Swedish interpreters' views and experiences of interpreting child forensic interviews

BACKGROUND

Child forensic interviewers have expressed concerns regarding the quality of interpreter-mediated child forensic interviews. However, research on interpreters' perspectives on these interviews is scarce and specialized education for interpreters limited.

OBJECTIVE

This mixed-methods study aimed to explore interpreters' experiences and knowledge of interpreting child forensic interviews.

PARTICIPANTS AND SETTING

A total of 130 Swedish interpreters with different authorization statuses responded to a digital survey about interpreting child forensic interviews.

METHODS

Qualitative data were analyzed with reflexive thematic analysis and content analysis, and quantitative data with descriptive and inferential statistics.

RESULTS

Interpreters reported challenges concerning children's limited language skills, the emotional effects of interpreting child forensic interviews, the limited access to information before interviews, and the complex balance between following interpreters' ethical guidelines and adjusting for situational demands. Regarding practical conditions, interpreters preferred interpreting in person instead of via telephone. Interpreters' general knowledge of child forensic interviewing did not differ between interpreters with different authorization statuses (F(2,108) = 0.80, ω2 = -0.002, p = .45), except from views on using leading questions (H(2) = 17.34, η2 = 0.14, p < .001) and whether interpreters may clarify terms to child interviewees (H(2) = 8.02, η2 = 0.06, p = .02).

CONCLUSIONS

It is crucial to consider interpreters' perspectives when striving to improve the quality of interpreter-mediated child forensic interviews. Interpreters should be provided sufficient information to prepare and assess their suitability. Interpreters should also be offered education in interpreting child forensic interviews and given appropriate service structures to support their wellbeing.

Access to appropriate interpretation is essential for the health of children

With 20% of Canadians reporting a mother tongue other than English or French, it is not uncommon for health professionals and patients to be proficient in different languages. When a physician and patient cannot properly communicate, there is potential for misunderstanding, which can lead to poor clinical outcomes and hospital readmission. Professional interpretation services are associated with improved communication, health care use, clinical outcomes, and satisfaction with care. Using untrained or ad hoc interpreters-including family members-has been shown to increase errors of omission, substitution, editorialization, and addition. Children and youth are not sufficiently developmentally mature to act as interpreters in health care. Using children and youth as interpreters in health care settings places them in an inappropriate and potentially difficult situation that may have lasting negative effects on both their own mental health and their relationships with other family members.

Providing Equitable Care for Patients With Non-English Language Preference in Telemedicine: Training on Working With Interpreters in Telehealth

Introduction

The COVID-19 pandemic has led to a large increase in telemedicine encounters. Despite this rise in virtual visits, patients who speak non-English languages have experienced challenges accessing telemedicine. To improve health equity, medical education on telehealth delivery should include instruction on working with interpreters in telehealth.

Methods

We developed a 25-minute self-directed module with collective expertise of faculty with experience in medical education, interpreter training, and communication training. The module was delivered online as part of a longitudinal health equity curriculum for third-year medical students. In addition to didactic information, the module contained video examples of interpreter interactions in telehealth.

Results

Sixty-four third-year medical students participated in the study, and 60 completed a postmodule survey. Students were satisfied with the content of the module, as well as the duration of time required to complete the tasks. Approximately 90% would recommend it to future students. Nearly 80% of students rated the module as being quite effective or extremely effective at increasing their comfort level with visits with patients with non-English language preference.

Discussion

Our module provides a basic framework for medical students on how to successfully work with interpreters during a language-discordant virtual visit. This format of asynchronous learning could also be easily expanded to resident physicians and faculty seeking more resources around working with interpreters in telemedicine.

Communication in the neonatal ICU for Spanish speaking parents: a qualitative interview study

BACKGROUND

In the neonatal intensive care unit (NICU), health outcome disparities exist between patients with limited English proficiency (LEP) and those proficient in English. Our objective was to investigate the communication experience of parents with LEP in the NICU to learn how to mitigate such health disparities.

METHODS

A certified bilingual provider conducted seventeen interviews of parents who identified Spanish as their preferred language and whose newborn was admitted to the NICU for ≥ 1 week. Interviews were conducted August 2020 - December 2021. Conventional content analysis utilizing an inductive open coding process was performed.

RESULTS

The experiences of Spanish speaking parents with LEP in the NICU can be characterized by 3 main themes: 1) Information accessibility 2) Perspectives about interpreters and 3) Emotional consequences.

CONCLUSIONS

Our findings can inform neonatal quality initiatives to facilitate timely and good communication for NICU families with LEP.

Association between no-show rates and interpreter use in a pediatric otolaryngology clinic

OBJECTIVES

To understand how primary language and interpreter use affect no-show rates in pediatric otolaryngology.

METHODS

This is a retrospective cohort study using medical records of new patients in a pediatric otolaryngology clinic from 2014 to 2019. Data was collected on patient demographics including age, primary language, insurance type, maternal education level, maternal primary language, interpreter use at the first visit, total number of appointments scheduled, number of missed appointments, and number of completed appointments. Inferential statistics using parametric (ANOVA) and non-parametric (Mann-Whitney U tests, Kruskal-Wallis tests, and Spearman correlation coefficient) methods were used.

RESULTS

Primary language was associated with significant differences in no-show rates (p = 0.0474), with Spanish and English speakers having the lowest no-show rate (33%). Overall, interpreter use at the first visit was not significantly associated with subsequent appointment attendance (p = 0.3674). Patients with a documented Spanish interpreter at the first visit had the lowest average no-show rate (31% ± 19%) compared to Haitian Creole (42% ± 18%) and all other languages (32% ± 19%) (p = 0.0265). Hispanic ethnicity, maternal education level, and maternal primary language were not associated with attendance.

CONCLUSION

Interpreter use at the first visit was not significantly correlated with no-show rates, but among patients that did require an interpreter at the first visit, those receiving services in Spanish had the best clinic attendance.

Development and evaluation of a training program for interpreters in the field of trauma-focused cognitive behavioral therapy

Background

The treatment of traumatized refugee minors is often challenging because of language barriers. International guidelines, therefore, recommend the use of language mediators. However, there is a scarcity of evaluated training programs that prepare language mediators to translate during psychotherapy developed specifically for this patient group, for instance trauma-focused cognitive behavioral therapy (TF-CBT).

Methods

Based on an extensive literature review and in collaboration with an expert focus group, a one-day TF-CBT-specific online training program was developed for language mediators willing to work with minor refugees, and delivered on nine occasions between November 2020 and June 2021. The participants answered pre- and post-training questions about trauma- and TF-CBT-related knowledge and attitudes relevant to therapy, as well as the perceived usefulness of the training. Bayesian estimation was used to determine pre-post changes.

Results

A total of 129 participants speaking 35 different languages participated in the training program. Analyses revealed 95% highest density intervals not containing the null with respect to knowledge gain (effect size median 0.28) and change in treatment-appropriate attitudes (effect size median 0.31). The participants rated the training as useful.

Conclusion

The TF-CBT-specific training course was successfully carried out. It was likely to disseminate both knowledge gains and a shift toward more treatment-appropriate attitudes. It was perceived as useful by the participants. Given the scarcity of evaluated training programs for language mediators working with minor refugees, the results are promising. The limitations include the lack of both a control group and the verification of the results using an external outcome measure.

Language barriers and kidney transplantation in children

BACKGROUND

Understanding disparities in pediatric kidney transplants is important to provide equitable care. We compared transplant outcomes between English-speaking (ES) and interpreter-needing (IN) pediatric kidney transplant recipients.

METHODS

Through retrospective review, primary kidney transplant recipients, 0-21 years transplanted between 2005 and 2019, were divided into ES and IN cohorts. Continuous and categorical variables were compared using Wilcoxon rank-sum, Welch two-sample t-test, and chi-squared analyses. Patient survival, graft survival, and rejection-free survival were evaluated using Kaplan-Meier methods and Cox regression. Days hospitalized were evaluated using negative binomial regression.

RESULTS

Our sample included 211 ES and 37 IN transplant recipients. Compared with the ES, the IN cohort was older at transplant (14.56 vs. 11.03 years; p < 0.01), had more time between kidney failure and transplant (0.9 vs. 0.3 years; p < 0.01), and more often received deceased over living donor transplants (78.4% vs. 30.4%; p < 0.01). Multivariate Cox proportional-hazard models evaluating adjusted 5-year patient survival demonstrated decreased 5-year post-transplant survival in the IN cohort (aHR = 10.10, 95% CI: 1.5, 66.8; p = 0.02). We did not identify differences in 5-year death-censored graft survival (aHR = 0.57; 95% CI: 0.14, 2.4; p = 0.4) nor rejection-free survival (aHR = 0.8; 95% CI: 0.4, 1.5; p = 0.5). We found significantly fewer hospitalization events in the IN cohort during the first year post-transplant (aRR: 0.62; 95% CI: 0.4, 0.9; p = 0.01) but no difference 5-year post-transplant. The IN cohort had more missed outpatient appointments (10.4% vs. 2.8%; p = 0.03) and undetectable serum immunosuppressant levels (mean: 3.8% vs. 1.3%; p = 0.02) 5 years post-transplant.

CONCLUSIONS

Pediatric kidney transplant recipients requiring interpreter services for healthcare delivery demonstrate fewer post-transplant interactions with their healthcare team (fewer hospitalizations and more no-show visits) and lower 5-year patient survival compared with recipients not requiring interpreters. A higher resolution version of the Graphical abstract is available as Supplementary information.

Language Accommodations for Limited English Proficient Patients in Rural Health Care

Over 25 million individuals living in America are limited English proficient, many of whom live in rural communities. Adequate language accommodations are critical to providing effective healthcare for these populations. An online questionnaire was delivered to 42 rural facilities in Washington State. It included questions about their demand for language services, modalities of interpretation, translated documentation and barriers to providing accommodations. Fifteen of 42 (35.7%) responded. Spanish, Russian, Vietnamese, Japanese, Ukrainian and Mam were encountered daily. Telephonic and virtual remote interpreter services were the most widely available. Not all facilities had vital documents translated to frequently encountered languages. Challenges to providing language access were reported by nearly all participants. The rural facilities surveyed all encountered LEP patient populations and offered oral interpretation. Overall, these facilities were meeting requirements for providing language accommodation services. Even so, many facilities reported experiencing barriers to providing these services.

A comparison of interpreters' wellbeing and work-related characteristics in the care of refugees across different work settings

Background

Interpreters in the care of refugees work in various different settings. Qualitative studies suggest that interpreters are confronted with a variety of demands depending on the context in which they work, which may in turn influence their wellbeing. To date, no larger-scale study has investigated differences between work settings regarding interpreters’ work-related characteristics or wellbeing.

Objective

The aim of this study was to compare the work-related characteristics and possible changes in the wellbeing of interpreters between four main work settings (psychotherapy, counselling, medical setting, and authorities) in the care of refugees.

Method

Interpreters in refugee care were recruited for a nationwide online survey in Germany with two measurement time points. Participants provided socio-demographic data and answered questions about the working conditions in their respective main work setting. In addition, psychological distress (Brief Symptom Inventory, BSI-18), work-related exhaustion (Copenhagen Burnout Inventory, CBI), and compassion satisfaction (Professional Quality of Life, ProQOL) were assessed.

Results

Overall, 158 interpreters were included at t1, of whom 63 were also included at t2. Significantly more traumatic content was interpreted in counselling settings and psychotherapy than in medical and authorities settings (H (3) = 26.09, p < .001). The highest proportion of interpreters with an interpreting degree worked in the authorities setting (Fisher’s exact test, p = .002). Significant differences between the four settings were found for psychological distress (Kruskal–Wallis-test, H (3) = 12.02, p = .01) and work-related exhaustion (Kruskal–Wallis-test, H (3) = 8.10, p = .04) but not for compassion satisfaction.

Conclusion

The presented results indicate differences regarding working conditions, psychological distress, and work-related exhaustion between different work settings of interpreters. Future studies may explore each setting in greater detail and include a larger sample size to reach a better understanding of the relationship between setting-specific challenges and interpreters’ wellbeing.

"It doesn't work at all, that's my experience": Swedish forensic interviewers' views on interpreter-mediated child interviews

BACKGROUND

Legal practitioners have expressed concerns regarding the quality of interpreter-mediated forensic interviews with child witnesses.

OBJECTIVE

This mixed-methods study aimed to examine Swedish forensic interviewers' experiences of conducting child interviews via a language interpreter.

PARTICIPANTS AND SETTING

Forty-one forensic interviewers from the Swedish Police Authority with experience conducting interpreter-mediated child interviews participated in a digital survey.

METHODS

Their responses were analyzed using both qualitative (thematic and content analyses) and quantitative (descriptive and inferential statistics) approaches.

RESULTS

The forensic interviewers' general experiences of conducting interpreter-mediated child interviews were negative. Limited access to authorized legal interpreters and doubts regarding the accuracy of interpretation were described as major obstacles in these investigations. The presence of an interpreter could negatively impact children's disclosure process and limit their chances of expressing their views during legal proceedings.

CONCLUSIONS

According to Swedish forensic interviewers, the quality of interpreter-mediated child interviews urgently needs to be addressed. Our results are consistent with previous surveys from Australia and the United States, highlighting the international relevance of these topics. Future improvements are vital to ensure that all children are provided an equal right to be heard during criminal investigations, regardless of the native language.

Overcoming the language barrier: a novel curriculum for training medical students as volunteer medical interpreters

BACKGROUND

Over 41 million people in the United States speak Spanish as their primary language, of which 16 million have limited English proficiency (LEP). It is well-established that language barriers contribute to health disparities and that the use of ad-hoc interpretation by untrained family members results in substandard care. We developed a novel interpreter training program for medical students to serve as in-person interpreters at a charitable, resident continuity clinic so as to overcome the language barrier in the delivery of healthcare to LEP patients.

METHODS

The Medical Student Interpreter Training Program (MSITP) consists of three steps. First, fluent Spanish-speaking students shadowed a licensed interpreter. Second, students took a standardized phone exam to demonstrate language proficiency. Finally, students completed a three-hour training on the methodology and ethics of interpreting conducted by the Department of Interpreter Services.

RESULTS

Pre- and post-tests were administered to assess students' familiarity with the Interpreter Code of Ethics and interpreter skills. Familiarity with the Interpreter Code of Ethics increased significantly with all students reporting feeling comfortable (47%) or very comfortable (53%) after training. The pre- and post-tests included free response questions, which were administered to assess competence in the methodology and ethics of interpreting. The cohort's aggregate score increased by 35% after the training (Wilcoxon signed rank z-score = 2.53; p = .01).

CONCLUSIONS

Implementing the MSITP resulted in an increased number of trained, Spanish-speaking interpreters available to provide their services to LEP patients at an affiliated charitable clinic and throughout the university hospital. Unlike other program models which are time and resource-intensive, this program is replicable and easily managed by volunteers. The MSITP is an effective model for training students as medical interpreters to ensure the delivery of quality healthcare for LEP patients.

Reasons for not using interpreters to secure patient-safe communication - A national cross-sectional study in paediatric oncology

OBJECTIVE

To investigate the reasons for not using interpreters to secure patient-safe communication.

METHODS

Healthcare personnel at six paediatric oncology centres in Sweden responded to the Communication over Language Barriers questionnaire. Descriptive and comparative analyses were performed.

RESULTS

The participants (n = 267) often cared for patients with limited Swedish proficiency, although they were not trained in using interpreters. A lack of time was perceived as a barrier in emergency care situations, but also in planned care situations. Another barrier was the interpreter's ability to correctly interpret medical/care terminology. There were significant differences in evaluating the interpreters' abilities between those with/without education in using interpreters, and between Medical Doctors and Nursing Assistants. Participants were unsure whether the patient had received the correct information and thought that it was difficult to control the family/patient's understanding of the given information. The vast majority did not perceive financial constraints as a barrier for using interpreters.

CONCLUSIONS

Economic resources and legislation are not enough to increase the use of interpreters. Reasons for not using interpreters are found in limitations of time, training, and interpreters' skills and knowledge.

PRACTICE IMPLICATIONS

There is a need for a greater focus on training, interpreters' skills, and booking procedures in paediatric healthcare.

The Roles of medical interpreters in intensive care unit communication: A qualitative study

OBJECTIVES

To understand healthcare team perceptions of the role of professional interpreters and interpretation modalities during end of life and critical illness discussions with patients and families who have limited English proficiency in the intensive care unit (ICU).

METHODS

We did a secondary analysis of data from a qualitative study with semi-structured interviews of 16 physicians, 12 nurses, and 12 professional interpreters from 3 ICUs at Mayo Clinic, Rochester.

RESULTS

We identified 3 main role descriptions for professional interpreters: 1) Verbatim interpretation; interpreters use literal interpretation; 2) Health Literacy Guardian; interpreters integrate advocacy into their role; 3) Cultural Brokers; interpreters transmit information incorporating cultural nuances. Clinicians expressed advantages and disadvantages of different interpretation modalities on the professional interpreter's role in the ICU.

CONCLUSION

Our study illuminates different professional interpreters' roles. Furthermore, we describe the perceived relationship between interpretation modalities and the interpreter's roles and influence on communication dynamics in the ICU for patients with LEP.

PRACTICE IMPLICATIONS

Patients benefit from having an interpreter, who can function as a cultural broker or literacy guardian during communication in the ICU setting where care is especially complex, good communication is vital, and decision making is challenging.

Do Standardized Scripts Improve Interpreter Use by Spanish-Speaking Patients?

Patients with limited English-proficiency (LEP) who need but do not receive interpreters have lower satisfaction and poorer understanding. A knowledge gap remains regarding the optimal way to offer interpreters. Using standardized scripts, we will determine whether the questions we use to offer interpreters increase utilization. Pilot prospective cohort study of postpartum mothers with LEP. Subjects were assigned one of three unique scripted question offering an interpreter. Data were analyzed using ANOVA, chi-square test, and Fisher's exact test. Fifty-five LEP patients were randomized into three study arms with similar sociodemographics. Overall interpreter use was 80% (44/55). There was a significant difference in interpreter utilization: 82.4%, 63.6%, 100%, respectively by arm (p = 0.015). Highest interpreter utilization occurred with "In what language do you prefer to receive your medical care?". There is opportunity for providers to refine the way they offer interpreters to optimize utilization.

Lost in Translation: An OSCE-Based Workshop for Helping Learners Navigate a Limited English Proficiency Patient Encounter

INTRODUCTION

Residents have been known to report a lack of self-efficacy in their ability to provide care for limited English proficiency (LEP) patients. Interpreters must be utilized to help navigate these patient encounters, but many institutions do not have a curriculum focused on utilizing interpreters effectively.

METHODS

We created a 3-hour workshop for physician learners working with the pediatric population. It included a panel discussion, best-practices presentation, video demonstration, observing scenarios, and pre- and postworkshop objective structured clinical exams (OSCEs). The first OSCE introduced learners to a scenario (4-day-old with jaundice with an LEP parent) where interpreter use was imperative. The second OSCE allowed learners to perform another case (12-year-old with an abscess with an LEP parent) and practice newly obtained skills from the workshop. Both OSCEs were scored using a 16-item yes/no checklist. All pediatric residents filled out an eight-item survey to evaluate the workshop; a subset of that group performed the pre- and postworkshop OSCEs.

RESULTS

Forty pediatric residents attended the workshop and completed the survey. The workshop was well received, with the majority of residents stating they would change their current interpreter usage practices. Ten pediatric residents performed the pre- and postworkshop OSCEs; all improved their scores.

DISCUSSION

The workshop was effective in improving how residents navigated LEP encounters. It is applicable to learners of all levels who want to improve their communication skills to provide better care for LEP patients and can be tailored to fit the needs of a specific institution.

Strengthening the migrant-friendliness of Thai health services through interpretation and cultural mediation: a system analysis

Background

In addition to healthcare entitlements, ‘migrant-friendly health services’ in Thailand include interpretation and cultural mediation services which aim to reduce language and cultural barriers between health personnel and migrants. Although the Thai Government started implementing these services in 2003, challenges in providing them still remain. This study aims to analyse the health system functions which support the interpretation and cultural mediation services of migrant health worker (MHW) and migrant health volunteer (MHV) programmes in Thailand.

Methods

In-depth interviews were conducted in two migrant-populated provinces using purposive and snowball sampling. A total of fifty key informants were recruited, including MHWs, MHWs, health professionals, non-governmental organisation (NGO) staff and policy stakeholders. Data were triangulated using information from policy documents. The deductive thematic analysis was classified into three main themes of evolving structure of MHW and MHV programmes, roles and responsibilities of MHWs and MHVs, and supporting systems.

Results

The introduction of the MHW and MHV programmes was one of the most prominent steps taken to improve the migrant-friendliness of Thai health services. MHWs mainly served as interpreters in public facilities, while MHVs served as cultural mediators in migrant communities. Operational challenges in providing services included insufficient budgets for employment and training, diverse training curricula, and lack of legal provisions to sustain the MHW and MHV programmes.

Conclusion

Interpretation and cultural mediation services are hugely beneficial in addressing the health needs of migrants. To ensure the sustainability of current service provision, clear policy regulation and standardised training courses should be in place, alongside adequate and sustainable financial support from central government, NGOs, employers and migrant workers themselves. Moreover, regular monitoring and evaluation of the quality of services are recommended. Finally, a lead agency should be mandated to collaborate with stakeholders in planning the overall structure and resource allocation for the programmes.

Vaccination Rates Among Patients Age 65 Years and Older Who Require Interpreter Services in the State of Minnesota

In the United States, the growing population of older adults with limited English language proficiency (LEP) faces profound health care disparities. Previous research on vaccination of older adults has been based on self-reported data, without clinical verification. We compared pneumococcal vaccination rates between a patient group with LEP and a group of English speakers in an older community-dwelling population. A population-nested matched cohort of participants age 65 years and older was identified in Minnesota. Patients with LEP were identified through an electronic alert within the electronic health record, designed to determine the need for an interpreter. Patients were matched 1 to 1 for age, sex, and Charlson comorbidity index. We used conditional logistic regression for the final analysis. In total, 24,052 patients were identified as older patients (mean [SD] age, 74 [7] years). Of them, 617 patients (2.6%) had LEP. The most common primary languages were Somali (24%), Vietnamese (15%), and Spanish (13%). We found lower rates of vaccination with 13-valent pneumococcal conjugate vaccine (PCV13) in the LEP group compared with English speakers [62% vs 77%; odds ratio (OR) (95% CI) 2.07 (1.61-2.66); P < 0.001]. Results were similar for 23-valent pneumococcal polysaccharide vaccine (PPSV23) [60% vs 75%; OR (95% CI) 1.97 91.54-2.51); P < 0.001]. These data are suggestive that older adults who required a language interpreter during health care encounters were less likely to be vaccinated with PCV13 and PPSV23 than older adults who did not require an interpreter. Effectiveness studies are needed to determine which interventions can help improve vaccination rates in the LEP population of elderly patients.

"Can we agree on that"? Plurality, power and language in participatory research

Participatory epidemiology (PE) is a method that gathers data from groups through focus group interviews and participatory visual and scoring exercises. The method is often used in poor communities in low-income countries where it is hard to obtain conventional epidemiological data. This paper draws on research on the public sphere and democratic deliberation, along with research on language and interpretation, to suggest how PE research could be better equipped to account for diversity in local knowledge, include minority views and acknowledge power dynamics. These aspects are discussed under the three themes of 'plurality', 'power' and 'language'. A review of highly-cited PE literature suggests that PE research engages with plurality and power to a very limited extent, and only marginally more so with language and translation. Examples are taken from the authors' own PE research on African swine fever in -Uganda, classical swine fever in Germany, peste des petits ruminants (PPR) in Eastern Europe, and Ugandan pastoralists' understanding of cattle disease to provide more detail as to why conventional PE studies might fail to record issues of plurality, power and language, and also to suggest how this can be addressed. With reference to the literature on the public sphere and democratic deliberation, and on language and interpretation, this paper concludes with some suggestions as to how to take plurality, power and language into greater consideration in PE studies in future, thus improving the validity and reliability of PE data.

Ask and ye shall not receive: Interpreter-related access barriers reported by Deaf users of American sign language

BACKGROUND

Healthcare providers are mandated to provide reasonable accommodations for Deaf users of American Sign Language (ASL) accessing healthcare services, including ASL interpreters. Provision of accommodations improves access and provider/patient communication.

OBJECTIVE

Describe the types, frequency, severity, and trends in healthcare access complications experienced by Deaf patients.

METHODS

A six-year retrospective review of complaints (n = 108) filed regarding interpreter provision in healthcare settings with the Idaho Council for the Deaf and Hard of Hearing by Deaf users of ASL was conducted and summarized. An analysis of demographic and language factors associated with interpreter-related barriers and whether the complaint was resolved was performed using multivariate logistic regression.

RESULTS

Reasons for complaints of interpreter-related barriers to care included: 48.2% were "told an interpreter was not available"; 28.7% received an unqualified interpreter; interpreter was promised but not provided (18.5%). Factors independently associated with having been promised an interpreter were: medical clinics (vs. dental) (OR 3.92 95%CI 1.18-12.98), and complaints filed later in the study period (OR 1.55 per year 95%CI 1.19-2.01). For each additional year during the study period, complaints were 1.6 times (95%CI 1.15-2.22) more likely to have an interpreter promised but not provided. Patients from rural areas were less likely to have their complaints satisfactorily resolved (OR 0.18 95%CI 0.06-0.55).

CONCLUSION

Deaf patients experience various interpreter-related barriers throughout the process of accessing healthcare and communicating with providers/staff, though further regional and nationwide documentation is warranted.

Overcoming language barriers in paramedic care: a study protocol of the interventional trial 'DICTUM rescue' evaluating an app designed to improve communication between paramedics and foreign-language patients

Background

It is essential for medical treatment that patients and medical staff can communicate about acute complaints, pre-existing conditions, and the treatment procedure. Misunderstandings can have far-reaching consequences, particularly in time-critical emergencies, which require rapid assessments and decision-making and in which interpreters are rarely available.

In this study, we aim to develop a digital communication tool that is to help paramedics communicate with patients who speak hardly any or no German, to monitor its implementation, and to investigate its effect on communication between foreign-language patients and staff. Furthermore, a large amount of data on patients that are cared for in emergency medical services in Germany are collected for the first time.

Methods

To consider the complex situations of paramedic care and to meet paramedics’ demands, we use an action-oriented research approach to develop the tool. We include the staff of the participating emergency medical service stations and software designers in our approach. The tool is then used and evaluated within an open interventional, non-randomised study with two control groups. Control group 1 (German-speaking patients) and control group 2 (non-German-speaking patients treated without the tool) are recruited starting from the first study phase. In the second study phase, an intervention group is additionally recruited, i.e. non-German-speaking patients with whom the tool is used.

The primary outcome of the clinical trial is improved communication with non-German-speaking patients in emergencies by means of the communication tool. The secondary outcome is an improved quality and quantity of the collected information. We exploratively observe on-scene times, demands for emergency physicians, and the usage of the intervention. By recording patients’ clinical parameters, we consider the severity of the health restrictions.

Discussion

Our study is an innovative research project in paramedic healthcare comprising the development of a digital communication tool to overcome language barriers in emergency medical services and investigating its usability, acceptance, and effect on communication, in short, its usefulness and value for paramedic care. Additonally, we expect to gain comprehensive information on rescue operations.

Trial registration

German Clinical Trials Register, DRKS00016719, registered 08 February 2019, World Health Organization Trial Registration Data Set, http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00016719

The professional interpreter's effect on empathic communication in medical consultations: A qualitative analysis of interaction

OBJECTIVE

To investigate how empathic communication is expressed in interpreter-mediated consultations (IMCs) and the interpreter's effect on it.

METHODS

We coded 20 authentic video-recorded IMCs by using the Empathic Communication Coding System (ECCS). We compared patient-initiated empathic opportunities (EOs) and doctors' responses as expressed by patients and doctors and as rendered by interpreters.

RESULTS

We identified 44 EOs. In 2 of the 44 EOs there was a close match in the way the EOs were expressed by the patient in the first place and in the way they were rendered by the interpreter. Twenty-four of the 44 EOs that were passed on by the interpreter to the doctor and presented the doctor with an opportunity to respond, came with a shift in meaning and/or intensity. Twenty of the 44 EOs were not passed on by the interpreter to the doctor.

CONCLUSION

In IMCs, EOs are subject to the interpreter's renditions and the doctor's actions during interaction.

PRACTICE IMPLICATIONS

Doctors and interpreters require skills to detect patient cues, assess them correctly, render them completely and in an appropriate manner (interpreters) and display communicative behaviours that take into account the intricacies of interpreter-mediated clinical communication and facilitate each other's communicative goals.

Interpreter proxy versus healthcare interpreter for administration of patient surveys following arthroplasty: a pilot study

Background

Clinical quality registries and other systems that conduct routine post-discharge surveillance of patient outcomes following surgery may have difficulty surveying patients who have limited proficiency in the language of the healthcare provider. Interpreter proxies (family and carers) are often used due to limited access to certified healthcare interpreters (due to cost or availability). The aim of this study was to assess the reliability of engaging interpreter proxies compared with certified healthcare interpreters for the administration of patient-reported health-related surveys for people with limited English proficiency (LEP).

Methods

People with LEP and due for a routine 6-month telephone follow-up post knee or hip arthroplasty were invited to participate. Participants were randomly allocated to having their first interview with an interpreter proxy or a certified healthcare interpreter followed by the second (crossover) interview within 2 weeks (range: 4 to 12 days) after the first interview using the alternative method. Agreement between the two methods was assessed using quadratic weighted Cohen’s kappa, intraclass correlation and concordance correlation co-efficient where appropriate for EQ-5D health domains, total Oxford hip and knee scores, patient satisfaction, operation success, readmission, reoperation, and post-surgical complication responses. The mean of the differences between the same data items collected by each of the two methods was also calculated.

Results

Eighty five participants (96%) completed the study. There was substantial to excellent inter-rater agreement (kappa = 0.69–0.87 and ICCs above 0.74) for all but one measure. The mean differences between family proxy and healthcare interpreter scores for each participant were small, ranging from 0.01 (score range of 1–5) to 0.72 (score range of 0–100).

Conclusion

These results suggest that using interpreter proxies is a reliable alternative to certified healthcare interpreters in conducting patient-reported health surveys, potentially making this process easier and cost effective for researchers and registries.

Barriers to and solutions for addressing insufficient professional interpreter use in primary healthcare

Background

The aim of this nationwide study was to investigate barriers to adequate professional interpreter use and to describe existing initiatives and identify key factors for successful interpreter policies in primary care, using Switzerland as a case study.

Methods

Adult and paediatric primary care providers were invited to participate in an online cross-sectional questionnaire-based study. All accredited regional interpreter agencies were contacted first by email and, in the absence of a reply, by mail and then by phone. Local as well as the national health authorities were asked about existing policies.

Results

599 primary care physicians participated. Among other reasons, physicians identified cumbersome organization (58.7%), absent financial coverage (53.7%) and lack of knowledge on how to arrange interpreter interventions (44%) as main barriers. The odds of organising professional interpreters were 6.6-times higher with full financial coverage. Some agencies confirmed difficulties providing professional interpreters for certain languages at a timely manner. Degrees of coverage of professional interpreter costs (full coverage to none) and organization varied between regions resulting in different levels of unmet needs.

Conclusions

Professional interpreter use can be improved through the following points: increase awareness and knowledge of primary care providers on interpreter use and organization, ensure financial coverage, as well as address organizational aspects. Examples of successful interventions exist.

How do health professionals decide whether an interpreter is needed for families in neonatal and pediatric units?

OBJECTIVE

To examine how health professionals decide whether family members require an interpreter.

METHODS

69 health professionals, doctors, nurses, and allied health, from neonatal and pediatric units participated. Interviews used a verbal protocol analysis, which elicited their thoughts about using interpreters, including how they decided if an interpreter was needed.

RESULTS

Five themes captured the decision-making process health professionals use. Of these, three themes described the goals and beliefs participants brought to their interactions with family members: Ensuring understanding, Addressing socioemotional needs, and Who decides. The theme Assessing understanding was prominent within the interaction, while the final theme was Contextual factors influencing decision making. No differences were found between mono and multilingual participants, and few differences between health professional groups.

CONCLUSION

Health professionals find it difficult to assess whether a family member needs an interpreter and there is no consistency in how they make this decision, with some using heuristics and others a more systematic approach. Health professionals have beliefs about the purpose of an interpreter that potentially limit the voice of family members.

PRACTICE IMPLICATIONS

Health professionals need training to assist them in decisions about whether an interpreter is needed, including a decision tool and knowledge about policies.

Health care professional's communication through an interpreter where language barriers exist in neonatal care: a national study

Background

A number of parents in neonatal care are foreign-born and do not speak the local language, which makes communication between healthcare professionals and parents more difficult. Interpreters can be used when language barriers exist - parent interactions, medical communication and communication about the care of the child. The aim in this study was to examine healthcare professionals’ use of interpreters and awareness of local guidelines for interpreted communication in neonatal care.

Method

A survey was distributed to all 2109 employees at all 38 neonatal units in Sweden, thus to all physicians, registered nurses and nurse assistants in active service. Data were analysed with descriptive statistics and dichotomized so the professionals were compared in groups of two using the Mantel-Haenszel Chi Square test and Fisher’s Non Parametric Permutation test.

Results

The survey was answered by 41% (n = 858) representing all neonatal units. The study showed a difference between the professional groups in awareness of guidelines, availability of interpreters, and individual resources to communicate through an interpreter. Nurse assistants significantly lesser than registered nurses (p < .0001) were aware of guidelines concerning the use of interpreters. In emergency communications nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Physicians used authorized interpreters to a significantly higher extent than registered nurses (p 0.006) and non-authorized interpreters to a significantly lesser extent than registered nurses (p 0.013). In planned communications, nurse assistants used authorized interpreters to a significantly lesser extent than physicians (p < .0001) and registered nurses (p < .0001). Nurse assistants rated their ability to communicate with parents through an interpreter to a significantly lesser extent than physicians (p 0.0058) and registered nurses (p 0.0026). No other significant differences were found.

Conclusion

The results of the study show insufficient awareness of guidelines in all neonatal units in Sweden. Clinical implications might be to provide healthcare professionals with guidelines and training clinical skills in using interpreters and increasing the availability of interpreters by having interpreters employed by the hospital.

Electronic supplementary material

The online version of this article (10.1186/s12913-019-4428-z) contains supplementary material, which is available to authorized users.

The migration-related language barrier and professional interpreter use in primary health care in Switzerland

Background

With increased international migration, language barriers are likely becoming more relevant in primary care. The aim of this study was to investigate the language barrier in paediatric and adult primary care, present its consequences, reveal how it is overcome, as well as highlight the use of and potential unmet needs for professional interpreters, using Switzerland as a case study.

Methods

Primary healthcare providers were invited nation-wide to participate in an online questionnaire on language barriers faced and interpreter use.

Results

More than 90% of the 599 participants in this nation-wide cross-sectional study face relevant language barriers at least once a year, 30.0% even once a week. Using family members and friends for translations is reported as the most frequent resort for overcoming the language barrier (60.1% report it for more than 50% of encounters), followed by “using gestures” (32.0%) or just accepting the insufficient communication (22.9%). Minors interpret frequently (frequent use: 23.3%). Two thirds of physicians facing language barriers never have access to a professional interpreter, the majority (87.8%) though would appreciate their presence and approximately one quarter of these even see a cost-saving potential. Multiple consequences affecting quality of care in the absence of professional interpreters are identified.

Conclusion

Language barriers are relevant in primary care. Improved access to professional interpreters is warranted.

A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries - the 3C model

BACKGROUND

Migrants and refugees have important health needs and face inequalities in their health status. Health care delivery to this patient group has become a challenging public health focus in high income countries. This paper summarizes current knowledge on health care delivery to migrants and refugees in high-income countries from multiple perspectives.

METHODS

We performed a systematic literature review including primary source qualitative and quantitative studies between 2000 and 2017. Articles were excluded if the study setting was in low- or middle-income countries or focused on skilled migration. Quality assessment was done for qualitative and quantitative studies separately. Predefined variables were extracted in a standardized form. Authors were approached to provide missing information.

RESULTS

Of 185 identified articles, 35 were included in the final analysis. We identified three main topics of challenges in health care delivery: communication, continuity of care and confidence. All but one study included at least one of the three main topics and in 21/35 (60%) all three topics were mentioned. We further developed the 3C model and elaborated the interrelatedness of the three topics. Additional topics identified showed that the specific regional context with legal, financial, geographical and cultural aspects is important and further influences the 3C model.

CONCLUSIONS

The 3C model gives a simple and comprehensive, patient-centered summary of key challenges in health care delivery for refugees and migrants. This concept is relevant to support clinicians in their day to day practice and in guiding stakeholders in priority setting for refugee and migrant health policies.

Interpreter assemblages: Caring for immigrant and refugee patients in US hospitals

US hospitals have developed a variety of strategies to meet federal requirements and provide culturally and linguistically appropriate health care for people who report limited English proficiency. A key strategy is the use of healthcare interpreters who may be physically present in the room or in the room via telephone or video conference. This paper analyzes the contingent and unstable combinations of heterogeneous human and nonhuman elements that form and disperse during visits to the hospital when healthcare interpreters are used. It draws its analysis from 9 months of fieldwork in 2012 that included following 69 adult immigrant and refugee patients in one hospital in Maine and observing encounters with interpreters and clinic staff. It introduces the concept of interpreter assemblage to make sense of the transnational mixes of people, technologies, and ideas that bring multilingual hospital care to life and give it a character of its own.

Healthcare professional and interpreter perspectives on working with and caring for non-English speaking families in a tertiary paediatric healthcare setting

OBJECTIVE

To understand the perspectives of healthcare professionals and interpreters in relation to working with and caring for non-English speaking families accessing National Health Service paediatric tertiary health care services.

DESIGN

Focus group and interview methods were used to elicit the views of healthcare professionals and interpreters at one tertiary paediatric hospital in the United Kingdom. Data were subjected to framework analysis.

RESULTS

Participants identified a number of factors affecting communication and their interaction with non-English speaking families in this setting, including time, role uncertainty, and interlinked dimensions of culture and gender. They also described how the nature of this communication could impact on both the delivery of care and the patient and family experience. These findings highlight gaps in services, training, and support for families, staff and interpreters. These need to be recognised and addressed by those in practice to improve care delivery and help tackle health inequalities.

CONCLUSION

Our data show how significant the impact of language barriers can be, and the need to consider not only how communication can be improved, but also how this is situated in the specific context of tertiary paediatric care as well as a wider social context of inequity.

Development and evaluation of the Communication over Language Barriers questionnaire (CoLB-q) in paediatric healthcare

OBJECTIVE

To develop a valid and reliable questionnaire addressing the experiences of healthcare personnel of communicating over language barriers and using interpreters in paediatric healthcare.

METHODS

A multiple- methods approach to develop and evaluate the questionnaire, including focus groups, cognitive interviews, a pilot test and test-retest. The methods were chosen in accordance with questionnaire development methodology to ensure validity and reliability.

RESULTS

The development procedure showed that the issues identified were highly relevant to paediatric healthcare personnel and resulted in a valid and reliable Communication over Language Barriers questionnaire (CoLB-q) with 27 questions.

CONCLUSION

The CoLB-q is perceived as relevant, important and easy to respond to by respondents and has satisfactory validity and reliability.

PRACTICE IMPLICATIONS

The CoLB-q can be used to map how healthcare personnel overcome language barriers through communication tools and to identify problems encountered in paediatric healthcare. Furthermore, the transparently described process could be used as a guide for developing similar questionnaires.

A comparison of cancer risk assessment and testing outcomes in patients from underserved vs. tertiary care settings

In cancer genetics, technological advances (next generation sequencing) and the expansion of genetic test options have resulted in lowered costs and increased access to genetic testing. Despite this, the majority of patients utilizing cancer genetics services lack diversity of gender, ethnicity, and socioeconomic status. Through retrospective chart review, we compared outcomes of cancer genetics consultations at a tertiary cancer center and a Federally Qualified Health Center (FQHC) (58 tertiary and 23 FQHC patients) from 2013 to 2015. The two groups differed in race, ethnicity, use of translator services, and type of insurance coverage. There were also significant differences in completeness of family history information, with more missing information about relatives in the FQHC group. In spite of these differences, genetic testing rates among those offered testing were comparable across the two groups with 74% of tertiary patients and 60% of FQHC patients completing testing. Implementation of community-based cancer genetics outreach clinics represents an opportunity to improve access to genetic counseling services, but more research is needed to develop effective counseling models for diverse patient populations.

Using interpreters in medical consultations: What is said and what is translated-A descriptive analysis using RIAS

OBJECTIVE

To analyse the concordance of original utterances by healthcare providers (HCP) and patients with the corresponding translations by interpreters using the Roter Interaction Analysis System (RIAS).

METHODS

Video recordings of interpreted consultations were transcribed. Transcription was performed by professional interpreters, who first transcribed consultations in both languages, then provided a translation of what was said in the foreign language. Based on the translations, the videos were coded and analysed using RIAS.

RESULTS

Overall, 19 consultations with a total recording time of 865min were analysed. The main finding is the large difference in the number of utterances in the original language compared to the number of utterances in the target language: about one third of the HCPs' and the patients' utterances were not translated. In no instance were omissions explained to HCP or patient.

CONCLUSION

Interpreters in this sample did not always translate what had been said precisely; they omitted utterances by both HCPs and patients.

PRACTICE IMPLICATIONS

All participants of an interpreted consultation must be made aware of potential omissions in the process of translation. Further understanding of the causes and consequences of omissions is needed.

Using the model statement to elicit information and cues to deceit in interpreter-based interviews

We examined how the presence of an interpreter during an interview affects eliciting information and cues to deceit, while using a method that encourages interviewees to provide more detail (model statement, MS). A total of 199 Hispanic, Korean and Russian participants were interviewed either in their own native language without an interpreter, or through an interpreter. Interviewees either lied or told the truth about a trip they made during the last twelve months. Half of the participants listened to a MS at the beginning of the interview. The dependent variables were 'detail', 'complications', 'common knowledge details', 'self-handicapping strategies' and 'ratio of complications'. In the MS-absent condition, the interviews resulted in less detail when an interpreter was present than when an interpreter was absent. In the MS-present condition, the interviews resulted in a similar amount of detail in the interpreter present and absent conditions. Truthful statements included more complications and fewer common knowledge details and self-handicapping strategies than deceptive statements, and the ratio of complications was higher for truth tellers than liars. The MS strengthened these results, whereas an interpreter had no effect on these results.