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Prenatal Screening for Down's Syndrome 


The Prenatal Screening for Down's Syndrome project explored English as a lingua franca between healthcare professionals and clients in prenatal genetic counseling in Hong Kong. A language that is ‘lingua franca’ is a bridge language used when two people or groups of people do not have the same native language. In this case, English was used between Hong Kong medical professionals, whose first language is Cantonese, and non-Cantonese speaking patients. The research team collected authentic interactions between non-native English speaking healthcare providers (doctors and nurses) and female clients of diverse backgrounds who used English as their native or non-native language. The team investigated how participants engaged in three critical activities of prenatal counseling: information delivery, advice giving, and decision making. 


  • To examine how English was used as lingua franca in prenatal genetic counseling in Hong Kong. 

  • To investigate the wide range of discourse strategies used to facilitate communication within the analyzed context. 

  • To investigate the specific interactional means by which participants direct prenatal counseling encounters using English as lingua franca. 

  • To determine which contextual factors have an impact on how prenatal genetic counseling encounters unfold. 

  • To present the findings to medical professionals of Hong Kong to disseminate new information and knowledge for professional development. 



  • The research team found three critical activities being performed in prenatal counseling: information delivery, advice giving, and decision making. In addition to the language factor (i.e. English as lingua franca), a complex set of contextual factors had an impact on how these interactions unfolded: cultural factors, socioeconomic factors, and institutional factors appeared to be particularly prominent. The team also investigated a wide range of discourse strategies that facilitated communication in these counseling encounters. Both verbal (e.g. initial inquiries, perspective display series, hypothetical scenarios) and nonverbal (e.g. laughter) strategies were observed as means of communication. Participants also used specific methods of structuring discourse to achieve the main objective of prenatal counseling: for the female patient to arrive at an informed decision of whether to pursue prenatal screening and testing. 

  • The research team also found other themes and trends within the collected data. For example, it was found that within the observed context, Hong Kong health providers tended to be more directive than in comparable settings in other countries (as reported in relevant literature), and that women and their family members had a higher expectation to be directed by healthcare providers in the decision-making process. The results of these observation was reported in a series of papers, in which the team reported the specific interactions means by which participants expressed their agendas and concerns (see, Zayts et al. 2012, Pilnick and Zayts 2012, Zayts and Schnurr 2012 in professional resources). 

  • The results of this study were also summarized and presented to professionals in Hong Kong in July 2010. The workshop was attended by healthcare professionals from the main hospitals in Hong Kong, as well as professionals working in the private sector. Three international speakers also shared their experience of working in and researching  in prenatal genetic  in the UK (Angus Clarke, Allison Pilnik, Srikant Sarangi). The workshop was enthusiastically received and led to further collaborative activities (e.g. research seminars, workshops, pilot studies, funded projects). 

  • One of the main outcomes of the project was that the research team established solid collaborative ties with several hospitals, the Clinical Genetic Counseling Services, and private practitioners, as well as a mutual acknowledgement of the importance of collaborative work between medical professionals and linguists. The project has drawn attention to the importance of this genre of work, to the substantial impact that such research can have on professional practice, and to the unique multi-cultural and multi-lingual context of Hong Kong. 

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