Michelle C. FaraboughQualitative Research MethodsFall 2011

More than language:Providers indicate dynamics to consider in aninterpreter-mediated, bilingual medical encounter

Growing need for interpreter-mediated health communication

• Over 20% of all Americans over age 5 speak a language other than English at home• Previous literature and investigations• Civil rights and legal requirements• Professional interpreters positively impact LEP patient

comprehension, compliance, access, and care• Cost-benefits analysis• Recognition and differences between only

2 groups: “professional” or “ad hoc”

Growing awareness of confounding issuesleads to new research questions

• Emerging trends• Interpersonal dynamics between provider and interpreter

• Intertwined emotional support for patient • Dimensions of trust • Competition for control

• Taxonomy for interpreter types and aspects to evaluate• Acknowledging complexity of communication triad

• Patient’s desire for comfort • Provider’s need for cultural mediation• Interpreter’s role expectations

How to achieve shared understanding using an interpreter to mediate “differences”?

• Different types of interpreters• Role expectations in different medical events• Confounding factors for choosing one type of

interpreter over another• Degrees of control• Preferences

Research Design

• Data gathering• 39 health care providers from 4 specialties:

Obstetrics and gynecology; mental health;oncology; and nursing

• 8 specialty-focus groups and 7 individual interviews

• Provider perspective through personal narrative

Research Design

• Data analysis• Grounded theory—Strauss and Corbin

• Open coding• Axial coding• Selective coding

Interpreter

Policy

Time Therapeutic Objective

Interpersonal Dynamics

Considerations for choosing an interpreter:

Time constraints• Availability

“If it’s really not an emergency, then we are going to wait for an official interpreter to come over.”“Maybe we’ve got some nurses that can speak some Spanish, and we will utilize what we can ’til we get an interpreter.”

• Ease of use“Most of the time we go with the family member not knowing what was really communicated. And that is FAR from ideal. But it’s usually time constraint.”“ ’Cause I would use them SO MUCH MORE often if they were just right there… instead of having to call and wait 25 minutes for them to get up here.”

Pivotal to therapeutic objectives

• Dependent on clinical complexity“To a certain extent [it’s] just time constraint, which goes with severity of illness.” “If the patient has something that’s gonna require quite a bit [of] medical explanation, that’s why our [on-site] interpreters are, you know, they have a lot more medical training, and interpretation of medical jargon as opposed to the general person on the street.”“We need information very, very quickly. If they [the patient] got someone there that maybe even just speaks a little bit of English, then we are gonna use that at least to start so I can get whatever information I can, and if it’s not an emergency, then […] we are going to wait for an official interpreter to come over.”

Pivotal to therapeutic objectives

• Respecting patient privacy“The obvious concern would be confidentiality issues. And the patient will not be forthcoming with the interpreter and I can’t really ask the things I need to ask through the family member.”“If a woman or a male [is talking] about really significant private information, so you are going to get history of sexual background or HIV or […] or pregnancy potential, you know if that opposite sex neighbor or opposite sex distant relative or even an adolescent female’s mother, those will be the situations that we would want to get an [on-site] interpreter.”

• Connecting through compassion“It’s challenging when I have someone that is very, very upset if I’m breaking bad news […] It’s nice to have an [on-site] interpreter […] that cannot only interpret but can assist in providing that compassion and empathize. That’s very helpful to the treatment.”

Institutional policies

• Legal:“I mean it’s never ok to not get consent out of a patient for a basic procedure just because we don’t or can’t communicate with them because of the language barrier.”“Everybody worries about malpractice. I think [on-site] interpreters REDUCE my risks, because you can communicate with patients more accurately and obtain better information.”

• Financial“So, I agree that professional interpreters are our preference, but unfortunately, financially, it’s nearly impossible to do that.”“It is… the best use of resources… who’s tied up doing interpretation [instead of paid role].”

Alliances of coordinated care

• Minimizing patient anxiety“If you’re going to take the patient’s baby away because their drug test was positive or whatever, you know something important like that, I make sure I have an [on-site] interpreter and make sure they [the patient] understood everything.”“I will try to respect that [patient’s preference] unless I see that it [the translation] is just totally inadequate.”

• Advancing the provider’s agenda“Again, this goes with experience. I mean you got an [on-site] interpreter that has been with a large number of patients […] and they KNOW we are not going to stop what we are doing to, you know, do those patients’ requests.”“We have several interpreters here, and the ones I work with for a long time […] I am very comfortable with them redirecting the patient and stopping the patient.”

Interpersonal dynamics are complex

Provider-patient• Relationship• Nonverbal• Privacy

Interpreter-Provider

• Working history• Alliance

• Agenda setting

Patient-interpreter

• Alliance• Trust

Discussion

• Confounding conditions play a role in determining the type of interpreter used.• Providers are both controlled by and have varying

degrees of control over certain conditions.

• Providers may sometimes aim for salience transfer through a specific interpreter or interpreter type.

• Careful consideration toward conditions and objectives could aid in choosing anappropriate interpreter.