Physician perceptions of the types of roles interpreters play in limited English proficient pediatric encounters and how they evaluate the quality of interpretation

Abstract

PurposeThe purpose of this study is to understand different roles that interpreters play in a pediatric, limited English proficient (LEP) health care encounter and to describe what factors within each role inform physicians’ assessment of the overall quality of interpretation.BackgroundLanguage barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts. Use of professional medical interpreters has been shown to improve communication and decrease medical errors in pediatric LEP patients. In addition, in many pediatric encounters, interpreters take on roles beyond that of a pure language conduit.MethodsWe conducted 11 semi-structured interviews with pediatricians and family medicine physicians in one health system. Transcripts were audio-recorded and transcribed verbatim. We analyzed our data using directed content analysis. Two study team members coded all transcripts, reviewed agreement, and resolved discrepancies.FindingsPhysicians described four different interpreter roles: language conduit, flow manager, relationship builder, and cultural insider. Within each role, physicians described components of quality that informed their assessment of the overall quality of interpretation during a pediatric encounter. We found that for many physicians, a high-quality interpreted encounter involves multiple roles beyond language transmission. It is important for health care systems to understand how health care staff conceptualize these relationships so that they can develop appropriate expectations and trainings for medical interpreters in order to improve health outcomes in pediatric LEP patients.

Nurses’ Barriers to Care of Ethnic Minorities: A Qualitative Systematic Review

“…Communication issues were the most common concerns that nurses reported. Similar studies with immigrant populations reporting health care professionals' views have mentioned that health care professionals in Western countries encounter difficulties when communicating with immigrants (Møen, Terrangni, Kumar, Diaz, 2018;Schwei, Guerrero, Small, & Jacobs, 2019). One study reported that efficient and effective communication between immigrant patients and health care professions is a significant mediator for the immigrants' good health maintenance (Maleku, Kim, & Lee, 2019).…”

Technical Meets Traditional: Language, Culture, and the Challenges Faced by Hmong Medical Interpreters

“…Evidence suggests that professional and family interpreters have different interpreting skills and may play different roles in the clinical environment (Hartford et al, 2019; Leanza et al, 2010). While professionals interpreters have been known to be cultural brokers, mediators, conduits, advocators, and more (Schwei et al, 2019; Wu & Rawal, 2017), family interpreters commonly act as advocates (Zendedel et al, 2018). Evidence has consistently indicated that the use of professional interpreters improves the quality of care for LEP patients, resulting in increased patient satisfaction with care, a better understanding of diagnoses and prognoses, and better health outcomes compared to family interpreters (Boylen et al, 2020; Hartford et al, 2019; Leanza et al, 2010).…”

A Conduit for a Culturally Competent Consent

“…2,[10][11][12][13] Certified medical interpreters act as a bridge between HCPs and patients not only as direct language interpreters but also as cultural mediators and patient advocates. [14][15][16] Given the critical role interpreters play in patient understanding, their presence during medical consent would be assumed/ standard, yet this is far from the case. 17 Informed consent is ethically and legally mandated due to the principle of patient autonomy and there is an associated documentation requirement.…”

“…As the number of patients with LEP in the United States increases, language-concordant care is essential to mitigating health care disparities, by promoting improved patient comprehension of their condition and treatment plan 2,10–13 . Certified medical interpreters act as a bridge between HCPs and patients not only as direct language interpreters but also as cultural mediators and patient advocates 14–16 …”