Use Of Trained Interpreters Research Articles

Results of a Multidisciplinary Workshop to Reduce Bias and Improve Health Equity for Patients With Limited English Proficiency [ID: 1375774

INTRODUCTION: Birthing people with limited English proficiency (LEP) often face systemic limitations to care and are at increased risk for disparate birth outcomes due to barriers in patient–provider communication. Patients with LEP are particularly vulnerable to biases and microaggressions that can limit timely health care delivery and the quality of services received. We developed a multidisciplinary curriculum to educate providers about 1) unconscious bias (UCB), 2) barriers to equitable health care delivery for patients with LEP, and 3) use of trained interpreter services to promote patient–provider communication. METHODS: We developed a 60-minute workshop for physicians/midwives/nurses (n=75). Surveys were used to assess change in knowledge. Results were evaluated by descriptive statistics, t tests for significance, and thematic analysis. Institutional review board approval was obtained. RESULTS: Approximately 75 participants attended the workshop. Thirty-three percent of pre-workshop survey respondents (13/39) had not received cultural competency training within the last 3 years. Approximately 1 in 5 (22%) pre-workshop respondents were unaware of their hospital's interpreter services policy. After a brief didactic presentation, participants identified common microaggressions and barriers to care for patients with LEP. They also developed 15 unique strategies to promote communication via use of trained interpreters when the patient/family initially opt for ad hoc interpretation instead. At workshop completion, 97.1% of participants reported that they will adopt or modify an existing strategy when communicating with LEP patients and families. CONCLUSION: Post-workshop survey results suggest that continuing education can be used to address UCB for patients with LEP and promote use of interpreter services to improve patient–provider communication.

Access to health care for vulnerable migrants in Switzerland, all equal?

Switzerland, after having been a nation of emigration for a long time, has seen its situation reversed with the industrial revolution and a succession of international crises responsible for several waves of migration. Some of these immigrants have health needs that vary according to their country of origin and their migratory route. Due to communication difficulties or legal issues, they do not always have access to appropriate health care. Although Switzerland tries to provide a framework and coordinate the care pathway, inequalities persist. Good information for professionals and patients, the use of trained interpreters and knowledge of local structures to which these patients can be referred might improve the situation.

Involving migrants in the adaptation of primary care services in a 'newly' diverse urban area in Ireland: The tension between agency and structure.

In line with World Health Organization policy (WHO, 2016; 2019), primary care services need to be adapted to effectively meet the needs of diverse patient populations. Drawing from a European participatory implementation study, we present an Irish case study. In a hybrid participatory space, migrants, general practice staff and service planners (n = 11) engaged in a project to implement the use of trained interpreters in primary care over 17 months. We used Normalisation Process Theory to analyse data from 15 Participatory Learning and Action research focus groups and related sources. While stakeholders' agency and expertise produced relevant positive results for the introduction of changes in a general practice setting, structural factors limited the range and scope for sustained changes in day-to-day practice.

Barriers to the use of trained interpreters in consultations with refugees in four resettlement countries: a qualitative analysis using normalisation process theory

BackgroundIncreasing numbers of primary care practitioners in refugee resettlement countries are providing care to refugees. Access to trained interpreters is a priority for these practitioners, but there are many barriers to the implementation of interpreted consultations in routine care. There is a lack of international, theoretically informed research. The purpose of this paper is to understand barriers to interpreter use in primary care consultations in four resettlement countries using Normalisation Process Theory.MethodWe conducted a cross-sectional online survey with networks of primary care practitioners (PCPs) who care for refugees in Australia, Canada, Ireland and the US (n = 314). We analysed qualitative data from the survey about barriers to interpreter use (n = 178). We completed an inductive thematic analysis, iteratively developed a Normalisation Process Theory (NPT)-informed coding frame and then mapped the emergent findings onto the theory’s construct about enacting interpreted consultations.ResultsIn all four countries, the use of an interpreter presented communication and interaction challenges between providers and patients, which can impede the goals of primary care consultations. Primary care practitioners did not always have confidence in interpreted consultations and described poor professional practice by some interpreters. There was variation across countries, and inconsistency within countries, in the availability of trained interpreters and funding sources.ConclusionThere are shared and differential barriers to implementation of interpreted consultations in a consistent and sustained way in the four countries studied. These findings can be used to inform country-specific and international level policies and interventions focusing on improving skills and resources for interpreted consultations to improve implementation of interpreted primary care consultations.

Reducing infectious disease inequities among migrants.

migration has reached unprecedented levels, with 3.6% of the world's population living outside their country of birth. Migrants comprise a substantial proportion of high-income country populations, are at increased risk of a range of infectious diseases, compared to native-born populations and may experience worse health outcomes due to barriers accessing timely diagnoses and treatment. Poor access to essential healthcare services can be attributed to several factors, including language and cultural barriers and lack of specific inclusive health policies. This review draws on evidence from the immigrant health and travel medicine literature, with a focus on infectious disease risks. It presents strategies to reduce barriers to healthcare access through health promotion and screening programs both at the community and clinic level and the delivery of linguistically and culturally competent care. The Methods: Salud Entre Culturas (SEC) 'Health Between Cultures' project from the Tropical Medicine Unit at the Hospital Ramon y Cajal in Madrid is described as an effective model of care. For those providing healthcare to migrant populations, the use of community-consulted approaches are considered best practice in the development of health education, health promotion and the delivery of targeted health services. At the clinic-level, strategies optimizing care for migrants include the use of bilingual healthcare professionals or community-based healthcare workers, cultural competence training of all clinic staff, the appropriate use of trained interpreters and the use of culturally appropriate health promotion materials. Multifaceted strategies are needed to improve access, community knowledge, community engagement and healthcare provider training to provide appropriate care to migrant populations to reduce infectious disease disparities.

4.1-O6Developing a health care system level response to support the routine use of trained interpreters in the Irish healthcare system: A participatory, theoretically informed project

4.1-O6Developing a health care system level response to support the routine use of trained interpreters in the Irish healthcare system: A participatory, theoretically informed project

Interpreting in palliative care: A systematic review of the impact of interpreters on the delivery of palliative care services to cancer patients with limited English proficiency.

123 Background: According to the 2011 U.S. Census 60% of people living in the U.S. speak a language other than English at home, and of these approximately 40% have limited English proficiency (LEP). Language barriers can affect the health outcomes of LEP patients and the use of trained interpreters can improve patient-physician communication. Since effective communication is the cornerstone of delivering adequate palliative care, a systematic review was conducted to determine the impact of interpreters on the delivery of palliative care services to LEP patients with cancer. Methods: We conducted a systematic review of the literature search in all available languages of 6 databases from 1966 and 2013. Studies evaluated interpreter interventions for LEP patients receiving palliative care services. Of 38 references, 11 articles were found by multiple reviewers to meet inclusion criteria. Data were collected on the study design, size, comparison groups, outcomes, and interpreter characteristics. Results: A total of 6 qualitative and 5 quantitative studies assessed the use of interpreters. All studies found that the quality of care provided to LEP patients receiving palliative services is affected by communication. Most studies showed that when no trained interpreters were used, LEP patients and families had inadequate understanding about their diagnosis or prognosis during goals of care conversations, and worse symptom management at end of life including pain and anxiety. Half of the studies concluded that trained interpreters are not utilized adequately and several suggested that pre-meetings between clinicians and interpreters are important to discuss topics and terminology to be used during goals of care conversations. Conclusions: Published studies show worse outcomes during end of life care and goals of care discussions when trained interpreters are not used. Moreover, trained interpreters are not being used appropriately in the field. More clinically relevant studies are needed to improve the quality of care provided to LEP patients and families receiving palliative services.

Is it time to talk? Interpreter services use in general practice within Canterbury

Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. For the years 2008-2010, approximately 10 742 consultations per year involved a non-Englishspeaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies.

How to use interpreters in general practice: the development of a New Zealand toolkit

New Zealand is becoming more ethnically diverse, with more limited English proficiency (LEP) people. Consequently there are more primary care consultations where patients have insufficient English to communicate adequately. Because effective communication is essential for good care, interpreters are needed in such cases. The literature on the use of interpreters in health care includes the benefits of using both trained interpreters (accuracy, confidentiality, ethical behaviour) and untrained interpreters (continuity, trust, patient resistance to interpreter). There is little research on the actual pattern of use of interpreters. Our research documented a low use of trained interpreters, despite knowledge of the risks of untrained interpreters and a significant use of untrained interpreters where clinicians felt that the communication was acceptable. A review of currently available guidelines and toolkits showed that most insist on always using a trained interpreter, without addressing the cost or availability. None were suitable for direct use in New Zealand general practice. We produced a toolkit consisting of flowcharts, scenarios and information boxes to guide New Zealand practices through the structure, processes and outcomes of their practice to improve communication with LEP patients. This paper describes this toolkit and the links to the evidence, and argues that every consultation with LEP patients requires clinical judgement as to the type of interpreting needed. Primary care practitioners need understanding about when trained interpreters are required.

Why do we not use trained interpreters for all patients with limited English proficiency? Is there a place for using family members?

Australia and New Zealand both have large populations of people with limited English proficiency (LEP). Australia's free telephone interpreter service, which is also used by New Zealand through Language Line (LL) but at a cost to the practices, is underused in both countries. Interpreter guidelines warn against the use of family members, yet the lack of uptake of interpreter services must mean that they are still often used. This paper reviews the literature on medical interpreter use and reports the results of a week-long audit of interpreted consultations in an urban New Zealand primary health centre with a high proportion of refugee and migrant patients. The centre's (annualised) tally of professionally interpreted consultations was three times more than that of LL consultations by all other NZ practices put together. Despite this relatively high usage, 49% of all interpreted consultations used untrained interpreters (mostly family), with more used in 'on-the-day' (OTD) clinics. Clinicians rated such interpreters as working well 88% of the time in the OTD consultations, and 36% of the time in booked consultations. An in-house interpreter (28% of consultations) was rated as working well 100% of the time. Telephone interpreters (21% of consultations) received mixed ratings. The use of trained interpreters is woefully inadequate and needs to be vigorously promoted. In primary care settings where on-going relationships, continuity and trust are important - the ideal option (often not possible) is an in-house trained interpreter. The complexity of interpreted consultations needs to be appreciated in making good judgements when choosing the best option to optimise communication and in assessing when there may be a place for family interpreting. This paper examines the elements of making such a judgement.

Common mental health problems in immigrants and refugees: general approach in primary care.

Recognizing and appropriately treating mental health problems among new immigrants and refugees in primary care poses a challenge because of differences in language and culture and because of specific stressors associated with migration and resettlement. We aimed to identify risk factors and strategies in the approach to mental health assessment and to prevention and treatment of common mental health problems for immigrants in primary care. We searched and compiled literature on prevalence and risk factors for common mental health problems related to migration, the effect of cultural influences on health and illness, and clinical strategies to improve mental health care for immigrants and refugees. Publications were selected on the basis of relevance, use of recent data and quality in consultation with experts in immigrant and refugee mental health. The migration trajectory can be divided into three components: premigration, migration and postmigration resettlement. Each phase is associated with specific risks and exposures. The prevalence of specific types of mental health problems is influenced by the nature of the migration experience, in terms of adversity experienced before, during and after resettlement. Specific challenges in migrant mental health include communication difficulties because of language and cultural differences; the effect of cultural shaping of symptoms and illness behaviour on diagnosis, coping and treatment; differences in family structure and process affecting adaptation, acculturation and intergenerational conflict; and aspects of acceptance by the receiving society that affect employment, social status and integration. These issues can be addressed through specific inquiry, the use of trained interpreters and culture brokers, meetings with families, and consultation with community organizations. Systematic inquiry into patients' migration trajectory and subsequent follow-up on culturally appropriate indicators of social, vocational and family functioning over time will allow clinicians to recognize problems in adaptation and undertake mental health promotion, disease prevention or treatment interventions in a timely way.

Pediatricians' Use of Language Services for Families With Limited English Proficiency

Patients with limited English proficiency confront multiple barriers to health care access in the United States. Appropriate language services for families with limited English proficiency are essential; however, little is known about pediatricians' use of language services. The objective of this study was to examine pediatricians' provision of language services to patients with limited English proficiency and the pediatrician, practice, and state characteristics associated with use of these services. Data were obtained from the Periodic Survey of Fellows No. 60, a nationally representative survey of members of the American Academy of Pediatrics. A total of 1829 surveys were mailed, and responses were obtained from 58%. Use of 6 language services was assessed. Factors associated with language services use were examined after adjusting for physician, practice, and state characteristics. Bilingual family members (70%) and bilingual staff (58%) were the most frequently reported language services; 40% of respondents report the use of professional interpreters, 28% use telephone interpreters, and 35% of practices report provision of translated written materials. Pediatricians in smaller and rural practices and in states with higher proportions of limited English proficiency persons report less use of professional interpreters. Pediatricians in states with third-party reimbursement for language services are more likely to report use of professional interpreters. Most pediatricians report using untrained interpreters to communicate with limited English proficiency patients and their families. Pediatricians in regions with high proportions of limited English proficiency persons may be less likely to provide appropriate language services. Third-party reimbursement for professional language services may increase the use of trained interpreters and quality of care.

Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders

Research Issues for Improving Treatment of U.S. Hispanics With Persistent Mental Disorders

Barriers to the use of interpreters in emergency room paediatric consultations

To identify barriers to the use of trained interpreters in emergency department (ED) paediatric consultations. A cross-sectional survey of non-English-speaking-background (NESB) carers who presented a child aged 14 years or less to the Fairfield Hospital ED during a 3-month period was undertaken using a multilingual postal questionnaire or a phone interview with interpreter assistance. Of the 1388 paediatric consultations during the study period, 406 of the carers were registered as being of NESB, with 316 being eligible for study inclusion. Of the 278 (88%) respondents who completed the questionnaires, assistance with interpretation was required by 131 (47%) respondents: 55 (20%) used ad hoc interpreters, 47 (17%) used a trained interpreter and 21 (8%) did not receive the required assistance. Fifty-four (41%) carers who required interpreter assistance were identified as having this requirement at clerical registration in the ED, but only 18 of these were provided with a trained interpreter during the consultation. Limited English proficiency was self-reported by 127 (46%) respondents, with these respondents being more likely to need interpreter assistance (odds ratio (OR) 44.2; 95% CI 21.6-90.7), to have impaired understanding of the consultation (OR 8.2; 95% CI 4.7-14.1) and to consult a language concordant general practitioner (OR 10.1; 95% CI 5.1-19.4) compared with English proficient respondents. Barriers to the use of interpreters in ED paediatric consultations include poor identification of the need for and provision of an interpreter in the ED, and a preference for NESB carers to use ad hoc interpreters or no interpreter. Recommendations include the implementation in the ED of strategies to improve identification of NESB carers, as well as to improve awareness, access and use of trained interpreters during paediatric consultations. There is also a need to explore the experience of ED staff in accessing and using trained interpreters.

Trained medical interpreters in the emergency department: effects on services, subsequent charges, and follow-up.

The study was conducted to investigate the impact of an Interpreter Service on intensity of Emergency Department (ED) services, utilization, and charges. This study describes the effects of language barriers on health care service delivery for the index ED visit and a subsequent 90-day period. In all 26,573 ED records from July to November, 1999, resulted in a data set of 500 patients with similar demographic characteristics, chief complaint, acuity, and admission rate. Noninterpreted patients (NIPs) who did not speak English had the shortest ED stay (LOS) and the fewest tests, IVs and medications; English-speaking patients had the most ED services, LOS, and charges. Subsequent clinic utilization was lowest for NIPs. Among discharged patients, return ED visit and ED visit charges were lowest for interpreted patients (IPs). Use of trained interpreters was associated with increased intensity of ED services, reduced ED return rate, increased clinic utilization, and lower 30-day charges, without any simultaneous increase in LOS or cost of visit.