TOWARD A MODEL OF INFORMAL INTERPRETER-MEDIATED COMMUNICATION IN HEALTH CARE Barbara Schouten NPIT3 CONFERENCE, WINTERTHUR, May.5-7 2016
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TOWARD A MODEL OF INFORMAL INTERPRETER-MEDIATED COMMUNICATION IN HEALTH CARE Barbara Schouten NPIT3 CONFERENCE, WINTERTHUR, May.5-7 2016
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What is the problem?
“I never know whether these women want their husbands to accompany them or that these men think they ought to come along, to control part of the conversation. Maybe I should ask them at the start of the consultation: are you here just to translate?” (Dutch female general practitioner)
CONCEPTS MODEL - Interpreters’ roles: “Are you here just to translate?” - Trust: “I never know whether these women want their husbands
to accompany them..” - Control (and Power): ”.. or that these men think they ought to
come along, to control part of the conversation.” Concepts identified by recent literature review (Brisset, Leanza & Laforest, 2013)
Based on concept approach (Kok, Schaalma, Ruiter & van Empelen, 2004) by linking concepts to theory.
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Interpreter - Individual - Social - System
Patient - Individual - Social - System
Provider - Individual - Social - System
Role expectations
Role conflict patient-interpreter
Role conflict provider-interpreter
Patient’scontrol
Provider’s control
Patient’spower
Provider’s power
Patient’strust
Provider’strust
Patient-Interpreter-Provider communication
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Interpreter - Individual - Social - System
Patient - Individual - Social - System
Provider - Individual - Social - System
Role expectations
Role conflict patient-interpreter
Role conflict provider-interpreter
Patient’scontrol
Provider’s control
Patient’spower
Provider’s power
Patient’strust
Provider’strust
Patient-Interpreter-Provider communication
‘Are you here just to translate’? ROLES
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“Behaviours and skills associated with being an interpreter as expected by
institutions, practitioners and patients” (Brisset et al., 2013). (AND
INTERPRETERS THEMSELVES)
Role expectations: beliefs concerning the qualities, behaviors and characteristics
suitable to the interpreters’ role performances.
Shaped by:
Individual factors: socio-demographics, language proficiency
Social factors: interpersonal relations, i.e. between interpreter-patient-provider
System factors: healthcare context, socio-cultural context
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Interpreter - Individual - Social - System
Patient - Individual - Social - System
Provider - Individual - Social - System
Role expectations
Role conflict patient-interpreter
Role conflict provider-interpreter
Patient’scontrol
Provider’s control
Patient’spower
Provider’s power
Patient’strust
Provider’strust
Patient-Interpreter-Provider communication
ROLE CONFLICT Discrepant role expectations between patient and provider è Provider: conduit role, caretaker role, system agent role Patient: conduit role, caretaker role, advocating role Interpreter: wide variety of roles
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Lifeworld
System
Lifeworld
System
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Interpreter - Individual - Social - System
Patient - Individual - Social - System
Provider - Individual - Social - System
Role expectations
Role conflict patient-interpreter
Role conflict provider-interpreter
Patient’scontrol
Provider’s control
Patient’spower
Provider’s power
Patient’strust
Provider’strust
Patient-Interpreter-Provider communication
‘Do these men come along to control part of the conversation’? CONTROL Perceived/actual behavioral control:
“The extent to which one is able (or perceives oneself to be able) to have control over the course and content of the communication process, in order to achieve relational and strategic outcomes.” (adapted from Ajzen’s Theory of Planned Behavior, 1991).
Influenced by - Internal factors: skills and abilities (e.g. linguistic/communicative
skills) - External factors: resources (e.g. Interpreter)
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Control Providers: diminished sense of control over the communication process
when working with informal interpreters Why? Interpreters’ communicative behaviors are not aligned with
expected conduit role (e.g. sidetalk, primary interlocutor, etc.) Patients: low level of control over affective communication. Higher level
of control over instrumental content of communication. Why? Interpreters block/ignore patient’s emotional utterances
(Family) interpreters advocate for patient’s rights to receive adequate treatment.
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Interpreter - Individual - Social - System
Patient - Individual - Social - System
Provider - Individual - Social - System
Role expectations
Role conflict patient-interpreter
Role conflict provider-interpreter
Patient’scontrol
Provider’s control
Patient’spower
Provider’s power
Patient’strust
Provider’strust
Patient-Interpreter-Provider communication
Power Social power: “The potential to influence beliefs or behaviors of a person...” (French & Raven,
1959). Expert power: based on having skills and expertise needed by another (e.g.
medical expertise) Loss of control leads to loss of expert power among providers to influence beliefs/behavior patient
Legitimate power: based on feelings of entitlement, derived from group norms
and values, to invoke the help of the interpreter by patients Having instrumental control leads to feelings of empowerment among patients to exert influence on the beliefs/behaviors of the provider (i.e. decision-making process).
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Interpreter - Individual - Social - System
Patient - Individual - Social - System
Provider - Individual - Social - System
Role expectations
Role conflict patient-interpreter
Role conflict provider-interpreter
Patient’scontrol
Provider’s control
Patient’spower
Provider’s power
Patient’strust
Provider’strust
Patient-Interpreter-Provider communication
“I never know whether..”: the concept of trust
“The optimistic acceptance of a vulnerable situation in which a truster [patient/provider] believes the trustee [interpreter] to care for the truster’s interests.” (Hall, Dugan, Zheng & Mishra, 2001). 5 Dimensions: 1. Fidelity: ‘pursuing a patient’s best interests’ 2. Competence: ‘avoiding mistakes and producing the best achievable results’ 3. Honesty:‘telling the truth and avoiding intentional falsehoods’ 4. Confidentiality:‘protection and proper use of sensitive or private information’ 5. Global trust: irreducible, holistic, component of trust.
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Trust: empirical findings Providers: low levels of trust in informal interpreters’ competence, confidentiality, honesty Patients: mixed results More trust in informal interpreters’ fidelity, honesty, as well as global trust (e.g. Edwards, 2005; Robb & Greenhalgh, 2006). More trust in professional interpreters’ competence and confidentiality (e.g. Macfarlane, Dzebisova, Karapish, Kovacevic, Ogbebor & Okonkwo, 2009)
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Interpreter - Individual - Social - System
Patient - Individual - Social - System
Provider - Individual - Social - System
Role expectations
Role conflict patient-interpreter
Role conflict provider-interpreter
Patient’scontrol
Provider’s control
Patient’spower
Provider’s power
Patient’strust
Provider’strust
Patient-Interpreter-Provider communication
NEXT STEP: Testing the model (PhD-project Rena Zendedel)
• Mixed-method study in general practice (interviews, surveys, observational data)
• Interviews: explore & input for the surveys • Surveys: relate concepts • Observations: develop coding system to relate concepts to
interpreters’ communicative behaviors.
- Translations - Reactions - Initiations - Ignoring
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TRANSLATIONS
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(Delayed)Translation Pat/HCP
“Correct” translation
Literal Paraphrase
Revised translation
Addinfo Omitinfo Cult. Adaptation
Instrumental Instrumental Affective Affective
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Concept Comm. Behaviors Codes Examples
Conduit role Literal translation TRANSPAT-LIT TRANSDOC-LIT
Advocacy role: Performing role behaviors that strive to achieve the interests of the voice of the lifeworld
Adding affective info.
TRANSPAT-REV-ADDINFO-AFFECT.
p: “My headache bothers me” i: “Her headache bothers her a lot. I even saw her cry this morning”
System role Performing role behaviors that strive to achieve the interests of the voice of medicine
Reacting to patient’s utterance
REACTPAT-SYSTEM
p: “A long time ago, euhm.. i: “Just tell it to me!”
Thank you [email protected]
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