As childbirth becomes more complicated- technically, diagnostically, and socially, it is becoming even more difficult to communicate these intricacies to pregnant, laboring and postpartum women with Limited English Proficiency (LEP). Are providers and hospitals keeping up with these changes? In an study called, “Do Hospitals Measure up to the National Culturally and Linguistically Appropriate Services Standards?”, researchers looked at the federal regulations (The Culturally and Linguistically Appropriate Services) required of health care organizations to provide interpreter services to LEP patients. They found that of the hospitals studies, 13% met all the CLAS requirements, 68% met some of the regulations, and 19% met non of the requirements at all. They concluded, “Enforcement of these regulations is inconsistent, and thus does not motivate hospitals to comply...our study reinforces the importance of these efforts and helps target interventions to improve the delivery and safety of care to limited English proficient patients”(Diamond, Jacobs, Wilson-Stronks 1).
When interpreter services are available, are interpreters being utilized appropriately? In an qualitative study called, “Getting by: Underuse of Interpreters by Resident Physicians”, researchers used in-depth interviews with care providers working in a hospital with excellent interpreter services. The research concluded that although an interpreter was ready and accessible, physicians were not using them- “residents at the study institutions with interpreters readily available found it easier to "get by" without an interpreter, despite misgivings about negative implications for quality of care.”(Diamond, Schenker, Curry, Bradley and Fernandez 1) Instead of using interpreting services, most the of the physicians in this study were communicating with LEP patients using hand movements, the patients limited language skills or by asking a nearby family member or friend, which “normalized the underuse of professional interpreters, despite recognition that patients with LEP are not receiving equal care” (Diamond, Schenker, Curry, Bradley and Fernandez 1)
In the case of no interpreter available, what does research say about the abilities of non-interpreters in communicating care? In an article called, “Are Good Intentions Good Enough? Informed Consent Without Trained Interpreters”, Authors Hunt and Voogd found, “In observing consultations with Spanish speaking patients, we were often struck by the limited amount of information that was actually communicated. Interpreters often seemed to lack the linguistic fluency and/or the technical medical understanding necessary to provide an adequate interpretation” (Hunt, Voogd 1). Additionally, it is clear from a 2010 consumer survey called, “Language barriers and the use of interpreters in the public health services. A questionnaire-based survey”, consumers of interpreter services are dissatisfied with the care they are receiving- “Many survey participants expressed dissatisfaction with both their own methods of working with interpreters and with the interpreter's qualifications” (Syed 1)
It is clear that either the misuse of interpreters or no use of interpreters at all contributes to the growing health disparities we see in our country. In terms of risks an benefits, it seems the risks to the patient are considerable- uninformed consent and unequal care being the two central issues. The benefits seem to only be bestowed on the care provider, who without an interpreter to slow them down, is allowed to provide quick, easier to administer (though ultimately sub-par) care. Without the use of an interpreter for LEP client/patients, care is not specialized, informed or appropriate for the needs of the client/patient. Although most of the research on this subject is from hospitals, and more research is needed on Midwifery Care and interpreter use, it is fair to deduce that all care providers would benefit from increased cultural competency in this arena.
How do we, as providers of care, bridge the language gap and provide specialized care to our LEP clients? First, clients need to have access to professionally trained interpreters. Second, it seems clear that all providers within institutions need to create concrete policies for LEP patients. In a study called, “Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practice”, researchers came to the conclusion that, “Based on our results, we believe that other priority activities will include developing an explicit hospital policy statement on interpreter use (when, why and how interpreters should be called), and communicating this policy during orientation of all new staff” (Hudelson and Vilpert 1). Making correct, efficient and reliable translation services available must be a priority, as well as educating care providers on how to utilize these services correctly.
Annotated Bibliography
Syed, Kale. "Language barriers and the use of interpreters in the public health services. A questionnaire-based survey.." National Center of Minority Health Research. 81.2 (2010): Print
The authors of this study sought to examine consumer satisfaction with interpreter services. They studied how often health care workers had a need for translation services, how they work with interpreters in those situations, and how competently they felt the care was used. Both physicians and nurses answered the survey. From the outcome of the survey, the authors felt there was enough evidence to suggest that there should be come awareness raising of the interpreter issue and how they are used with clients/patience.
Diamond, Wilson-Stronks, and Jacobs. "Do hospitals measure up to the national culturally and linguistically appropriate services standards?." Department of Health Policy Research. (2010): Print.
In this study researchers investigated the issue of CLAS, a federal cultural and linguistics regulating body, and if hospitals were complying with their regulations. The authors used a cross-sectional survey of Hospital Interpreter Service Managers and found that over 30% of hospitals studies were non-compliant with these federal regulations. Ironically, they found that although patients were informed of their rights to interpreter services, they were only informed in English.
Diamond, , Schenker, Curry, Bradley, and Fernandez. "Getting by: underuse of interpreters by resident physicians.." Robert Wood Johnson Scholors Program, Yale University School of Medicine. (2009): Print.
In this study, the authors looked at language barriers and how it complicated physician-patient communication. They looked specifically at the decision making process of physicians who had access to “excellent” translation service for LEP patients. Interestingly, the physicians seemed to prefer to struggle though communication using incomplete information and hand gestures than waiting for interpreter services to communication with the patient directly. I can only draw from this that the physicians involved in the study were under the impression that translation services were too bothersome, time consuming or inefficient to be used.
Hunt, and Voogd. "Are Good Intentions Good Enough?: Informed Consent Without Trained Interpreters." Society of Generalized Internal Medicine. 22.5 (2007): 598-605. Print.
This is one of the few articles I found that was directly related to prenatal care. The study was framed within the context of informed consent- something that cannot be fully obtained if the client is not able to understand the provider. The authors mostly found that communication issues were a consequence of untrained translators relying on their own interpretation of what the client did or did not understand in the consent process.
Hudelson, , and Vilpert. "Overcoming language barriers with foreign-language speaking patients: a survey to investigate intra-hospital variation in attitudes and practices." BMC Health Service Reserves. 15. (2009): 187. Print.
I was not able to find much in the way of problem solving in this subject specifically (although much of the cultural competency reading we did could easily apply to this issue), but this article did offer some concrete ideas about improving the use of interpreters. Creating training standards and implementing policy level change are definitely changes that need to be implemented of this issue is going to be solved.
