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

Rebecca J Schwei,Natalie Guerrero,Alissa L Small,Elizabeth A Jacobs

doi:10.1017/s1463423618000890

Rebecca J Schwei, Natalie Guerrero + Show 2 more

Open Access

https://doi.org/10.1017/s1463423618000890

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Abstract

The 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. Language 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. We 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. Physicians 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.

Highlights

In 2013, ~25.1 million individuals in the United States were considered limited English proficient (LEP), which is defined as anyone above the age of 5 who reports speaking English less than ‘very well’ (‘The Limited English Proficient Population in the United States,’ 2015)
Previous research has documented that language barriers contribute to lower quality of care in LEP pediatric patients compared to their English-speaking counterparts (Flores et al, 2005; Cohen and Christakis, 2006; Galbraith et al, 2008; Mayo et al, 2016) For example, children whose parents’ primary language at home was not English less often received timely illness and routine care (Galbraith et al, 2008), and infants were half as likely to receive preventive care as compared to infants of parents whose primary language at home was English (Cohen and Christakis, 2006)
Physicians described the different roles they have seen interpreters plays or roles they want interpreters to play in a medical encounter, which we describe as: language conduit, flow manager, relationship builder, and cultural insider

Summary

Introduction

In 2013, ~25.1 million individuals in the United States were considered limited English proficient (LEP), which is defined as anyone above the age of 5 who reports speaking English less than ‘very well’ (‘The Limited English Proficient Population in the United States,’ 2015). Of these 25.1 million people, 10% were children between the ages of 5 and 17 (‘The Limited English Proficient Population in the United States,’ 2015). Use of professional medical interpreters has been shown to decrease health disparities in adult LEP patients (Jacobs et al, 2001) and improve communication and decrease medical errors in pediatric LEP patients (Flores et al, 2003).

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