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Interpreter-mediated communication in health care What do informal interpreters want, feel and do? Barbara Schouten 7 th Terminology Seminar, April 2014, Brussels

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Interpreter-mediated communication in health care What do informal interpreters want, feel and do?

Barbara Schouten

7th Terminology Seminar,

April 2014, Brussels

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TRICC-PROJECT

Five European countries:

Netherlands, UK, Germany, Italy, Turkey.

Objective:

Develop interventions to enhance intercultural &

bilingual competencies in health care.

(see http://www.tricc-eu.net/)

STUDY 1: RATIONALE

In the research literature on interpreting, the role of context

has been pointed out as an important factor shaping

interpreters’ views and practices (e.g. Angelelli, 2004).

…… however, no comparative empirical research in

different geographical and cultural settings yet.

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Comparative study Turkey-Netherlands

AIM

To examine the influence of distinct socio-political and

cultural contexts on interactions between health care

providers, patients and informal interpreters from the

perspective of informal interpreters.

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INTERPRETING REALITY: Netherlands

Dutch healthcare providers infrequently make use of professional

interpreting services;

A majority of migrant patients with limited Dutch language proficiency

is accompanied by a family member to interpret for them (Meeuwesen

& Twilt, 2011)

Free provision of professional interpreting services in health care has

been scrapped since 2012.

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INTERPRETING REALITY: Turkey

A policy of monolingualism: ‘One state, one nation,one flag, one

language.’

Attempts to effectively ban people from speaking Kurdish.

From the ‘90s, a more flexible approach to minority languages and the

Kurdish issue.

However, so far, next to nothing has been done to train or pay

professional interpreters.

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SAMPLE 1

Dutch sample:

- 15 informal interpreters (5 men, 10 women);

- 8 Moroccan, 3 Turkish, 2 Azeri, 1 Iranian, 1 Italian-

Colombian;

- Mean age: 23 years (range 19-34);

- Mean interpreting experience: 10 years;

- - Mainly interpret for parents.

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SAMPLE 2

Turkish sample:

- 15 informal interpreters (9 men, 6 women);

- All Kurds: 9 Kurmani-speaking, 4 Zazas, 2 mixed.

- Mean age: 28 years (range 22-40);

- - Mean interpreting experience: 15 years;

- - Interpret for relatives and strangers.

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RESULTS: TECHNICAL ASPECTS

Turkey Netherlands

Half consider themselves good interpreters

Two third consider themselves good interpreters

No use of communication tools

Use of communication tools

Technical challenges in translating medical terminology

Technical challenges in translating medical terminology

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RESULTS: EMOTIONAL ASPECTS

.

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Turkey

Netherlands

Interpreting is regarded as part of everyday family life.

Over a third mention feeling burdened, often because of conflicting schedules.

A majority is upset about having to interpret at all for a person whose mother tongue is the most widely-used language in that area. “…interpreting means doing something that is forced on you by the state”.

A few expressed annoyance at the fact that their parents did not learn Dutch. “Sometimes I think: why don’t you have command of the [Dutch] language?”

RESULTS: PREFERENCES

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Turkey

Netherlands

Turkish doctors should learn Kurdish/more Kurdish-speaking doctors should be employed.

Strong preference for interpreting themselves.Professional interpreters are seen as ‘outsiders’.

“My family has been living on their own

land for … thousands of years. That’s why

I want them to have their own doctors,

using their own language. … We’re not

Turks living in Germany; we’re Kurds living

in Kurdistan …. We’re the real owners of

this land …. I’m not demanding

[professional interpreting services]; in fact I

want exactly the opposite.”

“I know about the whole situation, while a [professional] interpreter doesn’t know my mother at all. He or she does the job and goes home. But I know my mother’s complaints and when she suffers from them”.

RESULTS: ROLES

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Turkey

Netherlands

Many interviewees claim to function

as neutral conduits, rendering literate

translations. However, they often act as

advocates/primary interlocutors for the

patient.

No evidence for conduit role. Many act as ‘co-health care providers’ and advocates.

“I once went to the doctor with this old lady

and [the doctor] said: “I only give a referral if

she suffers because of her heart at night”.

But the old lady said, “I don’t have any pain

at night”. […]. I said, “Just say you are in

pain at night!”. Because I knew what the

doctor had just said to me, you know, so I

said: “Yes, she is in pain at night, but not as

much as during the day”. And then he said,

“Okay, if she is suffering at night, then I will

write a referral”.

CONCLUSIONS

Informal interpreters are unlikely to act as neutral conduits:

- Technical and emotional challenges.

- They commonly act as advocates.

Interpreters’ perspectives heavily influenced by socio-political and cultural contexts:

- Turkish interpreters less negative about their task than Dutch interpreters.

- - Preferences for professional/informal interpreting shaped by socio-political context.

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FOLLOW-UP STUDY

OBJECTIVE:

To investigate Dutch informal interpreters’ actual

performances in family practice regarding affective

communication.

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BACKGROUND

Focus on Turkish-Dutch informal interpreters:

- Turkish-Dutch patients largest minority group (CBS, 2013).

- Visit GP more often than native-Dutch patients (Devillé, Uiters, Westert & Groenewegen, 2006).

Focus on verbal expression of emotions:

- Less affective communication with migrant patients (e.g. Johnson, Roter,

Power, & Cooper, 2004; Schouten & Meeuwesen, 2006) - - Adequate emotion expression related to better health outcomes (e.g. Floyd,

Lang, McCord & Keener, 1995)

Sample & Method

11 Transcripts of triadic GP consultations with Turkish-Dutch

patients/interpreters;

- - 5 husbands, 3 sons, 1 daughter, 1 daughter-in-law, 1 female neighbour.

- - Mean age patients: 45 years (SD=11.8)

- - 10 Female patients

Coding system

Verona coding system for emotional sequences (VR-CoDES/VR-

CoDES-P)

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VR-CoDES Patients’ expression of emotions are coded as ‘cues’ and ‘concerns’.

Concern:

“A clear and unambiguous expression of an unpleasant current or recent

emotion that is explicitly verbalized”

Cue:

“A verbal or nonverbal hint which suggests an underlying unpleasant

emotion that lacks clarity.”

(e.g. Expressions of uncertainty, emphasizing, physiological correlates)

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VR-CoDES-P

Responses to patients’ cues are coded with 4 main

categories:

1. Non-explicit reducing space (NR): e.g. information-advice

2 Non-explicit providing space (NP): e.g. backchanneling

3. Explicit reducing space (ER): e.g. blocking

4. Explicit providing space (EP): e.g. empathic response

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Coding transcripts

VR-CoDES:

- Patients’ cues and concerns

- Interpreters’ independent cues/concerns

Interpreters’ responses to patients’ cues/concern:

1.Translation: correct, revision (downplaying, exaggerating, omission)

2. Response: VR-CoDES-P

3. Ignoring

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RESULTS: PATIENT & INTERPRETERS’ CUES Cues and

concerns

Mean per consultation

Frequencies

Cues patient 4.7 52

Cues interpreter 1.6 18

Concern patient interpreter

0 0

Concerns interpreters

0 0

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RESULTS: INTERPRETERS’ RESPONSES

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Interpreters’ responses to patients’ cues (%)

RESULTS: INTERPRETERS’ TRANSLATIONS

16% of cue translations correct.

42% of cues is being downplayed:

Pt: “Belim de agriyor her gun. Duramiyorum agridan.” [Translation: “My back hurts every day. The pain is

unbearable.”],

Int: “Yes, her back troubles her too because of that.”

16% of cues is being exaggerated:

Pt: “Cok agriyor.” [Translation: It hurts a lot.”]

Int: “This hurts a lot more now. This big, big, I have never seen that before.”

26% of cues is being ommitted:

Pt: “Haa ya iste o nefesi alamiyorum. Alirken nefesim daraliyor nefesim boyle, yaparken zorlaniyorum.”

[Translation: Oohh yes, that air I cannot breath. When I breathe, I suffocate when I do this, then I find that

tiring.”]

Int: “Very difficult breathing, that.”

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RESULTS: INTERPRETERS’ RESPONSES 75% non-explicit response

67% reducing space response

Information-advice (33%)

Pt: “Onu diyorum ya, kemik o zaman daha kotu olur ilerde. Turkiyeye gittigim doktor da

oyle dedi daha kotu olur dikkat et dedi hani yuruyus yap iste boyle kendi kendine boyle

sey.” [That’s what I mean, then the bone will get even worse in the future. The doctor in

Turkey has said that as well, that it will become worse. You have to take care, he said,

you have to walk and those kind of things.]

Int: “Simdi sey buldular ona ya sey buldular oraya sunni sey koyuyorlar.” [They now have

developed so and so for that, they put something artificial there.]

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CONCLUSIONS No patient concerns:

inhibition of emotion expression in the presence of family interpreters.

A quarter of all cues is being expressed independently by the interpreter:

Substantial translation revision of emotional cues

Interpreters’ responses most often concern non-explicit reducing space utterances

no evidence of conduit roles; informal interpreters perform other roles (e.g. advocate, system

agent, co-health care providers)

Discrepancy between self-reports and actual performance regarding affective

communication

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THANK YOU!

For more information: [email protected]

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