Psychology and Behavioral Science Collection, Social Work Abstracts, and Soclndex with FuU Text using the key words "language minority," "non-English speaking population," "limited English profi- ciency," and "cross-cultural" yielded no literature that explicitly discussed culturaDy responsive social work research methods specific to language mi- norities.

A handful of social work articles have addressed cultural and methodological issues in research with minorities and vulnerable popula- tions (Amador, Travis, McAuley, Bernard, & McCutcheon, 2006; Potocky & Rodgers-Farmer, 1998; Poupart, Baker, & Horse, 2009; Shams & Robinson, 2005), but none of these articles suggested or discussed strategies on how to include language minorities in research investigations.

Given the unique challenges of including language minorities in research, this article extends the literature by bringing together dispar- ate research on language minorities to provide a conceptual framework for research with this population. Specifically, we adapt Meleis's (1996) conceptual framework for culturally competent scholarship to offer practical strategies to systemat- ically include language minorities throughout the research process from problem formulation to dissemination.

The tying together of extant research on language minorities to inform research methods can assist in bridging the gap between the call for knowledge regarding lan- guage minorities' service needs and the paucity of research.

CONCEPTUAL FRAMEWORK:

MELÉIS S CULTURALLY COMPETENT SCHOLARSHIP Meléis (1996) presented eight criteria of culturally competent scholarship:

1.

contextuality, an understanding of the socio- cultural, political, and historical context of where the study participants live; 2.

relevance, research questions that address issues faced by the study population and serve interests in improving their lives; 3.

communication style, an understanding of the preferred cominunication styles of the research participants and their communities and the subtleties and variations inherent in the language used; 4. awareness of identity and power differences, a cognizance of researcher—participant power differences, the establishment of credibility, and the development of more horizontal relationships; 5.

disclosure, the avoidance of secrecy and the building of trust with the study population; 6.

reciprocation, research that meets mutual goals and objectives of the researcher and the study population; 7.

empowerment, a research process that contri- butes to empowering the study population; and 8. time, a flexible approach to time in the research process in terms of quantity and quality of time spent.

These criteria do not suggest independent qual- ities or a hierarchal order of competence; rather, they are interrelated, and all qualities are necessary for culturally competent research (see Figure 1).

To our knowledge, Meleis's framework (1996) is one of the few that has integrated the concept of cultural competence into research methods.

The firamework has been used to evaluate culturally competent knowledge development (Mendias Se Guevara, 2001), culturally specific measurements (Im, Meléis, & Lee, 1999), and the evaluation of the rigor and credibility of research with divene populations Qacobson, Chu, Pascucci, & Gaskins, 2005; MiQ & Ogilvie, 2003; Saltus, 2006). Although Meléis developed these criteria for nursing scholars, we believe them to be valid for culturally competent social work research because they focus on values relevant to Social Work VOLUME 57, NUMBER I JANUARY 1011 Figure 1:

Culturally Competent Research Criteria Culturally Competent Research Awareness of Identity & Power ' ^ ^"v. \ DifTerence Note:

Framework modeled after Meleis's (1996) culturally competent scholarship criteria.

social work practice, such as awareness of pow^er differences and empowerment perspectives.

Although Meleis's (1996) original fiamework provided criteria for culturally competent scholar- ship, it offered no specific strategies to apply such criteria in research methods. We synthesized the literature on language lTiinorities to expand and adapt Meleis's criteria to address specific meth- odological issues that are unique to this popula- tion. Furthermore, specific strategies for overcoming the challenges of including language minorities in research are provided. To this end, this article is organized by the following four methodological areas:

(1) research problem formu- lation, (2) recruitment and retention, (3) measure- ment, and (4) dissemination (see Figure 2).

METHODOLOGICAL CONSIDERATIONS Research Problem Formulation Research with language minorities calls for a con- sideration of the unique challenges faced by this population. Culturally responsive research problem formulation with this population, there- fore, necessitates consideration of contexuality, relevance, reciprocation, and empowerment.

An understanding of context includes knowledge regarding where the target population lives and a consideration of the environmental factors asso- ciated with the problems faced by the study popu- lation. Such understanding would provide the researcher with the requisite knowledge to effect- ively conduct research with this population.

It may also equip the researcher to understand what problems are considered to be most salient, or relevant, by the study population. Investigating a research problem that is identified as an issue or a concern by the population of interest may, in turn, encourage reciprocation, whereby research results are considered to be mutually beneficial to both the researcher and the study population in addressing the problem, and this process will empower the study population.

Culturally competent research criteria compel researchers to develop strategies to identify and CASADO ET AL.

/ Culturally Competent Social Work Research Figure 2: Culturally Competent Research Criteria for Methodological Areas " Redpiocation • Exnpowennextt 1 \„ \ • CommimicaAon style •Tune Dissemination Measurement Research Problem Formulation Recruitment & Retention • Contexuality • Relevance • Recipiocation • Empoweiment \ \ 1 * Awareness of Identity & Power Differences " Disclosure • Hme understand the unique issues faced by a target language population.

To this end, due to the paucity of research with this population, a litera- ture review alone may not be sufficient to develop contextually relevant research questions. One pos- sible strategy includes conducting focus groups with community leaders and providers and enlist- ing a culturally and linguistically specific commit- tee composed of community leaders to consult during the research development process (Han, Kang, Kim, Ryu, & Kim, 2007; Ogilvie, Burgess-Pinto, & Caufield, 2008). Work with these community leaders can assist researchers in understanding the sociopolitical context of the community where the target language minority individuals live. Furthermore, it can help identify research problems that are a concern of and are relevant to the community.

Recruitment and Retention Recruitment and retention of minority research participants has been a major challenge for scien- tific research.

It is even more difficult to recruit and retain language minority individuals, because, as U.S. Census Bureau (2008) data indicate, many of these individuals do not speak English well and live in linguistically isolated households.

Consequently, it requires considerable effort to reach out to language minority individuals and attain their interest, trust, and agreement to par- ticipate in research.

Culturally Competent Research Team.

Foremost, developing a culturally competent research team that can communicate effectively with the community is crucial for the recruitment and retention of language minorities. Such a re- search team usually requires bilingual/bicultural staff who can potentially take on the roles of interpreter and translator.

It should be noted that although the literature routinely refers to bilingual staff as culturally and linguistically competent, being able to speak a language does not necessar- ily translate to cultural competence. Some re- search indicates that accessing language minorities is more difficult when researchers are considered to be "cultural outsiders" (that is, the researchers are from a different cultural background) (Phenice, Griffore, Hakoyama, & Silvey, 2009).

It is often assumed that "insider" researchers are more capable and effective in research with ethnic minorities. In many cases, however, bilingual staff may differ greatly firom the study population because of their varied socioeconomic back- grounds and immigration histories (Tsai et al., 2004).

Therefore, some argue that cultural match- ing of researchers/staff and study participants does Social Work VOLUME 57, NUMBER I JANUARY 2012 not necessarily ensure culturally competent re- search; rather, the most important characteristic in this relationship is the cultural responsiveness of the researchers (Sawyer et al., 1995).

Accordingly, in addition to linguistic compe- tence, each research staff person also needs to possess competence in culturally sensitive commu- nication characterized by Meleis's criteria:

Communicating in a manner that is sincere and respectful (communication style), working as an equal partner (awareness of identify and power dif- ferences), and avoiding secrecy (disclosure) are all important qualities necessary for a culturally re- sponsive research team. Researchers have reported that culturally appropriate and personal communi- cations are particularly effective in recruiting and retaining immigrant study participants (Aroian, Katz, & Kulwicki, 2006; Maxwell, Bastani, Vida, & Warda, 2005; Taylor-Piliae, 2007). Adequate cul- tural sensitivity training for all bilingual staff is then essential, because bilingual research staff often play a pivotal role in communicating with the target community and potential study participants.

Community Relationship Building. Building supportive relationships with the target language minority community is crucial for the successfiil recruitment and retention of study participants.

To this end, it is essential to understand that lan- guage minority communities often build and operate their own social support networks to support members who have hmited ability to communicate with mainstream U.S. society.

These social support networks may include reli- gious organizations, community social service organizations, voluntary organizations, and interest groups. Researchers must then have buy-in from community leaders as they may be especially vital in the recruitment of minority individuals. In fact, this buy-in from community leaders will facilitate the recruitment of study participants. Consistent communication with and exposure to the com- munity has been found to be an effective strategy for building trusting relationships with commu- nity leaders and securing their support (Han et al., 2007; Yancey, Ortega, & Kumanyike, 2005).

Such relationship building requires additional time and effort both before and during research; there- fore, researchers may need to buOd extra time and flexibility into their time table.

Culturally Sensitive Research Settings.

Culturally competent recruitment of study parti- cipants requires that researchers be cognizant of researcher-participant power differences and dis- close their positions. Consideration of these com- petency criteria can allow researchers to create a research environment that is culturally sensitive and appropriate for the target population. Because of their potentially fiagHe immigration status, for example, many language minorities may fear in- volvement in formal activities, such as research.

Language minorities may then be reluctant to sign fomial documents, even when these are translated into their language (Han et al., 2007), out of a fear of compromising their immigration status. For some immigrants, signing a technical form may also remind them of traumatic or difficult experi- ences in their home country (Yick & Berthold, 2005).

This may create a challenge in obtaining signed informed consent. Although the informed consent process should not be compromised, some flexibility in requiring written informed consent may be needed with language minorities.

Researchers may then need to act as "cultural brokers" between the ethnic minority community and the research establishment and may have to educate the institutional review board members regarding culturally responsive protocol that also meets the ethical standards of research (Norris & DeMarco, 2005).

Measurement Measurement issues have always been a central concern when conducting research with ethnic minorities. Consideration of measurement issues is especially important in research with language minorities because of cultural and lin- guistic differences in perceptions and expressions among each language minority group. Careful examination and understanding of such differ- ences within the target population ensures use of valid measurements in research with the population.

Measurement Translation.

Research with lan- guage minorities necessitates the use of measures in the language used by the target language popu- lation. Although it is most preferred to use trans- lated versions of standardized instruments that have been tested and validated through rigorous research, it is often difficult to find such instru- ments in every language. For that reason, transla- tion and subsequent analysis of the psychometric properties of a measure are often necessary in CASADO ET AL.

/ Culturally Competent Social Work Research research with language minorities. Therefore, it is essential that researchers be knowledgeable about the issues involved in the translation of instru- ments (Carlson, 2000).

The translation of measures require more than simple verbatim trans- lation of words in one language to another lan- guage.

It is an intricate process that requires an understanding of the context of the concept being studied. Specifically, an understanding of the cultural meaning of the concept of interest is vital to being able to convey the subtle meaning of the concept in the most accurate manner possible and, therefore, developing linguistic equivalency (van de Vijver & Leung, 1997).

With an increasing demand for linguistically and CulturaUy vaHd instruments, a number of techniques and guidelines have been recom- mended for instrument translation (for example, Chavez & Canino, 2005; U.S. Census Bureau Methodology and Standards Council, 2004; van de Vijver & Leung, 1997; World Health Organization, 2009). The most widely used tech- nique in these guidelines is the model proposed by BrisHn (1970, 1980), which consists of a series of translations and back-translations of the original instrument by bilingual individuals. This tech- nique involves four steps:

(1) forward-translation of the English instrument into the target language by a bilingual individual, (2) back-translation of the translated instrument into English by another bilingual individual, (3) comparative review of the original English and back-translated English ver- sions of the instrument for any inconsistencies, and (4) revision of the translated instrument through collaborative work by the bilingual trans- lators (and possibly additional bilingual indivi- duals).

A recent review of instrument translation methods identified six types of translation approaches:

(1) forward-only, (2) forward-only with testing, (3) back-translation only, (4) back- translation with monolingual testing, (5) back-translation with bilingual testing, and (6) back-translation with both monolingual and bilin- gual testing (Maneesriwongul & Dixon, 2004).

Another commonly used translational method is a committee approach in which a team of bilingual committee members translates the instrument as a group (van de Vijver 6c Leung, 1997).

Researchers usually use these procedures in com- bination, followed by pretesting of the instrument and revisions as needed.

It is likely that the selection of appropriate translation methods depends on the resources that the researcher has because some methods require more resources than do others. Nonetheless, it is essential that translation be conducted by at least two bilingual individuals who understand culturally specific lan- guage use and expressions in both English and the target language.

The foremost concern of instrument translation is ensuring measurement equivalence—that is, the translated version of the measure should w^ork equivalently in the target population as the origin- al measure does and measure the same construct it is designed to measure (Carlson, 2000). Although numerous types of equivalence have been suggested in ensuring the cross-cultural validity of measure- ment, equivalence essentially refers to ensuring the validity of a measure across culture (Chang, Chau, & Holroyd, 1999; Willgerodt, Kataoka-Yahiro, Kim, & Ceda, 2005). Measurement equivalence of the translated instruments should be examined through psychometric analysis before research hy- potheses are tested, because the translation process inherently leads to changes in the psychometric properties of an instrument (Carlson, 2000; Hilton & Skrutkowski, 2002).

Van de Vijver (2003) wamed that absence of measurement equivalence indicates cross-cultural difference in the conceptual- ization of the measure or poor translation and, thus, should not be used to infer cross-cultural differences.

For that reason, evaluation of the translated version of the instrument is a vital step in the development of a cross-culturally valid measure with each specific language population.

Qualitative Data. Culturally responsive data collection and interpretation of qualitative data require that researchers understand the preferred communication style of study participants and have knowledge and skills in contextualizing the meaning of the words and behaviors, and their subtleties and variations, exhibited by study parti- cipants.

The translation and the interpretation of qualitative data collected firom language minorities involve unique methodological issues that require special considerations. Researchers need to deter- mine how data wül be collected and in which language the data wiD be analyzed—in the lan- guage of the study population or in English.

It is essential that researchers collecting qualita- tive data carefijUy consider who collects the data.

Bilingual researchers may be able to collect data Social Work VOLUME 57, NUMBER I JANUARY 2012 on their own, but when researchers do not speak the language of the study population, they have to rely on bilingual interviewers for data collec- tion. In such cases, one of the most important decisions that nonbüingual researchers need to make is whether they want to actively participate in data collection in real time when the bilingual interviewer collects data. One approach is to provide extensive training for buingual inter- viewers, and then the trained bilingual inter- viewers can conduct data collection entirely without the participation of the nonbüingual re- searcher (for example. Quine, 1999; Wong, Yoo, & Stewart, 2005). Whereas this approach may be more time efficient, it limits the researcher's ability to control data collection beyond what was planned and what the bilingual interviewer was trained to do. An alternative approach that allows the nonbüingual researcher's real-time participa- tion is the rapid buingual appraisal model (Whelan, 2004), in which an interpreter interprets the proceedings to the researcher as the buingual interviewer collects data. Adapting this model, Garrett, Dickson, Lis-Young, Whelan, and Roberto-Forero (2004) conducted focus groups with several language groups and reported that this approach allowed the nonbüingual researcher to fuüy engage in data coUection whüe ensuring the natural flow of the focus group interview.

Unlike in the case of instrument translation, no methodologically rigorous standards for analyzing data collected in a language other than English (to be used for English language dissemination) exist (Lopez, Figueroa, Connor, & Maliski, 2008). In their review of the literature, Lopez et al. found that researchers commonly used a method wherein data is collected in the language of the study parti- cipants; this is then translated into English and tran- scribed for analysis. They warned that this method can create "the opportunity for interpreter bias" and proposed that a more accurate analysis can be obtained through adaptation of Brislin's (1970, 1980) process: verbatim transcription of the source language first, translation of the transcript, review of the two transcripts by multiple translators, and corrections if necessary.

Another important consideration is who trans- lates and analyzes the data. Although insider researchers have the ability to potentially translate and analyze data on their own, which is advanta- geous, some warn of the threat of bias in this process and recommend the use of additional lin- guisticaüy and culturaüy competent individuals to minimize bias (Squires, 2008). A recent study further suggested that having only insider researchers analyzing data may result in shortcom- ings.

Specifically, Tsai et al. (2004) found that "outsider" coders tended to raise questions about the meanings of words, whereas insider coders did not. They suggested that insider coders may have been so well acquainted with the behaviors and concepts shared by participants that it prevented them firom identifying relevant and unique cul- tural concepts. Subsequently, Tsai et al. recom- mended the use of both insider and outsider coders in qualitative data analysis with linguistic minorities.

Finaüy, as described earlier, the translation process for instruments and qualitative data con- sists of a series of repeated translation and review steps that is likely to require additional time.

Because time is an important factor in implemen- tation of the research project, researchers need to buüd adequate time for translation into a study's process design.

Dissemination Dissemination of study findings is the goal of any scientific inquiry. Meléis (1996) stressed reciproca- tion and empowerment as essential criteria for culturally competent scholarship. These criteria call for the dissemination of findings for the purpose of advancing mutual goals and empower- ing the community for further improvement of the lives of its people. Dissemination of study findings is particularly important for research with ethnic minorities (Yick & Berthold, 2005). Lack of data on language minorities has resulted in such minorities' relative invisibüity in both research and poUcy, which leads to the exclusion of this population's needs and problems in the develop- ment of policy, programs, and treatments (Li et al., 2001). Culturally responsive research demands that researchers bear the responsibiHty of disseminating study findings to address this gap in the knowledge base. In addition to scientific pub- lication, it is important that study findings be dis- seminated to stakeholders at all levels. Researchers could use various dissemination strategies, such as press releases, summary reports, research brief bro- chures, policy briefs, study newsletters, commu- nity agency publications and Web sites, and local CASADO ET AL.

/ Culturally Competent Social Work Research events and meetings (Community Alliance for Research and Engagement, 2009).

Dissemination of research findings to the com- munity is crucial to the process of facilitating the use of evidence to ameliorate the consequences of social problems faced by the community (Papadopoulos & Lees, 2002). Researchers have long been criticized for their lack of long-term in- vestment in the communities where they conduct their research (Gü & Bob, 1999; Pinto, McKay, & Escobar, 2008). Lack of foUow-through in sharing of study results and long-term commitment from researchers can often result in distrust among community members, especially those who are socially isolated from mainstream establishments, such as language minorities. Consequently, lan- guage minorities may become cautious about par- ticipating in future studies or collaborating with researchers. Hence, it is imperative that researchers return to the community on completion of the study and disseminate key findings. The realiza- tion of such reciprocal opportunities allows for future research and collaborative opportunities to work toward the improvement of the community.

CONCLUSION UnderutOization of social and health care services among ethnic and racial minority populations compels the development of culturally responsive programming (CaldweU et al., 2008). Although limited English proficiency is known to be a barrier to the effective delivery of services (Funnan et al., 2009), scant literature has focused on advancing the social work knowledge and skills needed for work with language minorities.

Moreover, perhaps due to a presumption of social worker competence in dealing with language minorities, little discussion has appeared on the unique methodological challenges of and research strategies for working with language minorities, further hindering research in this area. The gap in the knowledge base regarding the distinct and diverse needs of language minorities has signifi- cant repercussions for our ability to conduct research with them. Perhaps this gap is partially attributable to the myriad challenges involved in including language minority participants in research studies. Regardless, research with these groups is essential for the development of cultur- ally responsive health and social programming.

Social work researchen may be at an advantage to conduct research with language minorities because of the profession's traditional relationship with the community and prominent role in the human services sector. Furthermore, the profes- sion's explicit focus on social justice charges social work researchers with the responsibility to con- tribute to the knowledge base on vulnerable populations.

To this end, this is one of the first studies to offer a culturally responsive conceptual framework for research with language minorities.

By expanding and adapting Meleis's (1996) cri- teria for culturally competent scholarship to include language minorities, this article offers practical strategies to effectively work with lan- guage minority communities throughout the research process. Specifically, this article's adapta- tion of Meleis's conceptual framework allows researchers to logically and systematically examine methodological issues in research with language minorities. The incorporation of such culturally responsive research practices with language minorities has the potential to enhance trust and, thus, improve the recruitment and retention of language minorities.

In addition, the inclusion of culturally responsive criteria throughout the research process may generate results with improved validity (Jacobson et al., 2005) and, thus, further the knowledge base regarding lan- guage minorities. More important, the advancement of research with language minorities is an important step toward the improvement of health and social services access and quality of care among this group. B!¡3 REFERENCES Amador, T. K., Travis, S., McAuley, W., Bernard, M., & McCutcheon, M. (2006). Recniitment and retention of ethnically diverse long-tenn family caregivers for Tesearch. Journal of Gerontological Social Work, 47, 139-152.

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Banghwa Lee Casado, PhD, and Nalini Junko Negi, PhD, are assistant professors, and Michin Hong, MSW, PhD, is an adjunct faculty member, School of Social Work, University of Maryland, Baltimore. An earlier version of this article was presented at the 2009 annual program meeting of the Council on Social Work Education, November 7, 2009, San Antonio, TX. Address correspondence to Banghwa Lee Casado, School of Social Work, university of Maryland, 525 West Redwood Street, Baltimore, MD 21201; e-mail:

bcasado@ssw.

uniaryland.

edu.

Original manuscript received November 17, 2009 Final revision received July 8, 2010 Accepted July 12, 2010 Advance Access Publication May 31, 2012 NASW PRESS POLICY ON ETHICAL BEHAVIOR T he NASW Press expects authors to ad- here to ethical standards for scholarship as articulated in the NASW Code of Ethics and Writing for the NASW Press:

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