“It’s just another added layer of difficulty”: Language access equity and inclusion in pediatric interpreted medical encounters — Provider and interpreter perspectives
DOI:
https://doi.org/10.7203/Just.1.24879Keywords:
Language access equity, language access inclusion, pediatrics, medical interpreters, interpreted medical encounters
Abstract
Limited English proficient or language-diverse patients and families in pediatric interpreted medical encounters (IME) are susceptible to health disparities and inequities in the US compared to English proficient patients and families in language-concordant medical encounters. Policies to improve access to language services intend to bridge this gap, yet evidence suggests that significant inequities still exist. This study explores perspectives of interpreters and pediatric critical care medical providers to better understand the complexities of IME in pediatric settings. Qualitative data were analyzed from two interview studies with medical interpreters and providers using thematic coding and inductive analysis. Several factors were identified by both interpreters and medical providers that negatively affected communication, equity, and inclusion. These included systems-level factors (e.g., time constraints and language variety), interpersonal factors (e.g., difficulties with communication and mistrust), and intrapersonal factors (e.g., implicit biases and judgements). These results highlight multiple layers of potential inequities which adversely affect patients and families in pediatric IME.
Downloads
Author Biographies
Amy Olen, Translation & Interpreting Studies, College of Letters & Sciences, University of Wisconsin–Milwaukee, PO Box 413, Milwaukee, WI 53201.
Paulina S. Lim, University of Wisconsin-Milwaukee, College of Letters & Sciences, PO Box 413, Milwaukee, WI 53201
Kathryn A. Balistreri, University of Wisconsin-Milwaukee, College of Letters & Sciences, PO Box 413, Milwaukee, WI 53201
W. Hobart Davies, University of Wisconsin-Milwaukee, College of Letters & Sciences, PO Box 413, Milwaukee, WI 53201
Matthew C. Scanlon, Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Ave. MS 681, Milwaukee, WI 53226
Charles B. Rothschild, Division of Critical Care, Department of Pediatrics, Medical College of Wisconsin, 9000 W. Wisconsin Ave. MS 681, Milwaukee, WI 53226
References
Anderson Freeman, Kathryn & Jessie K. Finch. 2017. “The role of racial microaggressions, stress, and acculturation in understanding Latino health outcomes in the USA.” Race and Social Problems 9: 218–233. https://doi.org/10.1007/s12552-017-9212-2.
Basu, Gaurab, Vonessa Phillips Costa & Priyank Jain. 2017. “Clinicians’ obligations to use qualified medical interpreters when caring for patients with limited English proficiency.” AMA Journal of Ethics 10 (3): 245–252. https://doi.org/10.1001/journalofethics.2017.19.3.ecas2-1703.
Brandenberger, Julia, Christian Pohl, Florian Vogt, Thorkild Tylleskär & Nicole Ritz. 2021. “Health care provided to recent asylum-seeking and non-asylum-seeking pediatric patients in 2016 and 2017 at a Swiss tertiary hospital — A retrospective study.” BMC Public Health 21 (80): 1–9. https://doi.org/10.1186/s12889-020-10082-z.
Brandenberger, Julia, Thorkild Tylleskär, Katrin Sontag, Bernadette Peterhans & Nicole Ritz. 2019. “A systematic literature review of reported challenges in health care delivery to migrants and refugees in high-income countries — The 3C model.” BMC Public Health 19: article 755 (1-11). https://doi.org/10.1186/s12889-019-7049-x.
Brownson, Ross C., Shiriki K. Kumanyika, Matthew W. Kreuter & Debra Haire-Joshu. 2021. “Implementation science should give higher priority to health equity.” Implementation Science 16 (28): 1–16. https://doi.org/10.1186/s13012-021-01097-0.
Coghlan, David & Mary Brydon-Miller. 2014. The SAGE encyclopedia of action research. Los Angeles, CA: Sage. https://dx.doi.org/10.4135/9781446294406.
Creswell, John W. 2014. Research design: Qualitative, quantitative and mixed methods approaches. 4th ed. Thousand Oaks, CA: Sage.
Crezee, Ineke H. M. & Cynthia E. Roat. 2019. “Bilingual patient navigator or healthcare interpreter: What’s the difference and why does it matter?” Cogent Medicine 6 (1): 1–15. https://doi.org/10.1080/2331205X.2019.1582576.
Davidson, Brad. 2000. “The interpreter as institutional gatekeeper: The social-linguistic role of interpreters in Spanish-English medical discourse.” Journal of Sociolinguistics 4 (3): 379–405. https://doi.org/10.1111/1467-9481.00121.
Diamond, Lisa C., Yael Schenker, Leslie Curry, Elizabeth H. Bradley & Alicia Fernandez. 2008. “Getting by: Underuse of interpreters by resident physicians.” Journal of General Internal Medicine 24 (2): 256-262. https://doi.org/10.1007/s11606-008-0875-7.
Eneriz-Wiemer, Monica, Lee M. Sanders, Donald A. Barr & Fernando S. Mendoza. 2014. “Parental limited English proficiency and health outcomes for children with special health care needs: A systematic review.” Academic Pediatrics 14 (2): 128–136. https://doi.org/10.1016/j.acap.2013.10.003.
Flores, Glenn. 2005. “The impact of medical interpreter services on the quality of health care: A systematic review.” Medical Care Research Review 62 (3): 255–299. https://doi.org/10.1177/1077558705275416.
Flores, Glenn, Milagros Abreu, Cara Pizzo Barone, Richard Bachur & Hua Lin. 2012. “Errors of medical interpretation and their potential clinical consequences: A comparison of professional versus ad hoc versus no interpreters.” Annals of Emergency Medicine 60 (5): 545–553. https://doi.org/10.1016/j.annemergemed.2012.01.025.
Gandin, Stefania. 2009. “What is really lost in translation? Some observations on the importance and the ethics of translation.” Annali della Facoltà di Lingue e Letterature Straniere di Sassari 6: 77–92. https://core.ac.uk/download/pdf/11689885.pdf.
Gmünder, Myriam, Julia Brandenberger, Sina Buser, Christian Pohl & Nicole Ritz. 2019. “Reasons for admission in asylum-seeking and non-asylum-seeking patients in a paediatric tertiary care centre.” Swiss Medical Weekly 150: article w20252 (1–10). https://doi.org/10.4414.smw.2020.20252.
Gonzalez-Sobrino, Bianca & Devon R. Goss. 2019. “Exploring the mechanisms of racialization beyond the black-white binary.” Ethnic and Racial Studies 42 (4): 505–510. https://doi.org/10.1080/01419870.2018.1444781.
Granhagen Jungner, Johanna, Elisabet Tiselius & Pernilla Pergert. 2021. “Reasons for not using interpreters to secure patient-safe communication – A national cross-sectional study in paediatric oncology.” Patient Education and Counseling 104 (8): 1985–1992. https://doi.org/10.1016/j.pec.2021.01.017.
Hsieh, Elaine. 2015. “Not just ‘getting by’: Factors influencing providers’ choice of interpreters.” Journal of General Internal Medicine 30 (1): 75–82. https://doi.org/10.1007/s11606-014-3066-8.
Hsieh, Elaine, Hyejung Ju & Haiying Kong. 2010. “Dimensions of trust: The tensions and challenges in provider interpreter trust.” Qualitative Health Research 20 (2): 178–181. https://doi.org/10.1177/1049732309349935.
Hsieh, Elaine & Sachiko Terui. 2015. “Inherent tensions and challenges of oncologist-patient communication: Implications for interpreter training in health-care settings.” Journal of Applied Communication Research 43 (2): 141–162. https://doi.org/10.1080/00909882.2015.1019542.
Jimenez, Nathalia, Douglass L. Jackson, Chuan Zhou, Nelly C. Ayala & Beth E. Ebel. 2014. “Postoperative pain management in children, parental English proficiency, and access to interpretation.” Hospital Pediatrics 4 (1): 23–30. https://doi.org/10.1542/hpeds.2013-0031.
Kanter, Jonathan W., Daniel C. Rosen, Katherine E. Manbeck, Heather M. L. Branstetter, Adam M. Kuczynski, Mariah D. Corey, Daniel W. M. Maitland & Monnica T. Williams. 2020. “Addressing microaggressions in racially charged patient-provider interactions: A pilot randomized trial.” BMC Medical Education 20: article 88 (1-14). https://doi.org/10.1186/s12909-020-02004-9.
Karliner, Leah S., Elizabeth A. Jacobs, Alice Hm Chen & Sunita Mutha. 2007. “Do professional interpreters improve clinical care for patients with limited English proficiency? A systematic review of the literature.” HSR: Health Research and Educational Trust 42 (2): 727–754. https://doi.org/10.1111/j.1475-6773.2006.00629.x.
Kuo, Dennis Z., Karen G. O’Connor, Glenn Flores & Cynthia S. Minkovitz. 2007. “Pediatricians’ use of language services for families with limited English proficiency.” Pediatrics 119 (4): e920–e927. https://doi.org/10.1542/peds.2006-1508.
Lion, K. Casey, Jesse Gritton, Jack Scannell, Julie C. Brown, Beth E. Ebel, Eileen J. Klein & Rita Mangione-Smith. 2021. “Patterns and predictors of professional interpreter use in the pediatric emergency department.” Pediatrics 142 (2): e20193312 (1–9). https://doi.org/10.1542/peds.2019-3312.
Mellinger, Christopher D. 2020. “Positionality in public service interpreting research.” FITISPos International Journal 7 (1): 92–109. https://doi.org/10.37536/FITISPos-IJ.2020.7.1.250.
Mellinger, Christopher D. 2022. “Healthcare in the US Latinx community: Challenges, disparities, and opportunities.” In Healthcare in Latin America: History, society, and culture, edited by David S. Dalton & Douglas J. Weatherford, 117–129. Gainsville, FL: University of Florida Press. https://doi.org/10.2307/j.ctv2t46r5k.12.
Meyer, Bernd. 2002. “Medical interpreting: Some salient features.” In Interpreting in the 21st century: Challenges and opportunities, edited by Guiliana Garzone & Maurizio Viezzi, 159–169. Amsterdam: John Benjamins.
Mikkelson, Holly. 1999. “Relay interpreting: A solution for languages of limited diffusion?” The Translator 5 (2): 361–380. https://doi.org/10.1080/13556509.1999.10799051.
Pérez-Stable, Eliseo J. & Sherine El-Toukhy. 2018. “Communicating with diverse patients: How patient and clinician factors affect disparities.” Patient Education and Counseling 101 (12): 2186–2194. https://doi.org/10.1016/j.pec.2018.08.021.
Pham, Kiemanh, J. Daryl Thornton, Ruth A. Engelberg, J. Carey Jackson & Randall Curtis. 2008. “Alterations during medical interpretation of ICU family conferences that interfere with or enhance communication.” Chest 134 (1): 109–116. https://doi.org/10.1378/chest.07-2852.
Rice, Sabriya. 2014. “Hospitals often ignore policies on using qualified medical interpreters.” Modern Healthcare. August 30. https://www.modernhealthcare.com/article/20140830/MAGAZINE/308309945/hospitals-often-ignore-policies-on-using-qualified-medical-interpreters.
Rodrigues, Jeni. 2022. The letter or the spirit of the law? An institutional ethnography of effective communication access in U.S. hospitals. Doctoral dissertation, Gallaudet University. https://www.proquest.com/docview/2659247649.
Saldaña, Johnny. 2016. The coding manual for qualitative researchers. 3rd ed. Thousand Oaks, CA: Sage.
Skutnabb‐Kangas, Tove. 1990. “Legitimating or delegitimating new forms of racism — The role of researchers.” Journal of Multilingual and Multicultural Development 11 (1-2): 77–100. https://doi.org/10.1080/01434632.1990.9994402.
Tajfel, Henri & John C. Turner. 2001. “An integrative theory of intergroup conflict.” In Intergroup relations: Essential readings, edited by Michael A. Hogg & Dominic Abrams, 94-109. Philadelphia: Psychology Press.
Thornton, J. Daryl, Kiemanh Pahm, Ruth A. Engelberg, J. Carey Jackson & J. Randall Curtis. 2009. “Families with limited English proficiency receive less information and support in interpreted ICU family conferences.” Critical Care Medicine 37 (1): 89–95. https://doi.org/10.1097/CCM.0b013e3181926430.
United States. 1964. Title VI of the Civil Rights Act of 1964. 42 U.S.C. § 2000D et seq. Adopted 2 July 1964. https://www.govinfo.gov/content/pkg/USCODE-2008-title42/html/USCODE-2008-title42-chap21-subchapV.htm.
United States. 2010. Patient Protection and Affordable Care Act of 2010. Public Law No. 111–148, 124 Statute 119. Adopted 23 March 2010. https://www.congress.gov/111/plaws/publ148/PLAW-111publ148.pdf.
United States. Department of Justice. 2020. “Limited English proficient (LEP).” Civil rights. Office of Justice Programs. https://www.ojp.gov/program/civil-rights/limited-english-proficient-lep.
Williams, David R., Selina A. Mohammed, Jacinta Leavell & Chiquita Collins. 2010. “Race, socioeconomic status, and health: Complexities, ongoing challenges, and research opportunities.” Annals of the New York Academy of Sciences 1186 (1): 69–101. https://doi.org/10.1111/j.1749-6632.2009.05339.x.
Zurca, Adrian D., Kiondra R. Fisher, Remigio J. Flor, Catalina D. Gonzalez-Marques, Jichuan Wang, Yao I. Cheng & Tessie W. October. 2017. “Communication with limited English-proficient families in the PICU.” Hospital Pediatrics 7 (1): 9–15. https://doi.org/10.1542/hpeds.2016-0071.
Downloads
Published
How to Cite
-
Abstract954
-
PDF387
Issue
Section
License
Authors grant the journal the right of first publication with the work simultaneously licensed under Attribution-NoDerivatives 4.0 International license, allowing third parties to copy and redistribute the work in any medium and format for any purpose, even commercially, as long as the material is not transformed, and ensuring that its authorship and initial publication in this journal are credited.
Authors retain copyright and are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) once it has been published, as it can lead to productive exchanges (see The Effect of Open Access). Gender aware practices are advised.
Similar Articles
Language
Information
Keywords
Make a Submission
