“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.1.24879Palabras clave:
Equidad en el acceso lingüístico, inclusión en el acceso lingüístico, pediatría, intérpretes médicos, encuentros médicos interpretadosResumen
En los encuentros médicos interpretados (EMI) en pediatría en los EE.UU., las personas y familiares que acuden a una consulta médica con un dominio limitado del inglés o con otras lenguas están expuestas a perjuicios y desigualdades en materia de salud, en comparación con aquellas que dominan el inglés y que asisten a las consultas en su idioma. Las políticas para mejorar el acceso a los servicios lingüísticos pretenden salvar esta brecha, pero los datos indican que siguen dándose desigualdades significativas. Este estudio explora las perspectivas de intérpretes y de proveedores de atención sanitaria crítica pediátrica para comprender mejor las complejidades de los EMI en contextos pediátricos. Se analizan los datos cualitativos procedentes de dos estudios con entrevistas a intérpretes y proveedores de atención sanitaria utilizando codificación temática y análisis inductivo. Los resultados muestran que ambos grupos detectan varios factores que afectan negativamente a la comunicación, la equidad y la inclusión. Estos factores se localizan a nivel sistémico (como son las limitaciones de tiempo y la variedad lingüística), interpersonal (por ejemplo, las dificultades de comunicación y la desconfianza) y a nivel intrapersonal (como son los sesgos implícitos y los prejuicios). Estos resultados ponen de manifiesto las múltiples capas de desigualdades potenciales que perjudican a pacientes y familiares en los EMI en pediatría.
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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.
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