ReviewWorking with interpreters in health care: A systematic review and meta-ethnography of qualitative studies
Introduction
The combination of globalization and the different waves of immigration to Western countries has resulted in an increasingly socio-culturally diverse population. Since many migrants do not speak the official language of their host country, this linguistic gap has been shown to be one of the major causes of health disparities [1]. The literature reports inappropriate diagnosis [2], poorer adherence to treatment [3] and follow-up [4], [5], more medication complications [6], longer hospitalizations [7] and decreased patient satisfaction [8]. One way to overcome these problems is to work with interpreters.
Ever since this issue came to the attention of the scientific community in the 1980s, interest in it has continued to grow. When reviews were conducted all concluded that working with interpreters was essential to reducing health disparities and improving quality of care; medical interpreters [9], [10], bilingual physicians and staff [9], [11], and bi/multilingual nurses from various cultural backgrounds experienced in transcultural nursing [10] were called on to act as interpreters. Many of the studies from which these reviews drew their conclusions, however, did not differentiate between the effects of different types of interpreters on improved quality of care. In response, Karliner et al. [12] and Bauer and Alegria [13] questioned the specific impact of professional versus non-professional interpreters (which we call “ad hoc” interpreters) on clinical and psychiatric care. Both studies concluded that working with professional interpreters improved quality of care. Interpretation is more than just a technique to make health service more accessible to patients who speak a foreign language, however. As Tribe and Lane [14] mentioned in their review and guidelines on working with interpreters in mental health, interpretation also offers clinicians an opportunity to expand their knowledge and understanding of a range of clinical perspectives. Investigating the relational issues involved in providing interpretation during medical consultations appears to be the next step in improving quality of care.
Although qualitative and quantitative studies have long been shown to be complementary [15], the systematic reviews mentioned above [9], [12], [13] seem to have neglected their respective contributions. The results of the selected studies are treated similarly, as if both types of research generated similar types of results.
The aim of our study was to conduct a systematic review and meta-ethnography [16], [17] of qualitative studies on interpreting in healthcare settings to better understand the relational issues involved in interpreted consultations with different types of interpreters, and to make recommendations for future research.
Habermas's distinction between the System and the Lifeworld was used as an interpretative framework to organize and give meaning to the results. These concepts have already been used profitably to understand communication in healthcare settings [18], [19], [20], and especially in interpreted consultations [21], [22]. The System, which comprises the economy and the state, is characterized by strategic action (oriented toward efficiency and success). The Lifeworld, which comprises the private and public spheres, is characterized by communicative action (oriented toward making collective sense of a situation in order to come to a consensual understanding on the course of action to take) [23].
Section snippets
Data sources
We conducted a systematic qualitative literature search for publications from the inception of each database to June 2010 in PsycInfo, EBSCO Medline, Current Contents, Web of Science, CSA Linguistics and Language Behavior Abstracts, SCA Sociological Abstracts and the Cochrane Library, with “interpreter*” and “health” as key words. After deletion of duplicates, our search produced 823 references (Appendix A).
Inclusion/exclusion criteria
We included all qualitative peer-reviewed publications in French and/or English. We
Quality of studies
We noted great variability in the way authors reported their findings (see Appendix C for details). Approximately half of the papers provide no information on participants’ socio-demographic characteristics (but numbers are rarely omitted). In total, 25 studies focus on professional interpreters only, 11 on ad hoc interpreters only, while more recent studies (n = 13) take both types into greater account. Seventeen of the studies do not specify the type of interpreters, but five provide sufficient
Contexts of publication
A distinct profile emerged when selected studies were considered based on country of publication. In the case of the three most productive countries, the increase in publication is clearly connected to their political situations. In the US, the increase in the number of publications coincided with Executive Order 13166, signed in August 2000 by President Clinton, requiring all federal agencies to comply with Title VI of the 1964 Civil Rights Act [91], which stipulates that the health system
Conflict of interest
The authors are not aware of any conflict of interest with regard to this manuscript.
Acknowledgements
We wish to thank Alexandra Boilard, Isabelle Boivin, Émilie Charest, Jessica Garant, Guillaume Lafontaine, Stéphanie Landry, Évelyne Marquis-Pelletier, Thomas Michaud Labonté and Myriam Sylvain for their invaluable assistance in the selection and abstraction process. We also thank Richard Dufour, librarian at Laval University, for his contribution to our literature search.
References (101)
- et al.
Giving voice to the lifeworld. More humane, more effective medical care? A qualitative study of doctor–patient communication in general pratice
Soc Sci Med
(2001) - et al.
Communicative and strategic action in interpreted consultations in primary health care: a Habermasian perspective
Soc Sci Med
(2006) - et al.
Role conflict among ‘culture brokers’: the experience of native Canadian medical interpreters
Soc Sci Med
(1984) - et al.
Not all are desired: providers’ views on interpreters’ emotional support for patients
Patient Educ Couns
(2010) - et al.
Doctor–patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters
Patient Educ Couns
(2007) Interpreters as co-diagnosticians: overlapping roles and services between providers and interpreters
Soc Sci Med
(2007)- et al.
Through interpreters’ eyes: comparing roles of professional and family interpreters
Patient Educ Couns
(2008) - et al.
Arranging and negotiating the use of informal interpreters in general practice consultations: experiences of refugees and asylum seekers in the west of Ireland
Soc Sci Med
(2009) - et al.
Health care interpreters: a physiotherapy perspective
Aust J Physiother
(2005) Provider-interpreter collaboration in bilingual health care: competitions of control over interpreter-mediated interactions
Patient Educ Couns
(2010)
The paradoxical use of interpreting in psychiatry
Soc Sci Med
Conflicts in how interpreters manage their roles in provider–patient interactions
Soc Sci Med
Interruptions and resistance: a comparison of medical consultations with family and trained interpreters
Soc Sci Med
Alterations during medical interpretation of ICU family conferences that interfere with or enhance communication
Chest
When nurses double as interpreters: a study of Spanish-speaking patients in a US primary care setting
Soc Sci Med
Errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters
Ann Emerg Med
Language proficiency, gender and self-reported health: an analysis of the first two waves of the Longitudinal Survey of Immigrants to Canada
Can J Public Health
Language proficiency and adverse events in US hospitals: a pilot study
Int J Qual Health C
The impact of language as a barrier to effective health care in an underserved urban Hispanic community
Mt Sinai J Med
Effect of language barriers on follow-up appointments after an emergency department visit
J Gen Intern Med
Race/ethnicity, language and patients’ assessments of care in Medicaid Managed Care
Health Serv Res
Drug complications in outpatients
J Gen Intern Med
The effect of English language proficiency on length of stay and in-hospital mortality
J Gen Intern Med
Health plan effects on patient assessments of medicaid managed care among racial/ethnic minorities
J Gen Intern Med
The impact of medical interpreter services on the quality of health care: a systematic review
Med Care Res Rev
Interpreters: a double-edged sword in nursing practice
J Transcult Nurs
Crossing the language chams. An in-depth analysis of what language-assistance look like in practice
Health Affair
Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature
Health Serv Res
Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: a systematic review
Psychiatr Serv
Working with interpreters across language and culture in mental health
J Ment Health
Introduction à la recherche en éducation
Conducting a meta-ethnography of qualitative literature: lessons learnt
BMC Med Res Methodol
Meta-ethnography: synthesizing qualitative studies
The discourse of medicine: dialectics of medical interviews
Pédiatres, parents migrants et interprètes communautaires: un dialogue de sourds?
Cahiers de l’Institut lausannois des sciences du langage
The theory of communicative action
L’analyse qualitative en sciences humaines et sociales
Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus group
Int J Qual Health C
Qualitative research: standards, challenges, guidelines
Lancet
Health sciences literature review made easy: the Matrix method
Health sciences literature review made easy: the Matrix method
A concept over-burdened: institutional roles for psychiatric interpreters in post-apartheid South Africa
Interpreting
Questions in cross-linguistic medical encounters: the role of the hospital interpreter
Anthropol Quart
Information transmission in bilingual, bicultural contexts: a field study of community health nurses and interpreters
J Community Health Nurs
Cultural mediation in cancer diagnosis and end of life decision-making: the experience of aboriginal patients in Canada
Anthropol Med
Roles of community interpreters in pediatrics as seen by interpreters, physicians and researchers
Interpreting
The role of interpreters in psychotherapy with refugees: an exploratory study
Am J Orthopsychiatry
The family caregiver as interpreter in the geriatric medical interview
Med Anthropol Q
Lost in translation: an interpretative phenomenological analysis of mental health professionals’ experiences of empathy in clinical work with an interpreter
Psychol Psychother
Cited by (142)
Working with interpreters in the family violence sector in Australia: “It's very hard to be in between”
2023, International Journal of Intercultural RelationsTypology of Healthcare Interpreter Positionings as applied to family medicine
2023, Patient Education and CounselingHealth Service Utilization of Black Immigrant Women Residing in the United States: A Systematic Review
2024, Journal of Racial and Ethnic Health DisparitiesBarriers to use of interpreters in outpatient mental health care: Exploring the attitudes of psychotherapists
2024, Transcultural PsychiatryPerceptions of nurses on the scope of culturally competent care in critical care: A qualitative study
2024, Nursing in Critical Care