Interpreter Services in Healthcare: An Untapped Resource in the Broad Area of Public Health

Valeria Pernas and Garvita Thareja

Equitable access to quality health care is a fundamental human right. For people living in the United States who do not speak English, a major barrier to healthcare accessibility is language; however, with reliable access to interpretation services, these patients could have better health outcomes. Understanding medical terminology and treatment plans can be difficult even for those that are English speaking Trying to understand unfamiliar medical terminology with limited-English proficiency (LEP) can add extra strain on achieving successful and satisfactory patient care Language interpretation services have an important role in health care for this population When present, they can help simplify and translate complex medical language to reduce barriers to quality healthcare in diverse communities. In order for someone with LEP to utilize interpretation services they need to have access. Having interpretation services available to LEP increases the chances of effective communication with a health provider, therefore improving patient outcomes.

The United States is a highly diverse country especially in terms of languages spoken, with 67 million people who speak a language other than English at home, as well as many whose proficiency in the English language is low (Camarota, 2014) Proficiency in understanding complex medical terminology and the ability to articulate one’s condition to a healthcare provider is important for patient success This population is also more likely to encounter uninformed consent, inconsistent treatment, and irregular follow ups due to miscommunication (Lang, 2022) Those who are in need of interpretation services and do not or are unable to utilize them are at a disadvantage in receiving both equitable and reliable health care. Access to applied interpreting services can make or break the success of a health protocol for a patient in this demographic.

There is a gap in the need for interpretation services and resources available. A study looking at 19,627 patients that stayed overnight at a hospital identified that “for 15.7% of episodes of care, a healthcare interpreter was identified as being required at hospital admission. In 3.7% [of patients needing an interpreter], a healthcare interpreter was provided” (Blay et al, 2018) This shows that of the cases that were identified as requiring an interpreter, only a very small percentage received the necessary support Understanding the factors that contribute towards this gap is important to develop solutions that could increase the healthcare experience for the language-diverse communities in the United States.

A problem faced within healthcare is the proper use of resources for linguistic interpretation provided during a health visit, creating barriers that prevent patients from effectively communicating with physicians and receiving adequate care (Al Shamsi et al, 2022) One factor that may decrease the utilization and accessibility of interpretation services is proper training and briefing of staff on what is available and how patients can use the services A survey conducted in 2020 of staff members at a hospital primarily serving LEP patients sought to gauge the staff member’s knowledge of the facility’s available interpretation services. Questions on the survey covered topics such as hospital staff’s personal training with interpretation services and what they knew about the resources. The results of this survey indicated that the staff at this hospital were severely under-trained in the aspect of interpretation services available for patients The findings from this study show that LEP patients sometimes have limited access to available interpretation services due to poor application or understanding of services by hospital staff (Taira et al, 2020)

A similar study showed the effects that insufficient use of interpretation services can have on an LEP patient’s experience during hospital visits. Seattle Children’s Hospital has various integrated language interpretation modalities, including over-the-phone interpretation services, touch screen devices with 24-hour access to video online interpreters, as well as one in-person Spanish translator dedicated to the emergency department during its peak hours (Hartford et al, 2019) Patient records showed that interpretation services for LEP patients were underutilized, with only 454% of them receiving the aid (Hartford et al, 2019) As for health outcomes, patients with LEP experienced a decreased likelihood of admittance as well as higher occurrences of unexpected ICU transfers within 24 hours for those who were admitted, compared to patients that were English-proficient (Hartford et al., 2019). The increase in ICU transfers within LEP patients was correlated to findings that showed they were given lower acuity and complexity ratings in terms of their condition during admittance, suggesting that the severity of their symptoms may not have been properly communicated or understood Hartford et al, 2019).

In-person interpretation is commonly thought to be the traditional application of translating resources, but financial and human-resource barriers can make this method inaccessible, as seen in the Seattle Children’s Hospital study, where only one Spanish interpreter was available during peak hours. While hiring more staff dedicated to interpreting roles may not be systemically accessible, implementing easy-touse translation services and properly training staff on their use and indications can be attainable and successful

There are many online, over-the-phone, and digital tools that can be used instead of inperson interpreters, which are available and accepted by LEP patients, such as AT&T interpreter call lines (Lee, L, J, et al., 2002). One survey found that LEP patients that used this AT&T call line had higher satisfaction in their care than when using proxy interpreters such as family or untrained staff (Lee, L, J, et al., 2002). While online and digital services can be more systemically accessible, face-to-face encounters within healthcare are more common and valuable depending on the medical setting, particularly hospitals and emergency departments The diversity within the United States is not only within patients, but medical staff as well Ad hoc interpreters, which are healthcare professionals that are not trained as interpreters, can be common in some settings where trained staff is not available (Lee, L, J, et al, 2002) Allocating funding to provide multilingual healthcare staff with training in medical interpretation could utilize already present human-resource to increase support of LEP patients.

The implementation of medical interpreters throughout a patient’s health encounter ensures that not only are patients able to understand their individual health protocols, but also that the patient's particular needs will also be correctly communicated to and understood by the provider (Karliner et al, 2010) This can improve patient outcomes, which are a crucial evaluation metric, which could positively affect the bottom line of healthcare systems and the families and communities of those affected.