Interpreter-mediated communication in health care

Transcription

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

2 TRICC-PROJECT Five European countries: Netherlands, UK, Germany, Italy, Turkey. Objective: Develop interventions to enhance intercultural & bilingual competencies in health care. (see 2

3 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. 3

4 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. 4

5 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

6 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. 6

7 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. 7

8 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. 8

9 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 9

10 RESULTS: EMOTIONAL ASPECTS Turkey. Interpreting is regarded as part of everyday family life. A majority is upset about having to interpret at all for a person whose mother tongue is the most widelyused language in that area. interpreting means doing something that is forced on you by the state. Netherlands Over a third mention feeling burdened, often because of conflicting schedules. 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? 10

11 RESULTS: PREFERENCES 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. 11

12 RESULTS: ROLES 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 12 write a referral.

13 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. 13

14 FOLLOW-UP STUDY OBJECTIVE: To investigate Dutch informal interpreters actual performances in family practice regarding affective communication. 14

15 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) 15

16 Sample & Method 11 Transcripts of triadic GP consultations with Turkish-Dutch patients/interpreters; husbands, 3 sons, 1 daughter, 1 daughter-in-law, 1 female neighbour. - - Mean age patients: 45 years (SD=11.8) Female patients Coding system Verona coding system for emotional sequences (VR-CoDES/VR- CoDES-P) 16

17 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) 17

18 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 18

19 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 19

20 RESULTS: PATIENT & INTERPRETERS CUES Cues and concerns Mean per consultation Frequencies Cues patient Cues interpreter Concern patient interpreter Concerns interpreters

21 RESULTS: INTERPRETERS RESPONSES Interpreters responses to patients cues (%) 21

22 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. 22

23 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.] 23

24 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 24

25 THANK YOU! For more information: 25