Michelle C. Farabough
Qualitative Research Methods
Fall 2011
More than language:
Providers indicatedynamicstoconsiderinan
...
Growingneed for interpreter-mediatedhealth
communication
• Over 20% of all Americans over age 5 speak
a language other tha...
Growingawarenessof confoundingissues
leads to new researchquestions
• Emerging trends
• Interpersonal dynamics between pro...
Howto achievesharedunderstandingusing
aninterpreterto mediate“differences”?
• Different types of interpreters
• Role expec...
ResearchDesign
• Data gathering
• 39 health care providers from 4 specialties:
Obstetrics and gynecology; mental health;
o...
ResearchDesign
• Data analysis
• Grounded theory—Strauss and Corbin
• Open coding
• Axial coding
• Selective coding
Considerationsfor choosingan interpreter:
Timeconstraints
• Availability
“If it’s really not an emergency, then we are going to wait for an
official interpreter to ...
Pivotalto therapeutic objectives
• Dependent on clinical complexity
“To a certain extent [it’s] just time constraint, whic...
Pivotalto therapeutic objectives
• Respecting patient privacy
“The obvious concern would be confidentiality issues. And th...
Institutionalpolicies
• Legal:
“I mean it’s never ok to not get consent out of a patient for a
basic procedure just becaus...
Alliances of coordinatedcare
• Minimizing patient anxiety
“If you’re going to take the patient’s baby away because their
d...
Interpersonaldynamicsare complex
Provider-patient
• Relationship
• Nonverbal
• Privacy
Interpreter-
Provider
• Working his...
Discussion
• Confounding conditions play a role in determining
the type of interpreter used.
• Providers are both controll...
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Faraboough qualitative research methods presentation

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NCA National Conference 2012

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  • Legal: U.S. Department of Health and Human Services’ Office for Civil Rights is empowered to enforce federal requirements mandating medical interpreter services2001 National Standards for Culturally and Linguistically Appropriate Service in Health Care (CLAS standards) final reportSince 2006, 43 states either requiring continuing education for physicians relative to cultural competency or to address language access in health care organizationsCost: focused on professional medical interpreters, measured health care expenditures, patient health insurance benefits, and patient access to care“Ad hoc (or informal) interpreter”:“an untrained person who is called upon to interpret, such as a family member interpreting for a parent, a bilingual staff member pulled away from other duties to interpret, or a self-declared bilingual in a hospital waiting-room who volunteers to interpet” (Karliner, Jacobs, Chen, & Mutha, 2007
  • focus explicitly on benefits or challenges to a specific type of interpreter or the comparison of two or three2006 Elaine’s “types”: Chance interpreter, untrained interpreter, bilingual health care provider, on-site interpreter, and telephone interpreter types are discussed in terms of availability, professionalism, comfort to patient, and interpreting quality.
  • Lacking is a holistic approach addressing the spectrum of interpreters used in health care—from child family/friend to medical professional interpretersAsking for a glass of water vs. intake evaluation vs. medication instructions vs. discharge informationEverything else: time, availability, ease of use, cultural mediation, nonverbal cues, privacy, and emotional support to name just a few
  • Faraboough qualitative research methods presentation

    1. 1. Michelle C. Farabough Qualitative Research Methods Fall 2011 More than language: Providers indicatedynamicstoconsiderinan interpreter-mediated,bilingualmedicalencounter
    2. 2. Growingneed for interpreter-mediatedhealth communication • Over 20% of all Americans over age 5 speak a language other than English at home • Previous literature and investigations • Civil rights and legal requirements • Professional interpreters positively impact LEP patient comprehension, compliance, access, and care • Cost-benefits analysis • Recognition and differences between only 2 groups: “professional” or “ad hoc”
    3. 3. Growingawarenessof confoundingissues leads to new researchquestions • Emerging trends • Interpersonal dynamics between provider and interpreter • Intertwined emotional support for patient • Dimensions of trust • Competition for control • Taxonomy for interpreter types and aspects to evaluate • Acknowledging complexity of communication triad • Patient’s desire for comfort • Provider’s need for cultural mediation • Interpreter’s role expectations
    4. 4. Howto achievesharedunderstandingusing aninterpreterto mediate“differences”? • Different types of interpreters • Role expectations in different medical events • Confounding factors for choosing one type of interpreter over another • Degrees of control • Preferences
    5. 5. ResearchDesign • Data gathering • 39 health care providers from 4 specialties: Obstetrics and gynecology; mental health; oncology; and nursing • 8 specialty-focus groups and 7 individual interviews • Provider perspective through personal narrative
    6. 6. ResearchDesign • Data analysis • Grounded theory—Strauss and Corbin • Open coding • Axial coding • Selective coding
    7. 7. Considerationsfor choosingan interpreter:
    8. 8. Timeconstraints • Availability “If it’s really not an emergency, then we are going to wait for an official interpreter to come over.” “Maybe we’ve got some nurses that can speak some Spanish, and we will utilize what we can ’til we get an interpreter.” • Ease of use “Most of the time we go with the family member not knowing what was really communicated. And that is FAR from ideal. But it’s usually time constraint.” “ ’Cause I would use them SO MUCH MORE often if they were just right there… instead of having to call and wait 25 minutes for them to get up here.”
    9. 9. Pivotalto therapeutic objectives • Dependent on clinical complexity “To a certain extent [it’s] just time constraint, which goes with severity of illness.” “If the patient has something that’s gonna require quite a bit [of] medical explanation, that’s why our [on-site] interpreters are, you know, they have a lot more medical training, and interpretation of medical jargon as opposed to the general person on the street.” “We need information very, very quickly. If they [the patient] got someone there that maybe even just speaks a little bit of English, then we are gonna use that at least to start so I can get whatever information I can, and if it’s not an emergency, then […] we are going to wait for an official interpreter to come over.”
    10. 10. Pivotalto therapeutic objectives • Respecting patient privacy “The obvious concern would be confidentiality issues. And the patient will not be forthcoming with the interpreter and I can’t really ask the things I need to ask through the family member.” “If a woman or a male [is talking] about really significant private information, so you are going to get history of sexual background or HIV or […] or pregnancy potential, you know if that opposite sex neighbor or opposite sex distant relative or even an adolescent female’s mother, those will be the situations that we would want to get an [on-site] interpreter.” • Connecting through compassion “It’s challenging when I have someone that is very, very upset if I’m breaking bad news […] It’s nice to have an [on-site] interpreter […] that cannot only interpret but can assist in providing that compassion and empathize. That’s very helpful to the treatment.”
    11. 11. Institutionalpolicies • Legal: “I mean it’s never ok to not get consent out of a patient for a basic procedure just because we don’t or can’t communicate with them because of the language barrier.” “Everybody worries about malpractice. I think [on-site] interpreters REDUCE my risks, because you can communicate with patients more accurately and obtain better information.” • Financial “So, I agree that professional interpreters are our preference, but unfortunately, financially, it’s nearly impossible to do that.” “It is… the best use of resources… who’s tied up doing interpretation [instead of paid role].”
    12. 12. Alliances of coordinatedcare • Minimizing patient anxiety “If you’re going to take the patient’s baby away because their drug test was positive or whatever, you know something important like that, I make sure I have an [on-site] interpreter and make sure they [the patient] understood everything.” “I will try to respect that [patient’s preference] unless I see that it [the translation] is just totally inadequate.” • Advancing the provider’s agenda “Again, this goes with experience. I mean you got an [on-site] interpreter that has been with a large number of patients […] and they KNOW we are not going to stop what we are doing to, you know, do those patients’ requests.” “We have several interpreters here, and the ones I work with for a long time […] I am very comfortable with them redirecting the patient and stopping the patient.”
    13. 13. Interpersonaldynamicsare complex Provider-patient • Relationship • Nonverbal • Privacy Interpreter- Provider • Working history • Alliance • Agenda setting Patient- interpreter • Alliance • Trust
    14. 14. Discussion • Confounding conditions play a role in determining the type of interpreter used. • Providers are both controlled by and have varying degrees of control over certain conditions. • Providers may sometimes aim for salience transfer through a specific interpreter or interpreter type. • Careful consideration toward conditions and objectives could aid in choosing an appropriate interpreter.

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