NCA National Conference 2012

1. Michelle C. Farabough
Qualitative Research Methods
Fall 2011
More than language:
Providers indicatedynamicstoconsiderinan
interpreter-mediated,bilingualmedicalencounter

2. Growingneed for interpreter-mediatedhealth
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”

3. Growingawarenessof confoundingissues
leads to new researchquestions
• 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

4. Howto achievesharedunderstandingusing
aninterpreterto 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

5. ResearchDesign
• 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

6. ResearchDesign
• Data analysis
• Grounded theory—Strauss and Corbin
• Open coding
• Axial coding
• Selective coding

7. Considerationsfor choosingan interpreter:

8. Timeconstraints
• 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.”

9. Pivotalto 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.”

10. Pivotalto 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.”

11. Institutionalpolicies
• 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].”

12. Alliances of coordinatedcare
• 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.”

13. Interpersonaldynamicsare complex
Provider-patient
• Relationship
• Nonverbal
• Privacy
Interpreter-
Provider
• Working history
• Alliance
• Agenda setting
Patient-
interpreter
• Alliance
• Trust

14. 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 an
appropriate interpreter.