Improving feeling of control and trust in interpreter-mediated mental health consultations.

Language barriers are among the most critical factors in health care disparities. Low language proficiency is consistently associated with a high prevalence and severity of mental health disorder symptoms. Despite the advantages of working with an interpreter, most practitioners report difficulties, especially with trust and the feeling of control. The main objective of this exploratory qualitative intervention research is to examine the impact of training when working with interpreters and their inclusion in follow-ups. This impact is evaluated in the changes in feelings of control and trust for the practitioners who received the training, for the trained interpreters included in follow-ups and for the patients of these follow-ups. Semistructured interviews were conducted with individuals involved in five follow-ups at four public mental health clinics in Paris, France. The project had two phases: before (N = 18) and a few months after (N = 12) the training. Interviews were transcribed and thematically analyzed. Before the training, practitioners perceived the potential for collaboration with interpreters and the complexity of triadic consultations. Interpreters expressed irritation and disappointment at the lack of recognition, and patients seemed confident because they had already built a relationship with practitioners. After the training and inclusion of interpreters, trust is better established between interpreters and practitioners, which has substantial effects. All the protagonists state that trust positively impacts the relationship with patients and the therapeutic process. Although some practitioners still doubt the sessions' control, the intervention helps them to gain knowledge and critically examines their clinical modus operandi. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Typology of Healthcare Interpreter Positionings as applied to family medicine.

Interpreters facilitate cross-cultural communication, particularly in health care systems where treatment is provided to patients who do not speak the institution language. The effectiveness of the process depends, among other things, on the ability of the interpreter and the clinician to collaborate, which the Typology of Healthcare Interpreter Positionings is intended to facilitate. OBJECTIVES: The primary purpose of this study was to assess the potential applicability of the Typology, previously tested in mental health settings, to a family medicine setting. The secondary objective was to verify the complementarity of the concept of interpreter stance. METHOD: A deductive thematic analysis and co-occurrence analyses were conducted following focus groups with 89 experienced and trainee family physicians. RESULTS: The potential of the Typology for family physicians was confirmed. Although the concept of stance was found to be complementary, it could not be integrated directly into the Typology. CONCLUSIONS: The Typology is applicable in both family medicine and mental health settings. The Typology provides conceptual guidance that the clinician and interpreter can use with confidence to deepen their collaboration.

[Seven Strategies for Collaborating with Public Service Interpreters]. / Sept stratégies pour collaborer avec l'interprète de service public.

Introduction Public Service Interpreting (PSI) is gradually becoming part of Quebec society. The institutional and organizational mechanisms designed to provide a framework for this interpretative practice are not yet generalized to all public services in the province, and where they are, many challenges remain. Objective The objective of the study was to provide stakeholders working in the mental health sector with practical strategies to foster collaboration with public service interpreters. Methodology A critical reading of the literature (narrative review) was carried out with the objective of offering a new perspective on the already existing object of study. Because it offers a critical synthesis of key information in the field, this method is particularly well suited to the needs of the reader who is not up to date with advances in the field. Results This critical reading first made it possible to identify two general challenges concerning mental health practitioners called upon to collaborate with public service interpreters: the recognition of the interpreter's role and the acknowledgement of the diversity of communicative situations likely to foster their collaboration. This paper presents seven interprofessional collaboration strategies that mental health practitioners can apply to meet these challenges: 1) using vocabulary drawn from the public service interpreter Positioning and Postures Typologies; 2) obtaining information to be transmitted in the interpreting assignment; 3) allocating time for briefings and 4) for debriefings; 5) encouraging the interpreter's presentation; 6) framing small and big talk; and 7) promoting the continuity of care. Discussion The present study offers a new perspective on some of the distinctive tensions in the PSI domain. The 7 proposed collaboration strategies are a response to these and aim to improve the quality of intercultural communication and services offered to users by promoting knowledge transfer. They are specifically addressed to knowledge users, take their practices into account and are explained using non-specific terms.

[Interpreter Mediated Psychological Assessment: A Three-Step Practice (Before-During-After)]. / L'évaluation psychologique avec interprète : une pratique en 3 phases (l'avant ­ le pendant ­ l'après).

The need for the services of a healthcare interpreter to treat allophone patients is, today, indisputable. The scientific literature demonstrates such a need in all medical specialties. In mental health, the situation is particularly sensitive when a psychological assessment requires the services of an interpreter. Objectives To explore the best practices highlighted in the previous literature for working with an interpreter in mental health and apply them to the specific context of psychological assessments. Methods A synthesis of key research recommendations for communicating through an interpreter was conducted. Results A compilation of best practices for ensuring quality psychological assessment when working in partnership with an interpreter is provided, focusing on key issues to consider when assessing linguistically and culturally diverse patients. This compilation is organized in 3 stages: before, during and after the consultation. For example, the need to prepare for the consultation with the interpreter (briefing), the impossibility of requesting "word-for-word" interpreting (except in very special cases), and the need for a debriefing with the interpreter to complete the assessment. Discussion Mental health professionals can optimize their collaboration with interpreters in psychological assessment by applying this three-step model, which will improve cross-cultural communication.

Using patient companions as interpreters in the Emergency Department: An interdisciplinary quantitative and qualitative assessment.

OBJECTIVES: To explore the perceived and actual quality of communication and the conversational mechanisms through which misunderstandings arise in linguistically diverse Emergency Department consultations. METHODS: A mixed method approach was used, based on audio-records of consultations which rely on patient companions for linguistic support, and ethnographic contextual data. Interpreting errors and their potential impact on the clinical reasoning process and doctor-patient relationships were quantitatively assessed. Complementary qualitative ethnographic research provided a richer understanding of the context. The study involved interdisciplinary collaboration with specialists in applied linguistics, medicine, and psychology. RESULTS: Accurate interpretation occurred in as few as 19% of interpreter speech turns. Answering for the patient and omitting information were the most frequent errors. The nature and severity of the impact of the errors varied. Answering for the patient had the greatest clinical impact. The omission of messages from the doctor to the patient negatively affected doctor-patient relationships. CONCLUSION: Gaps were observed between the perceived and the actual quality of communication, although patient companions often provided useful information. PRACTICE IMPLICATIONS: In addition to raising awareness among doctors on the potential risks of using AHIs, EDs should adjust their management to increase the utilization of onsite and remote PIs.

Qualitative studies of insomnia: Current state of knowledge in the field.

Despite its high prevalence and burden, insomnia is often trivialized, under-diagnosed, and under-treated in practice. Little information is available on the subjective experience and perceived consequences of insomnia, help-seeking behaviors, and treatment preferences. The use of qualitative approaches (e.g., ethnography, phenomenology, grounded theory) may help gain a better understanding of this sleep disorder. The present paper summarizes the evidence derived from insomnia studies using a qualitative research methodology (e.g., focus group, semi-structured interviews). A systematic review of the literature was conducted using PsycINFO and Medline databases. The review yielded 22 studies and the quality of the methodology of each of them was evaluated systematically using the critical appraisal skills programme (CASP) appraisal tool. Selected articles possess at least a very good methodological rigor and they were categorized according to their main focus: "Experience of insomnia", "Management of insomnia" and "Medicalization of insomnia". The main findings indicate that: 1) insomnia is often experienced as a 24-h problem and is perceived to affect several domains of life, 2) a sense of frustration and misunderstanding is very common among insomnia patients, which is possibly due to a mismatch between patients' and health care professionals' perspectives on insomnia and its treatment, 3) health care professionals pay more attention to sleep hygiene education and medication therapies and less to the patient's subjective experience of insomnia, and 4) health care professionals are often unaware of non-pharmacological interventions other than sleep hygiene education. An important implication of these findings is the need to develop new clinical measures with a broader scope on insomnia and more targeted treatments that take into account the patient's experience of insomnia. Greater use of qualitative approaches in future research may produce novel and more contextualized information leading to a more comprehensive understanding of insomnia.

A Systematic Review of Patients' Experiences in Communicating with Primary Care Physicians: Intercultural Encounters and a Balance between Vulnerability and Integrity.

Communication difficulties persist between patients and physicians. In order to improve care, patients' experiences of this communication must be understood. The main objective of this study is to synthesize qualitative studies exploring patients' experiences in communicating with a primary care physician. A secondary objective is to explore specific factors pertaining to ethnic minority or majority patients and their influence on patients' experiences of communication. Pertinent health and social sciences electronic databases were searched systematically (PubMed, Cinahl, PsychNet, and IBSS). Fifty-seven articles were included in the review on the basis of being qualitative studies targeting patients' experiences of communication with a primary care physician. The meta-ethnography method for qualitative studies was used to interpret data and the COREQ checklist was used to evaluate the quality of included studies. Three concepts emerged from analyses: negative experiences, positive experiences, and outcomes of communication. Negative experiences related to being treated with disrespect, experiencing pressure due to time constraints, and feeling helpless due to the dominance of biomedical culture in the medical encounter. Positive experiences are attributed to certain relational skills, technical skills, as well as certain approaches to care privileged by the physician. Outcomes of communication depend on patients' evaluation of the consultation. Four categories of specific factors exerted mainly a negative influence on consultations for ethnic minorities: language barriers, discrimination, differing values, and acculturation. Ethnic majorities also raised specific factors influencing their experience: differing values and discrimination. Findings of this review are limited by the fact that more than half of the studies did not explore cultural aspects relating to this experience. Future research should address these aspects in more detail. In conclusion, all patients seemed to face additional cultural challenges. Findings provide a foundation for the development of tailored interventions to patients' preferences, thus ensuring more satisfactory experiences. Health care providers should be sensitive to specific factors (cultural and micro-cultural) during all medical encounters.

Integration of interpreters in mental health interventions with children and adolescents: The need for a framework.

Few empirical studies have detailed the specificities of working with interpreters in mental healthcare for children. The integration of interpreters in clinical teams in child mental healthcare was explored in two clinics, in Montreal and Paris. Four focus groups were conducted with interpreters and clinicians. Participants described the development of the working alliance between interpreters and clinicians, the delineation of interpreters' roles, and the effects of translation on the people in the interaction. Integrating interpreters in a clinical team is a slow process in which clinicians and interpreters need to reflect upon a common framework. An effective framework favours trust, mutual understanding, and valorization of the contribution of each to the therapeutic task. The interpreter's presence and activities seem to have some therapeutic value.

Language barriers in mental health care: a survey of primary care practitioners.

Many migrants do not speak the official language of their host country. This linguistic gap has been found to be an important contributor to disparities in access to services and health outcomes. This study examined primary care mental health practitioners' experiences with linguistic diversity. 113 practitioners in Montreal completed a self-report survey assessing their experiences working with allophones. About 40% of practitioners frequently encountered difficulties working in mental health with allophone clients. Few resources were available, and calling on an interpreter was the most common practice. Interpreters were expected to play many roles, which went beyond basic language translation. There is a clear need for training of practitioners on how to work with different types of interpreters. Training should highlight the benefits and limitations of the different roles that interpreters can play in health care delivery and the differences in communication dynamics with each role.

Sleep and quality of life in urban poverty: the effect of a slum housing upgrading program.

STUDY OBJECTIVES: To evaluate the effect of a housing transition on sleep quality and quality of life in slum dwellers, participating in a slum housing upgrading program. DESIGN: Observational before-and-after study with a convergent-parallel mixed method design. SETTING: Five slums located in the metropolitan area of Buenos Aires, Argentina. PARTICIPANTS: A total of 150 slum dwellers benefited by a housing program of the nonprofit organization TECHO (spanish word for "roof"). INTERVENTIONS: Participants moved from their very low-quality house to a basic prefabricated 18 m(2) modular house provided by TECHO. MEASUREMENTS AND RESULTS: The Pittsburgh Sleep Quality Index (PSQI) and World Health Organization Quality of Life brief scale (WHOQOL-BREF) were administered before and after housing upgrading. Data about housing conditions, income, education, sleeping conditions, and cardiovascular risk were also collected. Semistructured interviews were used to expand and nuance quantitative data obtained from a poorly educated sample. Results showed that sleep quality significantly increased after the housing program (z = -6.57, P < 0.001). Overall quality of life (z = -6.85, P < 0.001), physical health domain (z = -4.35, P < 0.001), psychological well-being domain (z = -3.72, P < 0.001) and environmental domain (z = -7.10, P < 0.001) of WHOQOL-BREF were also improved. Interviews demonstrated the importance of serenity for improving quality of life. CONCLUSIONS: A minimal improvement in the quality of basic housing can significantly increase sleep quality and quality of life among slum dwellers. Understanding sleep and daily life conditions in informal urban settlements could help to define what kind of low-cost intervention may improve sleep quality, quality of life, and reduce existent sleep disparity.

Working with interpreters in health care: a systematic review and meta-ethnography of qualitative studies.

OBJECTIVE: To identify relational issues involved in working with interpreters in healthcare settings and to make recommendations for future research. METHODS: A systematic literature search in French and English was conducted. The matrix method and a meta-ethnographic analysis were used to organize and synthesize the data. RESULTS: Three themes emerged. Interpreters'roles: Interpreters fill a wide variety of roles. Based on Habermas's concepts, these roles vary between agent of the Lifeworld and agent of the System. This diversity and oscillation are sources of both tension and relational opportunities. DIFFICULTIES: The difficulties encountered by practitioners, interpreters and patients are related to issues of trust, control and power. There is a clear need for balance between the three, and institutional recognition of interpreters' roles is crucial. COMMUNICATION CHARACTERISTICS: Non-literal translation appears to be a prerequisite for effective and accurate communication. CONCLUSION: The recognition of community interpreting as a profession would appear to be the next step. Without this recognition, it is unlikely that communication difficulties will be resolved. PRACTICE IMPLICATIONS: The healthcare (and scientific) community must pay more attention to the complex nature of interpreted interactions. Researchers need to investigate how relational issues in interpreted interactions affect patient care and health.

The patient's Lifeworld: building meaningful clinical encounters between patients, physicians and interpreters.

In this paper, our objectives are first to explore the different ways physicians and interpreters interact with patients' Lifeworld, and second, to describe and compare communication patterns in consultations with professional and those with family interpreters. We conducted analyses of transcriptions of 16 family practice consultations in Montreal in the presence of interpreters. Patterns of communication are delineated, grounded in Habermas' Communicative Action Theory and Mishler's operational concepts of Voice of Medicine and Voice of Lifeworld. Four communication patterns emerged: (1) strategically using Lifeworld data to achieve biomedical goals; (2) having an interest in the Lifeworld for itself; (3) integrating the Lifeworld with biomedicine; and (4) referring to another professional. Our results suggest physicians engage with patients' Lifeworld and may benefit from both types of interpreters' understanding of the patient's specific situations. A professional interpreter is likely to transmit the patient's Lifeworld utterances to the physician. A family member, on the other hand, may provide extra biomedical and Lifeworld information, but also prevent the patient's Lifeworld accounts from reaching the physician. Physicians' training should include advice on how to work with all types of interpreters and interpreters' training should include mediation competencies in order to enhance their ability to promote the processes of co-construction of meaning.

Interruptions and resistance: a comparison of medical consultations with family and trained interpreters.

While working with trained interpreters in health care is strongly recommended, few studies have looked at the subtle differences in communication processes between trained and "ad hoc" interpreters, such as adult family members. Using Habermas' Communicative Action Theory (CAT) which distinguishes between the Lifeworld (contextually grounded experiences) and the System (decontextualized rules), we analysed 16 family practice consultations with interpreters, 10 with a trained interpreter and 6 with a family member. We found clear differences in communication patterns between consultations with a trained interpreter and consultations with a family member as interpreter. In both cases the Lifeworld is frequently interrupted and the outcomes are similar: the Lifeworld is rarely heard and acknowledged by the physician. Physicians interrupt the Voice of the Lifeworld significantly more with a trained interpreter than with a family member. Family members and trained interpreters also interrupt the Voice of the Lifeworld just as much. However, these interruptions differ in their functions (both physicians and interpreters interrupt to keep the interview on track to meet the biomedical goals; family interpreters interrupt to control the agenda). We have identified patients' resistance when physicians ignore their Lifeworld, but this resistance is usually only transmitted by professional interpreters (and not by family interpreters). We identified specific risks of working with family interpreters: imposing their own agenda (vs. the patient's one) and controlling the consultation process. Even if the collaboration with trained interpreters becomes more widespread, work with "ad hoc" interpreters will continue to occur. Therefore, institutions should provide training and organizational support to help physicians and patients to achieve communication in all situations.

Through interpreters' eyes: comparing roles of professional and family interpreters.

OBJECTIVE: We describe and compare the perceptions of professional and family member interpreters concerning their roles and tasks as interpreters in primary care clinical encounters. METHODS: Encounters between physicians (19) and patients (24) accompanied by a professional (6) or a family (9) interpreter were videotaped. Stimulated recall was used to elicit interpreters' perceptions of their role in the clinical encounter. We analyzed transcriptions of the interpreter interviews using Atlas-ti software. RESULTS: The roles professional interpreters identified were: information transfer; creating a safe environment for the patient; mediation between cultures; maintaining professional boundaries. Family interpreters perceived their roles (facilitating understanding; ensuring diagnosis and treatment; interacting with the health care system) as part of their responsibilities as a family member. CONCLUSION: Professional interpreters act mainly to ensure information transfer. Family interpreters act mainly as a third participant often speaking as themselves rather than rendering the words of doctor and patient into the other's language. PRACTICE IMPLICATIONS: To obtain the maximum benefit from a professional interpreter the physician must invite the interpreter to act as an advocate for the patient and a culture broker. Physicians should always use a professional interpreter to ensure accurate information transfer. A family member should often be included in encounters to serve as a valuable patient advocate.

Doctor-patient communication in primary care with an interpreter: physician perceptions of professional and family interpreters.

OBJECTIVE: This paper explores physician perceptions of the ways professional and family interpreters affect their performance of doctor-communication tasks described in the Calgary-Cambridge Framework. METHODS: Physicians' (19) encounters with patients (24) accompanied by an interpreter were videotaped. Stimulated recall was used to elicit each of the participants' perceptions of the clinical encounter. We analyzed transcriptions of the physician interviews using Atlas-ti software. RESULTS: Physicians perceived all communication tasks to be more difficult using an interpreter than when one was not needed. Physicians perceived family interpreters to be less skilled translators than professional interpreters. Physicians expected professional interpreters to serve as culture brokers at least some of the time. Although only some family interpreters were also caregivers, physicians assumed that all of them fulfilled caregiver roles. CONCLUSION: With professional interpreters, physicians follow communication rules they were taught. In contrast, physicians act as though these rules are not relevant with family interpreters who they treat as caregivers. PRACTICE IMPLICATIONS: Guidelines to working with an interpreter should include directives on working with both professional and family interpreters, describing the similarities and differences with each type, and modifying the clinical encounter process to correspond to those attributes.