Negotiating role boundaries in interpreter-mediated consultations: processes and perceptions
Dr Maria Stubbe, Research Director of the Department of Primary Health Care & General Practice, and Co-Director of the Applied Research on Communication in Health (ARCH) Group at the Wellington School of Medicine and Health Sciences, University of Otago
Friday, 17 October 2014, 1pm to 2pm
New Radcliffe House, Room 2
This is an internal University of Oxford seminar.
As New Zealand becomes more culturally and linguistically diverse, cross-cultural health encounters where the patient has limited proficiency in English are also becoming increasingly common. Interpreters are often needed to ensure adequate communication and clinical care in such cases. However, use of informal/untrained interpreters (or no interpreter) remains very common, in part due to resourcing constraints. Our previous research has shown that many clinicians also have limited knowledge or training to support their practice in this area. The overall aim of the study reported on here was to explore the interactional processes and perceptions of communication in New Zealand general practice consultations where an interpreter is used. Relatively few studies internationally have used direct observation to investigate the finer detail of how interpreted consultations unfold. Similarly, few studies address the issue of how effective and satisfactory such health interactions are from the perspectives of all participants. This paper will present findings relating to one analytic theme from this study, namely how the role of ‘interpreter’ is perceived and negotiated interactionally by all three parties to the interaction.
This was an observational study of interpreted general practice consultations in NZ. Using a novel methodology, the research team collected, transcribed and analysed video-recordings of 17 interpreted general practice consultations and post-consultation interviews with all participants using interactional and thematic analysis. This data set includes a variety of interpreting ‘models’, including professional interpreters, bilingual health professionals, and informal interpreters (family or community members).
Even where individual participants clearly articulate what they see as the role of the interpreter, these perceptions are not always concordant. When we closely observe the unfolding interaction, role boundaries are in fact continually being negotiated and re-negotiated along with sometimes competing interactional, interpersonal, cultural and clinical agendas. Participants can be observed to use a range of discursive strategies to manage such shifts in footing and alignment.
The interactional complexity of interpreter-mediated consultations is easily underestimated, and merits further consideration by health professionals. Findings from studies such as this one provide an evidence base for health practitioners, patients and interpreters to reflect on effective strategies to improve interpreter-mediated consultation.