A conversation analysis of verbal interactions and social processes in interpreter-mediated primary care encounters

Abstract

Language asymmetry between patients with limited English proficiency and health care providers increases the complexity of patient-provider communication. In this research, we used conversation analysis to examine the content and processes of five triadic clinical communication encounters between Spanish-speaking adult patients, English-speaking nurse practitioners, and clinic-based interpreters. Data collection included audio-recordings of the triadic clinical encounters and self-administered post-encounter surveys of the nurse practitioners and interpreters. Our findings revealed communication trouble spots that, when directly addressed by the interactants, facilitated processes of negotiating relationships, and coming to a mutual understanding. Exemplars labeled Making Assumptions; Colloquialisms as Signaling Potential for Trouble; Repairing a Mis-Statement; and Turn-Taking, Silences, and Laughter illustrated how the parties identified and navigated such trouble spots. The final exemplar, Attaining Intersubjectivity, represented a successful multi-lingual triadic communication. While the role of the interpreter often is seen as a conduit of information from one language to another, in practice they also enacted roles of communication collaborators and coconstructors. Future interdisciplinary research can include closer examination of occurrences of communication trouble spots and further exploration of how interpretermediated communication is conceptualized and problematized in diverse clinical settings, to promote language interpretation policies and practices that contribute to reducing health disparities among limited-English-proficient populations.

Improving the effectiveness of interpreted consultations: Australian interpreter, general practitioner and patient perspectives

“…and directly address what have been called "communication trouble spots" effectively (Estrada, Reynolds, & Hilfinger Messias, 2015). On the other hand, all parties in our study seemed to accept that the doctor had the ultimate responsibility for the effectiveness and outcomes of interpreted consultations.…”

“…The importance of negotiating communicative strategies and authority during an interactive and adaptive process has previously been recognised (Hsieh, ). Doctors who are intent on keeping control of consultations may fail to negotiate the respectful, professional relationship which will enable the two to work together and directly address what have been called “communication trouble spots” effectively (Estrada, Reynolds, & Hilfinger Messias, ). On the other hand, all parties in our study seemed to accept that the doctor had the ultimate responsibility for the effectiveness and outcomes of interpreted consultations.…”

Ethnomethodological studies of nurse-patient and nurse-relative interactions: A scoping review

“…interpreters) and tools play in communication between nurses and patients. The topics covered by the articles ranged from phonemediated interactions (Butler et al, 2009;Leydon et al, 2013), and the role of interpreters (Estrada et al, 2015), to the influence of medical records (Rhodes et al, 2008) and computer-assisted technologies (Murdoch et al, 2015) in nurse-patient interaction. These studies suggest that technological mediation hinders rather than facilitates nurse-patient interaction.…”

“…Even though phone-mediated conversation can be an opportunity for nurses' displaying of expertise, this can reduce patient participant (Butler et al, 2009). In translator-mediated communication, Estrada et al (2015) show that patients can misconstrue breaks in the translators' speech as turn completion points, which affects the unfolding of the interaction.…”

Excellence in Development of Health Care Providers

“…Language differences between health care providers and patients are the strongest causes of health care inequality in not only the United States but also worldwide (Fields, Abraham, Gaughan, Haines, & Hoehn, 2016). Lack of communication between two languages increases the complexity of health care, further increasing costs of the complications related to lack of health care and health disparities (Estrada, Reynolds, & Hilfinger, 2015). Latinos who do not speak English report worse health status and less access to care than those who speak English.…”