Role and Importance of Bilingual Interpreters Essay

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The Impact of Using Professional Bilingual Interpreters

Abstract

Elderly Hispanic patients experience numerous challenges when seeking for healthcare services since they are only eloquent in their native language and are classified as Limited English Proficient (LEP) patients. This paper examines patient-provider communication between these patients and healthcare providers. The evaluation is carried out to determine the role and significance of bilingual interpreters in promoting medication adherence among elderly Hispanic patients aged 50-75 years. The project will be implemented in an outpatient clinic and community center that provides care to different kinds of patients including elderly Hispanics. This project demonstrates that bilingual interpreters would help promote medication adherence and compliance with treatment among these patients.

Keywords: elderly Hispanics, patients, medication adherence, bilingual interpreters, treatment, patient-provider communication, healthcare providers.

Statement of the Problem

Hispanic population is one of the fastest growing groups of people in the United States, particularly among America’s elderly population. According to Markides et al. (1997), Hispanics have increased significantly in the United States over the past few decades. As the number of Hispanics continues to grow, this population is faced by numerous challenges including health problems. Health problems or conditions have become common and prevalent among this population to an extent that culturally-appropriate care is considered necessary toward enhancing their health and wellbeing. The healthcare sector in the United States is increasingly developing new measures for providing culturally-appropriate care to Hispanics and other patient populations across the country. Elderly Hispanics account for a significant portion of the group’s patient population. 

A significant portion of elderly Hispanics aged between 50 and 75 years are only eloquent in their native language. Consequently, these patients are referred to Limited English Proficient (LEP) patients since they are only eloquent in their native language. Given their eloquence in their native language, elderly Hispanics are always disadvantaged due to language barriers that often necessitate the use of an interpreter in the healthcare delivery process. In urgent medical cases like diabetes, ad hoc interpreters who are usually family members act as interpreters between the patient and the healthcare provider. While these family members continue to play a critical role in patient-provider communication, many elderly Hispanics fail to adhere to medications and other treatment regimes effectively. This compromises the quality of healthcare and patient outcomes among this population, especially those suffering from diabetes.

Therefore, the healthcare sector is faced with the need for improving patient-provider communication among elderly Hispanic patients suffering from diabetes. The poor patient outcomes associated with the use of family members as interpreters contributes to the need for involvement of professional interpreters in the care delivery process. Existing literature demonstrates that professional interpreters help improve patient-provider communication, which in turn results in better patient outcomes. It is important to determine whether bilingual interpreter call during provider visit improves communication between the patient and care provider and contribute to better health outcomes. While the government of New South Wales (NSW) policy establishes a standard procedure where professionals like bilingual interpreters are invited to provide interpretive services, these professionals are not adequately integrated in the healthcare delivery process. Additionally, the impact of bilingual interpreters in enhancing medication adherence among patients, particularly elderly Hispanic patients, remains unknown.

Background and Significance

Hispanic population accounts for a significant portion of the U.S. population as they account for over 50 million people. Diabetes is one of the major health issues among this population with prevalence rates estimated at 18.3% for diagnosed and undiagnosed patients (Sentell & Braun, 2012). The prevalence rates of diabetes among elderly Hispanics remain relatively high. Elderly Hispanics are predisposed to diabetes because of various factors such as limited knowledge, cardiometabolic abnormalities, and lack of access to resources. The prevalence rates of diabetes among Hispanics are significantly higher in comparison to non-Hispanic populations. Diabetes disorders among this population are associated with other health conditions like end-stage renal disease (Office of Minority Health, 2016). 

The management of diabetes and other health conditions affecting elderly Hispanics requires close collaboration between patients and their healthcare providers. Patients need to interact with their physicians on a one-on-one basis as part of effective patient-provider communication. Improved interactions help patients to articulate their health issues effectively while enabling physicians to better understand the health needs and challenges of patients. Effective patient-provider communication is critical in the healthcare delivery process since it has a direct impact on patient outcomes. When combating diabetes, better patient-provider communication helps in active management of the disorder with regarding to maintenance of optimum glycemic index and monitoring lifestyle factors (Jacobs et al., 2006). 

While effective communication between patients and healthcare providers is recognized as an important element for improving diabetes management among elderly Hispanic patients, most of these patients face language barriers when interacting with care providers. Language barriers emanate from the fact that many elderly Hispanics are only proficient in their native language. Elderly Hispanic patients are not eloquent in English language, which is commonly used in healthcare settings making them Limited English Proficient (LEP) patients. Healthcare providers face significant challenges when trying to teach LEP patients like elderly Hispanics on self-management practices and engaging them outside the healthcare setting or environment. According to Lee et al. (2002), Hispanics account for a significant percentage of the patient population though its only 20% of them who can communicate adequately in Spanish.

De Moissac & Bowen (2017) state that language barriers create the need for using third parties to facilitate communication between LEP patients and healthcare providers.

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Healthcare providers recognize the role and significance of effective communication between them and patients in improving medication adherence and patient outcomes (Hadziabdic, 2011). However, the current healthcare setting lacks comprehensive systems that are designed to deal with the challenges brought by language barriers when administering health services to LEP patients. Additionally, these patients are unaware of the significance of professional interpreters as they receive health service. These factors have contributed to lack of comprehensive data on the impact professional/bilingual interpreters on medication adherence and treatment outcomes among LEP patients like elderly Hispanic diabetics. This has in turn continued to affect the health outcomes and wellbeing of LEP patients.

Significance of this Project

This project seeks to examine whether the use of bilingual interpreter call during provider visit improve medication adherence among elderly Hispanic patients aged between 50 and 75 years within a 3-month period. The project will help address the gap in existing literature on the significance of linguistic assistance services in the clinical setting. This research will provide significant insights on the effectiveness of linguistic intervention in the administration of healthcare services, which is currently not comprehensively addressed in literature (Jacobs et al., 2006). Better research is currently needed on the extent with which language barriers affect the quality of healthcare and the impact of interventions like linguistic interpreters on healthcare delivery processes. Through addressing these issues, this study will inform policymakers on the importance of designing comprehensive linguistic intervention systems toward dealing with language barriers in the clinical setting and improving health outcomes among patients.

Systems Context

This project on diabetes management among elderly Hispanic patients will be conducted in an outpatient clinic and community senior center that targets this population among other patients. An outpatient clinic and community senior center provides a suitable setting for examining the impact professional interpreters have on medication adherence among elderly Hispanic patients suffering from diabetes. When conducting this project in such a setting, individual elderly Hispanic diabetics will be recruited using informational flyers and brochures in the clinic and/or community center. Participation in this study will be voluntary while the research is designed in a manner that will not compromise the healthcare delivery processes in the healthcare setting. 

The outpatient clinic and community center will comprise different stakeholders involved in delivery of healthcare services to these patients. The clinic and community center will be headed by the management who will help in decision making and approval for this project. Healthcare staffs i.e. physicians, doctors, and other non-clinical staffs will work together with professional interpreters under the guidance of the management team and the project team. The other members involved in delivery of care services in this center are patients and their families. As shown in Figure 1, the organizational system has a top-down or hierarchical structure comprising the management team, clinical and non-clinical staffs, and patients and their families. For this project, the organizational system will also include professional interpreters and the project team.

Each of these stakeholders will be assigned specific roles that will help in the implementation of this project. The management team will help create a suitable healthcare environment through which bilingual interpreters will be allowed to provide interpretive services during the healthcare delivery process. They will also provide financial and non-financial support and resources for effective implementation of the project. The financial support from the management team is attributable to the fact that the project is designed based on the assumption that the provider will underwrite all direct costs relating to project execution. Bilingual interpreters will act as intermediaries between patients and providers with regards to provide linguistic interventions for language barriers. These stakeholders will communicate with patients and providers to help patients articulate their issues better and promote improved understanding of patients’ issues by the care provider. Clinical and non-clinical staff will collaborate with the patient and bilingual interpreter to provide a suitable healthcare environment and ensure appropriate treatment approaches are adopted to address the patients’ conditions. The project team will provide supervise the project implementation based on the desired objectives and will collaborate with the healthcare staffs during this process. The collaborative approach adopted in this project ensures that all stakeholders provide feedback to one another during the implementation process as they work together. The roles of the stakeholders are intertwined to ensure process flow when executing the project.

Definition of Clinical, Satisfaction, and Cost Outcomes

The implementation of this project is expected to generate numerous benefits to patients and the healthcare setting/environment. To achieve the purposes of this project, the researcher has developed a comprehensive data collection plan that will help collect rich data. Some of the data collection instruments include interviews and video and audio recordings, which will be translated and transcribed. As shown in Table 1, the data collection outcomes included in the data collection plan are clinical, satisfaction, and cost outcomes. 

Clinical outcome refers to measurable changes in the quality of care or health as a result of a healthcare intervention. Clinical outcomes play a critical role in determining the success of this project since medical interventions or treatments are designed to help improve the health or quality of life of patient populations while lessening the occurrence of undesirable outcomes (Velentgas, Dreyer….....

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References

Aranguri, C., Davidson, B. & Ramirez, R. (2006, June). Patterns of Communication through Interpreters: A Detailed Sociolinguistic Analysis. Journal of General Internal Medicine, 21(6), 623-629. 

Center for Innovation in Research and Teaching. (n.d.). Ethics in Experimental Research. Retrieved from Grand Canyon University website: https://cirt.gcu.edu/research/developmentresources/research_ready/experimental/ethics

de Moissac, D., & Bowen, S. (2017). Impact of Language Barriers on Access to Healthcare for Official Language Minority Francophones in Canada. Healthcare Management Forum, 30(4), 207-212. http://dx.doi.org/10.1177/0840470417706378

Hadziabdic, E. (2011). The Use of Interpreter in Healthcare – Perspectives of Individuals, Healthcare Staff and Families. Retrieved July 21, 2018, from https://www.diva-portal.org/smash/get/diva2:444194/FULLTEXT01.pdf

Jacobs, E., Chen, A., Karliner, L., Agger-Gupta, N. & Mutha, S. (2006). The Need for More Research on Language Barriers in Health Care: A Proposed Research Agenda. The Milbank Quarterly, 84(1), 111-133. http://dx.doi.org/10.1111/j.1468-0009.2006.00440.x

Juckett, G., & Unger, K. (2014). Appropriate Use of Medical Interpreters. Aafp.org. Retrieved 26 January 2018, from https://www.aafp.org/afp/2014/1001/p476.html

Karliner, L.S., Jacobs, E.A., Chen, A.H. & Mutha, S. (2007, April). Do Professional Interpreters Improve Clinical Care for Patients with Limited English Proficiency? A Systematic Review of the Literature. Health Services Research, 42(2), 727-754.

Kennedy, G.D., Tevis, S.E. & Kent, K.C. (2014, October). Is there a Relationship between Patient Satisfaction and Favorable Outcomes? Annals of Surgery, 260(4), 592-600.

Lee, L.J., Batal, H.A., Maselli, J.H. & Kutner, J.S. (2002, August). Effect of Spanish Interpretation Method on Patient Satisfaction in an Urban Walk-in Clinic. Journal of General Internal Medicine, 17(8), 641-646.

Markides, K.S., Rudkin, L., Angel, R.J. & Espino, D.V. (1997). Health Status of Hispanic Elderly. Retrieved August 12, 2018, from https://www.ncbi.nlm.nih.gov/books/NBK109838/

Office of Minority Health (2016). Diabetes and Hispanic Americans. Retrieved from https://minorityhealth.hhs.gov/omh/browse.aspx?lvl-4&lvlid-63.

Sentell, T., & Braun, K. (2012). Low Health Literacy, Limited English Proficiency, and Health Status in Asians, Latinos, and Other Racial/Ethnic Groups in California. Journal of Health Communication, 17(sup3), 82-99. http://dx.doi.org/10.1080/10810730.2012. 

Patak et al. (2009, September). Improving Patient-Provider Communication: A Call to Action. Journal of Nursing Administration, 39(9), 372-376.

Tzelepis, F., Sanson-Fisher, R.W., Zucca, A.C. & Fradgley, E.A. (2015, June 24). Measuring the Quality of Patient-centered Care: Why Patient-reported Measures Are Critical to Reliable Assessment. Patient Preference and Adherence, 9, 831-835.

Velentgas, P., Dreyer, N.A. & Wu, A.W. (2013). Chapter 6 – Outcome Definition and Measurement. Retrieved August 12, 2018, from https://www.ncbi.nlm.nih.gov/books/NBK126186/

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