Healthcare staffs perceptions of using interpreters: a qualitative study

Who seeks care and for what reasons at a nurse-led walk-in center in an immigrant-dense area-A quantitative survey

OBJECTIVE

To describe who seeks care and for what reasons at a nurse-led primary healthcare walk-in center in an immigrant-dense area. Studies evaluating the use of nurse-led walk-in centers in primary healthcare, emphasizing migrants, are limited. Due to language difficulties and a healthcare system based on telephone consultations, access to care is limited/problematic for the care seeker and the healthcare provider. The center aims to provide migrants and Swedish-born persons equal access to primary healthcare. Care was integrated into a healthcare center with a multi-professional environment, offering Arabic and Somali interpreters.

DESIGN

Cross-sectional descriptive registry study.

SAMPLE

All consecutive patients visiting during 1-month.

RESULTS

Most individuals (70%) seeking care at the nurse-led walk-in center were non-European migrants from Syria, Iraq and Somalia, but Swedish-born persons (30%) also consulted the clinic. Women, middle-aged, and lower-educated patients dominated. Reasons for seeking care included different kinds of pain, ear/nose/throat issues, and skin problems. Migrants prioritized non-specific pain and dizziness/headaches, while Swedes sought help primarily for upper respiratory tract infections. About 25% of the migrants needed interpreters, mostly females.

CONCLUSION

The nurse-led walk-in center provides accessible care in a multi-professional team, if needed, serving migrants and Swedish-born persons, promoting equal healthcare for all.

Using artificial intelligence to promote equitable care for inpatients with language barriers and complex medical needs: clinical stakeholder perspectives

OBJECTIVES

Inpatients with language barriers and complex medical needs suffer disparities in quality of care, safety, and health outcomes. Although in-person interpreters are particularly beneficial for these patients, they are underused. We plan to use machine learning predictive analytics to reliably identify patients with language barriers and complex medical needs to prioritize them for in-person interpreters.

MATERIALS AND METHODS

This qualitative study used stakeholder engagement through semi-structured interviews to understand the perceived risks and benefits of artificial intelligence (AI) in this domain. Stakeholders included clinicians, interpreters, and personnel involved in caring for these patients or for organizing interpreters. Data were coded and analyzed using NVIVO software.

RESULTS

We completed 49 interviews. Key perceived risks included concerns about transparency, accuracy, redundancy, privacy, perceived stigmatization among patients, alert fatigue, and supply-demand issues. Key perceived benefits included increased awareness of in-person interpreters, improved standard of care and prioritization for interpreter utilization; a streamlined process for accessing interpreters, empowered clinicians, and potential to overcome clinician bias.

DISCUSSION

This is the first study that elicits stakeholder perspectives on the use of AI with the goal of improved clinical care for patients with language barriers. Perceived benefits and risks related to the use of AI in this domain, overlapped with known hazards and values of AI but some benefits were unique for addressing challenges with providing interpreter services to patients with language barriers.

CONCLUSION

Artificial intelligence to identify and prioritize patients for interpreter services has the potential to improve standard of care and address healthcare disparities among patients with language barriers.

Advancing language concordant care: a multimodal medical interpretation intervention

BACKGROUND

Ensuring language concordant care through medical interpretation services (MIS) allows for accurate information sharing and positive healthcare experiences. The COVID-19 pandemic led to a regional halt of in-person interpreters, leaving only digital MIS options, such as phone and video. Due to longstanding institutional practices, and lack of accessibility and awareness of these options, digital MIS remained underused. A Multimodal Medical Interpretation Intervention (MMII) was developed and piloted to increase digital MIS usage by 25% over an 18-month intervention period for patients with limited English proficiency.

METHODS

Applying quality improvement methodology, an intervention comprised digital MIS technology and education was trialled for 18 months. To assess intervention impact, the number of digital MIS minutes was measured monthly and compared before and after implementation. A questionnaire was developed and administered to determine healthcare providers' awareness, technology accessibility and perception of MIS integration in the clinical workflow.

RESULTS

Digital MIS was used consistently from the beginning of the COVID-19 pandemic (March 2020) and over the subsequent 18 months. The total number of minutes of MIS use per month increased by 44% following implementation of our intervention. Healthcare providers indicated that digital MIS was vital in facilitating transparent communication with patients, and the MMII ensured awareness of and accessibility to the various MIS modalities.

CONCLUSION

Implementation of the MMII allowed for an increase in digital MIS use in a hospital setting. Providing digital MIS access, education and training is a means to advance patient-centred and equitable care by improving accuracy of clinical assessments and communication.

Strategies to address perceived barriers to timely kidney transplantation in the Netherlands: A qualitative study from a stakeholders' perspective

Objective

We present strategies to perceived barriers to access to kidney transplantation (KT) in the Netherlands.

Methods

This qualitative study (N = 70) includes nephrologists, social workers, surgeons, nurses, patients, former living kidney donors, policy employees, and insurance representatives. Interviews were conducted both in focus groups and individually and coded with NVivo.

Results

Participants proposed strategies within five domains. 1.Policy: Making KT guideline more visible. 2.Medical: Increase access and transparency to KT medical eligibility criteria (e.g., age, BMI) for patients and healthcare providers. 3.Psychological: Support patients who continue to use dialysis because of social interaction opportunities associated with dialysis settings to find such interaction elsewhere. Link kidney patients with fears for KT to experienced experts or trained professionals. 4.Social: Support patients with language barriers with interpreters and visual explanations. Support patients using social media, e.g. Facebook, to identify potential donors. Better expectation management to reduce reports of inadequate aftercare for living donors. 5.Economical: Solving negative economic incentives for KT by changing incentives.

Conclusion

Stakeholders see strategies for barriers in the entire care pathway.

Innovation

This large qualitative study gives an important overview which strategies stakeholders see improving access to KT. Some strategies offer opportunities to solve barriers in the short-term.

Lost in translation? Information quality in pediatric pre-hospital medical emergencies with a language barrier in Germany

BACKGROUND

In pediatric medical emergencies, paramedics and emergency physicians must often rely on the information of third parties, often caregivers, to gather information. Failing to obtain relevant information may lead to misinterpretation of symptoms and subsequent errors in decision making and clinical treatment. Thus, children and/or caregivers with limited proficiency of the locally spoken language may be at risk for medical errors. This study analyzes logs of rescue missions to determine whether paramedics could obtain essential information from German-speaking and foreign-language children and their caregivers.

METHODS

We conducted a secondary data analysis based on retrospective data on pediatric patients of four emergency medical services (EMS) stations in Northern Germany. We defined language discordance with communication difficulties as main exposure. We used documentation quality as outcome defined as existing information on (a) pre-existing conditions, (b) current medication, and (c) events prior to the medical emergency. Statistical analyses include descriptive statistics, simple regression and multivariable regression. As multivariable regression model, a logistic regression was applied with documentation quality as dependent variable and language discordance with communication difficulties as independent variable adjusted for age, sex and Glasgow Coma Scale (GCS).

RESULTS

Data from 1,430 pediatric rescue missions were analyzed with 3.1% (n = 45) having a language discordance with communication difficulties. Patients in the pediatric foreign-language group were younger compared to German-speaking patients. Thorough documentation was more frequent in German-speaking patients than in patients in the foreign-language group. Pre-existing conditions and events prior to the medical emergency were considerably more often documented in German-speaking than for foreign-language patients. Documentation of medication did not differ between these groups. The adjustment of sex, age and GCS in the multivariable analysis did not change the results.

CONCLUSION

Language barriers are hindering paramedics to obtain relevant information in pediatric pre-hospital emergencies. This jeopardizes the safe provision of paramedic care to children who themselves or their caregivers are not fluent in German language. Further research should focus on feasible ways to overcome language barriers in pre-hospital emergencies.

TRIAL REGISTRATION

This is a retrospective secondary data analysis of a study that was registered at the German Clinical Trials Register (No. DRKS00016719), 08/02/2019.

The influence of sociodemographic factors and close relatives at hospital discharge and post hospital care of older people with complex care needs: nurses’ perceptions on health inequity in three Nordic cities

Hospital discharge of older people in need of both medical and social care following their hospital stay requires extensive coordination. This study aims to examine and compare the views of nurses in three Nordic cities on the influence of sociodemographic factors and having close relatives, for the hospital discharge and post hospital care of older people with complex health and social care needs. Thirty-five semi-structured interviews (Copenhagen n = 11, Tampere n = 8, Stockholm n = 16) with nurses were conducted. The nurses were identified through the researchers’ networks, invitation and snowball sampling, and recruited from hospitals, primary care practices, home care units, home nursing units, and geriatric departments. The interviews were transcribed and analysed using thematic analysis. Interpretations were discussed and agreed within the team. Four main themes and 13 sub-themes were identified. Across the cities, informants reported that the patient’s health status, rather than their gender or ethnicity, steered the discharge date and further care. Care costs, commonly reported in Tampere but also in Copenhagen and Stockholm including costs for medications and home help, were considered barriers for disadvantaged older people. Home situation, local arrangements and differences in collaboration between healthcare professionals at different sites also influenced the hospital discharge. Generally, the patient’s health status steered the hospital discharge and post-hospital care. Close relatives were regarded important and a potential advantage. Some informants tried to compensate for the absence of close relatives, highlighting the importance of care systems that can compensate for this to minimise avoidable inequity.

“I Know Hyena. Do you Know Hyena?” Challenges in Interpreter-Mediated Dementia Assessment, Focusing on the Role of the Interpreter

Dementia assessment requires functional communication and interaction between healthcare professionals and the patient being assessed. These can be affected by the requirement for an interpreter to communicate with the patient. The purpose of this study was to elucidate the interactions between patient, healthcare professionals and interpreter, focusing on the role of the interpreter and the challenges that may arise in interpreter-mediated dementia assessment. The study had an ethnographic design in which the data consisted of audio and video recordings of 19 dementia assessments conducted in the presence of an interpreter. The data were analyzed using the constant comparative method. The results showed that the interpreter could affect the patient’s performance and results during the dementia assessment. The interpreter could alter the meaning and content of what was communicated, sometimes change information and instructions exchanged between the patient and healthcare professionals, could avoid interpreting everything being said, and occasionally made their own corrections to what was being communicated. This occurred mainly because of the interpreter’s lack of linguistic skills and the interpreter failing to adhere to the ethical guidelines governing their profession. These challenges could also occur when the interpreter was not familiar with the context of dementia assessment. Alterations made by the interpreter to what was being communicated could lead to incorrect evaluation of the patient’s cognitive abilities and health status. This, in turn, may lead to misjudgment of the patient’s remaining resources and symptoms and their required treatment and support.

Factors influencing the use of video interpretation compared to in-person interpretation in hospitals: a qualitative study

BACKGROUND

Facilitating access to professional interpretation services is key to equitable hospital care for migrants with limited language proficiency; however, interpreter underuse has been documented. The factors that potentially enable or hinder professional interpreter use are not well understood. We aimed to compare perceptions held by hospital managers and healthcare practitioners of the factors influencing the use of remote video interpretation and in-person interpretation.

METHODS

This study employed a retrospective qualitative design. Two hospitals, located in Austria and Norway, with adequately similar baseline characteristics were purposively selected. Both hospitals used in-person interpreters, and the Austrian hospital had recently introduced remote video interpretation as an alternative and supplement. Fifteen managers and healthcare practitioners participated in focus groups and individual interviews. Data were thematically analysed with the aid of behavioural system theory.

RESULTS

Across sites, the facilitators of interpreter use included individual factors (knowledge about interpreter services, skills to assess when/how to use an interpreter, beliefs about favourable consequences), as well as organisational factors (soft budget constraints). Barriers were identified at the individual level (lack of interpersonal skills to handle difficult provider-interpreter situations, lack of skills to persuade patients to accept interpreter use, lack of trust in service professionalism), and at the organisational level (limited interpreter availability, time constraints). The introduction of remote video interpretation services seemed to counteract the organisational barriers. Video interpretation was further perceived to enable patient confidentiality, which was regarded as a facilitator. However, video interpretation introduced specific barriers, including perceived communication deficiencies.

CONCLUSION

This study has identified a range of factors that are perceived to influence the use of interpreters in hospitals. The research suggests that-implementing remote video interpretation services lessens the barriers to use and that such services should be introduced in hospital settings as an alternative or supplement to in-person interpreters. Further intervention functions should be considered to bring about change in the use of interpretation services, including developing guidelines for interpreter use, educating staff in the appropriate use of video technology, and training staff in communicating with interpreter and patients with limited language proficiency.

Unity in diversity: mapping healthcare interpreting studies (2007-2017)

This paper intends to examine the evolution of healthcare interpreting studies published in SSCI and A&HCI journals between 2007 and 2017. A total of 40 journal articles have been selected from 23 SSCI or A&HCI journals, covering journals on translation and interpreting, linguistics and communication as well as healthcare studies. Thematically, articles selected fall in such four major types as socio-political background, healthcare interpreting practice, and education and training. Methodologically, based on an existing framework of classification, articles selected are grouped into four categories, namely, pure empirical research, pro-empirical research, pro-non-empirical research, and pure non-empirical research. Built on such a characterization of past studies on healthcare interpreting, this paper serves as a general map of relevant studies of this sub-field in the past decade and attempts to provide recommendations on research directions in the future. Such directions include the integration and alignment between the T & I community and the healthcare research community in the study of healthcare interpreting, the development of inter-disciplinary perspectives on the socio-political background of healthcare interpreting, and the expansion of research that is specialty-based, informed and driven.

Interpreters in healthcare: Nursing perspectives

PURPOSE

This study explored nursing experiences using interpreters in primary healthcare settings.

METHODS

Eight nurses in southern Sweden were subjected to semistructured interviews. The responses were divided into three categories using content analysis: interpreter influence, challenges, and strategies.

RESULTS

Despite using an interpreter to minimize language barriers, nurses do not achieve the same level of person-centered care as those who speak the same language as their patients, but translation services remain a useful communication tool for patient care.

CONCLUSION

Communication through an interpreter is an inevitability for healthcare professionals, and formal education is recommended to improve nurses' utilization of these services.

Prehospital emergency care nurses' strategies while caring for patients with limited Swedish-English proficiency

AIMS AND OBJECTIVES

To explore the strategies of nurses working in the ambulance service while caring for patients with limited Swedish-English proficiency.

BACKGROUND

Communication difficulties due to lack of mutual language is a challenge in healthcare systems around the world. Little is known about nurses' strategies while caring for patients with whom they do not share a mutual language in an unstructured, unplanned prehospital emergency environment, the ambulance service.

DESIGN AND METHOD

A qualitative study design based on interviews was used, and a purposeful sample and snowball technique were used to identify nurses with prehospital emergency experience of caring for patients with limited Swedish-English proficiency.

RESULTS

Eleven nurses were interviewed, and the main strategy they used was adapting to the patients' need and the caring situation. The nurses used their own body, and tone of voice for creating a sense of trust and security. The nurses also used structured assessment in accordance with medical guidelines. Translation devices and relatives/bystanders were used as interpreters when possible. Another strategy was to transport the patient directly to the emergency department as they had not found a secure way of assessing and caring for the patients in the ambulance.

CONCLUSION

The nurses used a palette of strategies while assessing and caring for patients when there was no mutual language between the caregiver and care seeker.

RELEVANCE TO CLINICAL PRACTICE

The nurses need to be prepared for how to assess and care for patients when there is a lack of mutual language; otherwise, there is a risk of increased unequal care in the ambulance service. To further explore and learn about this field of research, studies exploring the patients' perspective are needed.

Language interpretation conditions and boundaries in multilingual and multicultural emergency healthcare

BACKGROUND

With an increasing migrant population globally the need to organize interpreting service arises in emergency healthcare to deliver equitable high-quality care. The aims of this study were to describe interpretation practices in multilingual emergency health service institutions and to explore the impact of the organizational and institutional context and possible consequences of different approaches to interpretation. No previous studies on these issues in multilingual emergency care have been found.

METHODS

A qualitative descriptive study was used. Forty-six healthcare professionals were purposively recruited from different organizational levels in ambulance service and psychiatric and somatic emergency care units. Data were collected between December 2014 and April 2015 through focus-group and individual interviews, and analyzed by qualitative content analysis.

RESULTS

Organization of interpreters was based on patients' health status, context of emergency care, and access to interpreter service. Differences existed between workplaces regarding the use of interpreters: in somatic emergency care bilingual healthcare staff and family members were used to a limited extent; in psychiatric emergency care the norm was to use professional interpreters on the spot; and in ambulance service persons available at the time, e.g. family and friends were used. Similarities were found in: procuring a professional interpreter, mainly based on informal workplace routines, sometimes on formal guidelines and national laws, but knowledge of existing laws was limited; the ideal was a linguistically competent interpreter with a professional attitude, and organizational aspects such as appropriate time, technical and social environment; and wishes for development of better procedures for prompt access to professional interpreters at the workplace, regardless of organizational context, and education of interpreters and users.

CONCLUSION

Use of interpreters was determined by health professionals, based on the patients' health status, striving to deliver as fast and individualized care as possible based on humanistic values. Defects in organizational routines need to be rectified and transcultural awareness is needed to achieve the aim of person-centered and equal healthcare. Clear formal guidelines for the use of interpreters in emergency healthcare need to be developed and it is important to fulfill health professionals' wishes for future development of prompt access to interpreters and education of interpreters and users.

Arab-migrant Cancer Survivors' Experiences of Using Health-care Interpreters: A Qualitative Study

Objective:

This paper is drawn from a larger mixed-method study that sought to explore the cancer experiences of Jordanian and Australian Arab cancer survivors and their family caregivers. This paper specifically focuses on the experiences of the Australian cancer survivors and their use of interpreter services to communicate with health-care providers (HCPs).

Methods:

Individual face-to-face interviews were conducted using a semi-structured interview guide. Data were manually thematically analyzed using an inductive approach.

Results:

Three key themes were identified which highlighted the communication issues the Arab-migrant cancer survivors experienced when using health-care interpreters: (1) “My language is weak” – needing someone to help them when communicating with their HCPs; (2) “I had a problem in the dialect” – the need to understand and to be understood by the interpreters; and (3) “I felt all the time that there is something missing” – not being heard by the interpreter. Low confidence in engaging and using the English language meant many cancer survivors were reluctant to seek support from cancer services or to attend workshops conducted in the English language. Despite the presence of professionally trained health-care interpreters in health-care communications, cancer survivors were frustrated when provided with interpreters who did not speak the same dialect, causing linguistic and cultural discord. This created confusion as information was often misinterpreted, resulting in the delivery and receipt of mixed messages.

Conclusions:

Despite the availability of professionally trained health-care interpreters, our findings identified the need for HCPs to ascertain linguistic and cultural congruence when arranging interpreter services.

Difficulties in using interpreters in clinical encounters as experienced by immigrants living in Sweden

AIMS AND OBJECTIVES

To study a group of immigrants' experiences regarding interactions with primary health care through an interpreter.

BACKGROUND

Approximately, 230 million people are resettled outside of their own home country. Thus, more than 3% of the world's population are migrants. It is a major challenge for health care providers to satisfy immigrants' needs for individualised health care services.

DESIGN

Qualitative study.

METHODS

Focus group interviews were conducted with four groups of immigrants (n = 24) from Bosnia and Herzegovina, Croatia, Kosovo and Somalia. The group interviews were audio recorded, transcribed and analysed, and the text was categorised using the content analysis method.

RESULTS

Participants' expectations of the interpreter-mediated consultations were high, but not always fulfilled. Interpreters being late, lacking professionalism or lacking knowledge in medical terminology and the use of health care professionals or relatives as interpreters were some of the problems raised.

CONCLUSION

A well-organised, disciplined interpreter service with professional and competent interpreters is needed to overcome problems regarding clinical consultations involving interpreters. A satisfactory language bridge has a significant impact on the quality of communications.

CLINICAL IMPLICATION

Interpreter services should be well organised, and interpreters should be linguistically, culturally and socially competent, as these factors may have a significant impact on consultation outcomes. Using relatives or staff as interpreters can sometimes be a solution but often results in an unsatisfactory clinical consultation.

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

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.

Working with interpreters: practical advice for use of an interpreter in healthcare

The aim of this descriptive commentary is to improve communication in healthcare when an interpreter is used by providing practical advice to healthcare staff when they consider using interpreters. This descriptive commentary considered the issues of preparation and implementation of interpretation sessions to reveal the complexities and dilemmas of an effective healthcare encounter with interpreters. Using the design of a discursive paper, this article seeks to explore and position of what is published in the literature on the topic studied and on the basis of previous studies to provide practical advice on the use of interpreters. The descriptive commentary showed that the interpreter should be used not only as a communication aid but also as a practical and informative guide in the healthcare system. In preparing the interpretation session, it is important to consider the type (trained professional interpreter, family member or bilingual healthcare staff as interpreters) and mode (face to face and telephone) of interpreting. Furthermore, it is important to consider the interpreter's ethnic origin, religious background, gender, language or dialect, social group, clothes, appearance and attitude. During the healthcare encounter, the interpreter should follow the recommendations given in guidelines for interpreters. Healthcare staff should choose an appropriate room and be aware of their own behaviour, appearance and attitude during the healthcare encounter. Good planning is needed, with carefully considered choices concerning the right kind of interpreter, mode of interpretation and individual preferences for the interpretation in order to deliver high-quality and cost-effective healthcare. Depending on the nature of the healthcare encounter, healthcare staff need to plan interpreting carefully and in accordance with the individuals' desires and choose the type of interpreter and mode of interpreting that best suits the need in the actual healthcare situation in order to deliver high-quality healthcare.

Immigrant women's experience of maternity services in Canada: a meta-ethnography

OBJECTIVE

to synthesise data on immigrant women's experiences of maternity services in Canada.

DESIGN

a qualitative systematic literature review using a meta-ethnographic approach

METHODS

a comprehensive search strategy of multiple databases was employed in consultation with an information librarian, to identify qualitative research studies published in English or French between 1990 and December 2011 on maternity care experiences of immigrant women in Canada. A modified version of Noblit and Hare's meta-ethnographic theoretical approach was undertaken to develop an inductive and interpretive form of knowledge synthesis. The seven-phase process involved comparative textual analysis of published qualitative studies, including the translation of key concepts and meanings from one study to another to derive second and third-order concepts encompassing more than that offered by any individual study. ATLAS.ti qualitative data analysis software was used to store and manage the studies and synthesise their findings.

FINDINGS

the literature search identified 393 papers, of which 22 met the inclusion criteria and were synthesised. The literature contained seven key concepts related to maternity service experiences including social (professional and informal) support, communication, socio-economic barriers, organisational environment, knowledge about maternity services and health care, cultural beliefs and practices, and different expectations between health care staff and immigrant women. Three second-order interpretations served as the foundation for two third-order interpretations. Societal positioning of immigrant women resulted in difficulties receiving high quality maternity health care. Maternity services were an experience in which cultural knowledge and beliefs, and religious and traditional preferences were highly relevant as well but often overlooked in Canadian maternity settings.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

in order to implement woman-centered care, to enhance access to maternity services, and to promote immigrant women's health, it is important to consider these women's social position, cultural knowledge and beliefs, and traditional customs in the health care.

Consultations between Immigrant Patients, Their Interpreters, and Their General Practitioners: Are They Real Meetings or Just Encounters? A Qualitative Study in Primary Health Care

Objective. In Sweden, about 19% of residents have a foreign background. Previous studies reported immigrant patients experience communication difficulties despite the presence of interpreters during consultations. The objective of this study was to gain insights into the participants' perceptions and reflections of the triangular meeting by means of in-depth interviews with immigrant patients, interpreters, and general practitioners (GPs). Method. A total of 29 participants-10 patients, 9 interpreters, and 10 GPs-participated in face-to-face interviews. Content analysis was used to process the interview material. Results. Six themes were generated and arranged under two subject areas: the interpretation process (the means of interpreting and means of informing) and the meeting itself (individual tailored approaches, consultation time, the patient's feelings, and the role of family members). Conclusion. This paper highlights feelings including frustration and insecurity when interpretation and relationships are suboptimal. Strategies for immigrant patients, interpreters, and GPs for getting a successful consultation may be needed. To transform the triangular meeting from an encounter to a real meeting, our results indicate a need for professional interpreters, for GPs to use a patient-tailored approach, and sufficient consultation time. Practice Implications. Use of professional interpreters is recommended, as is developing cultural competence.

Problems and consequences in the use of professional interpreters: qualitative analysis of incidents from primary healthcare

The aim of this study was to explore what problems are reported by healthcare professionals in primary healthcare concerning the use of interpreters and what the problems lead to. The study involved a single case in a real-life situation with qualitative content analysis of 60 incident reports written by different healthcare professionals. The main problems documented were related to language, such as lack of the interpreters with proficiency in a particular language, and to organisational routines, with difficulties in the availability of interpreters and access to the interpreter agency. The problems reported led to incorrect use of time and resources, which increased the workload and thus delayed treatment. Other consequences were limited possibilities to communicate and thus consultation was carried out without a professional interpreter, using family members instead. The results highlight the importance of developing good co-operation between the interpreter agency and the primary healthcare centre in order to fulfil the existing policy of using professional interpreters to provide the right interpreter at the right time and guarantee high-quality care.