The value of qualified language interpretation services for limited-English-proficient patients is gaining increasing recognition by policy makers and researchers in the United States. Yet the actual work experiences of health care interpreters have not been adequately studied. The purpose of this qualitative research was to explore the work experiences of formal and informal interpreters (n = 27). The core narrative finding from the interview data was the complex, challenging, exhausting, and often invisible work of language interpretation. Critical examination of health care interpreters' complex work and interactions with patients, providers, and administrators is needed to provide more effective and integrated services for limited-English proficient patients.
Purpose
Tummy Time is preventive positioning designed to strengthen an infant’s neck and upper body muscles and minimize musculoskeletal disorders, including positional plagiocephaly. Latino parents with limited English proficiency (LEP) may experience barriers to receiving instruction on this important health-promotion strategy. Study aims included 1) adaptation and implementation of a Spanish-language version of Tummy Time; 2) evaluation of participant Tummy Time knowledge; and 3) assessment of efficacy and acceptability of the Spanish language intervention.
Design and Methods
This feasibility study involved translation of educational materials into Spanish, creation of Spanish-language print materials, and training of bilingual research assistants to deliver the educational intervention. Participants were 21 Latino expectant and current parents with self-identified LEP. Participants completed brief pre- and post-tests and performed a return demonstration.
Results
Participant knowledge of Tummy Time increased post-intervention. Program evaluation and on-site observations supported feasibility and acceptability.
Conclusions
The cultural and linguistic tailoring of targeted educational interventions is a feasible and potentially effective strategy to overcome barriers experienced by parents with limited English proficiency and may contribute to improved infant health outcomes.
Practice Implications
To be effective, health education programs must be tailored to the target population. Pediatric nurses and nurse practitioners should be aware that populations with LEP face many barriers that may inhibit their ability to participate in and understand health promotion educational activities. While translating interventions can mitigate language barriers, providers should also evaluate and address other barriers such as time constraints, transportation issues, and trust.
The assurance that limited-English-proficient individuals have access to quality healthcare depends on the availability of competent healthcare interpreters. To further understand the complex work of interpreting, we conducted in-depth interviews with 27 formal and informal healthcare interpreters. Participants identified the technical conduit role as the professional standard. Yet they experienced considerable role dissonance and blurring. From their position "in the middle," they witnessed discrimination and bias. Having a social justice perspective encouraged expanding their role to include advocacy and cultural brokering. Implications for nursing include a shared commitment to language access and social justice.
Rural children experience factors unique to location that impact asthma development and outcomes, including housing quality, cigarette smoke exposure, and small/large-scale farming. Additionally, there are challenging barriers to appropriate asthma care that frequently are more severe for those living in rural areas, including insurance status, lack of primary care providers and pulmonary specialists, knowledge deficits (both patient and provider), and a lack of culturally tailored asthma interventions. Interventions designed to address rural pediatric asthma disparities are more likely to be successful when targeted to specific challenges, such as the use of school-based services or telemedicine to mitigate asthma care access issues. Continued research on understanding the complex interaction of specific rural environmental factors with host factors can inform future interventions designed to mitigate asthma disparities.
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