Current contributions and research on healthcare interpreting
Research on healthcare interpreting has expanded in the past decade both in quantity and geographical range. A literature review of healthcare interpreting studies published between 2007 and 2017 (Liu and Zhang 2019) noted the close correlation between governmental support and enhanced interpreting services and research, mainly in the United States and Europe. That research found important variations also in specific settings, such as mental health, and found both positive and negative evaluations of ad hoc versus professional interpreters. For example, providers felt that patient empowerment could be achieved through the greater accuracy of communication provided by professional interpreters, while patients generally felt more empowered by the advocacy and support provided by informal interpreters (Liu and Zhang 2019: 2).
Research continues, however, to reveal inadequacies in cross-cultural healthcare communication in virtually every location studied. Problems are attributed to lack of funding, lack of appropriate training, supervision and remuneration of interpreters, and the continued use of untrained staff and family members as interpreters. It is interesting that research participants often express satisfaction with the communication even when transcription and analysis of recorded interactions reveal critical communication lapses; Lesch and Saulse (2013), in a study of interpreting in South Africa, offer an illustration of this. The authors recommend improved policies for interpreting services and better training for providers on how to work with interpreters.
Taibi (2014) has brought attention to the situation in the Arab world, where, he says, community interpreting services are generally lacking. This lack exists despite a sizeable national language minority in Tunisia, a large migrant population in the United Arab Emirates, and the large numbers of religious pilgrims in Saudi Arabia. Taibi suggests strategies for change based on the experiences of Australia, Canada, and those European countries that have developed such services.
In much of Western Europe, however, language services remain uneven and varied in nature from country to country. An extensive survey in 2014 2015 by Angelelli (2018) investigated translation and interpreting services available in five EU member states (Germany, Greece, Italy, Spain and the UK) for EU citizens when they cross borders from one member state to another. The study revealed great diversity and widespread failure to attain EU human rights goals. Thus, in these five countries the survey found that EU citizens who crossed national borders frequently did not receive the quality language services promised under Directive 2011/24/EU. Specifically, except for the UK, where translation and interpreting services are ‘mandated by the country’s Equality Act 2010, language services are neither mandatory nor frequent in healthcare organisations’ in the countries studied (Angelelli 2018: 121). When study participants were asked to indicate to what extent translation and interpreting services were utilised, the response ‘only as a last resort’ was selected by 57 per cent of those working in Spain, 41 per cent in Greece, and 70 per cent in Germany, as opposed to only 22 per cent of participants in the UK (ibid.).
Gentile (2017) describes cutbacks in legal interpreting in the UK and in healthcare interpreting in the Netherlands, where privatisation of interpreting services has led to decreases in service quality and pay rates, leaving many qualified interpreters to quit the field. Thus, in the Netherlands, ‘informal interpreters’ are increasingly relied upon in healthcare settings rather than professional interpreters, previously available through government funding.
Research at the University of Amsterdam focused on patients’ perspective on interactions between General Practitioners and female Turkish-speaking immigrant patients supported by informal interpreters, whose role ‘besides providing linguistic translation’ was to ‘perform the roles of advocates and caregivers of the patients’ (Zendedel et al. 2018: 158). The focus in a series of interviews was on patient satisfaction with respect to trust and perceived empowerment, rather than on interpreter accuracy, neutrality and confidentiality as in many previous studies. Although none of the women interviewed had ever had the services of a professional interpreter, all indicated a preference for informal interpreters, nearly all of whom were family members, mainly on the basis of trust and the feeling that they were empowered through their interpreter-advocate (ibid.'. 165— 166); some indicated that they would trust professional interpreters more with respect to confidentiality.
In a journal article, Pôchhacker (2006) succinctly outlines the development of research specific to healthcare interpreting, encompassing such diverse disciplines as nursing, linguistics, mental health, medical and social sciences, and communication studies, in addition to more traditional interpreting studies, citing prominent examples in each area. His review also distinguishes the varying themes of research such as interpreter performance, communication practices, and goals and outcomes with respect to the service provided. Pôchhacker concludes by emphasising the overarching focus of this research on quality, which must ultimately be assessed in terms of benefits and the associated costs.
To close this sampling of recent research, a US study published in the Journal of Transcultural Nursing (Estrada and Messias 2018) looked at goal-directed triadic communication between providers (nurse-practitioners), well-qualified interpreters (also serving as patient navigators), and Hispanic patients with limited English proficiency, through examination of recorded and transcribed sessions and post-session interviews. The study revealed productive joint efforts at problem-solving. In the authors’ words, ‘three modes of co-constructed, collaborative knowledge generation [took place]: constructing connections, constructing mutual understanding, and constructing effective system navigation strategies’ (Estrada and Messias 2018: 500). Both the interactional model and the research design in this study appear worthy of emulation.