Effective TB Interviewing for Contact Investigation: Self-Study Modules
Working with Interpreters
One of the barriers to communication is language difference. In this case, a patient may have little or no proficiency in the language in which the interviewer is speaking. This is when an interpreter should be used. An interpreter is any individual who orally conveys speech for another individual who has little or no proficiency in the language in which the interviewer is speaking.
The interviewer must gauge when an interpreter is needed. In some cases this is very obvious, while in others it is not. The patient’s medical record may mention a language barrier so an interpreter can be arranged prior to meeting the patient. A patient may demonstrate language comprehension by nodding his or her head affirmatively or verbally indicate understanding by saying “yes” or “no” when answering questions. However, in this case, the interviewer must be watchful. Even though the patient may have some proficiency in the interviewer’s language, the patient may not have an adequate understanding of the interviewing messages. This is where open-ended questions play a key role. The responses to open-ended questions require more than a word or two and can assist the interviewer in judging how much is understood by the answer given. If the patient understands very little of the conversation, despite the interviewer’s simplifying of the language used and basing questions on the patient’s level of understanding, it is time to engage an interpreter.
If possible, a professionally trained or certified medical interpreter should be used for patient interviewing. Interviewers should be aware of resources available to provide appropriate interpretation and make all attempts to acquire an interpreter. One should utilize a third party who is unknown to the patient. A third party can provide unbiased communication and preserve confidentiality.2However, in some cases, individuals may feel more comfortable and trusting of people they know. In such instances, reiterate confidentiality issues, especially in small communities or settings where a TB diagnosis may be easily found out. If using an interpreter the patient knows, the patient must state that he or she is comfortable with this person in this role.
Often, a client will bring in a family member or friend to interpret. This can be challenging, especially if sensitive questions are being asked and confidentiality is a concern. Family members, especially children, should not be used as interpreters. Despite this general rule, there are some exceptions when family members may be a good source of interpretation, such as when the index patient is a young child. Urgency is also key. If an appropriate interpreter cannot be found in time to complete the interview as recommended, an available healthcare worker may serve this purpose. Asking a healthcare worker to serve as an interpreter may also be necessary if a patient is at risk of leaving an interview setting prior to a more appropriate interpreter being located.
There are two styles of interpretation in TB interviewing that can be used: consecutive and simultaneous. Consecutive is when one speaker says a few phrases or sentences and then awaits the interpreter to interpret. In the simultaneous style, the interpreter speaks as the dialogue occurs without pause. With both styles of interpretation, the interaction is face-to-face. However, there are times when a trained interpreter is not available in person. In these cases, a telephone interpretation service can be used. This may involve an interpretation in a remote location by use of a speaker phone. However, if a speaker phone is unavailable, the phone may be passed back and forth between the patient and interviewer, allowing the interpreter to know to whom he or she is speaking.
There are some essential points to keep in mind when working with an interpreter. The interviewer should assess verbal and nonverbal indicators to gauge how well the message is being understood and the patient’s comfort level. Note that communication through an interpreter will take more time than a noninterpreted interview and, as such, the interviewer and interpreter should plan accordingly.
Explain to the interpreter that the interviewer will be talking to the patient directly and that the interpreter is to convey exactly what was said. In turn, the interpreter should be instructed to state exactly what the patient has said back to the interviewer and not paraphrase or summarize the discussion. This is important so that all key facts are communicated.
Ensure that the interpreter is aware that all communication is confidential and cannot be shared with anyone outside of the interview.
Addressing the Patient
The interviewer should address the patient directly, using first- and second- person terminology (“I” and “you”). In general, in is best to look directly at the patient when speaking to the patient. Also, when the patient is responding, the interviewer should make eye contact as well. It is acceptable to look at the interpreter when he or she is conveying the patient’s statements.
Use of Language
Avoid slang terminology, as many local words and phrases may not translate accurately into other languages. Also, do not use healthcare jargon. If the interpreter is a layperson, he or she may not know how to state medical terms accurately. Use simple language. Short, precise questions and sentences work well.
Rate of Speech
Speak slowly and clearly. Gauge the pace at which the interpreter can convey messages back and forth. Ask the interpreter at the beginning of the interview to inform the interviewer at anytime if the conversation is proceeding too quickly. Also, take breaks as needed to counter fatigue and to give the interpreter a chance to interpret what has been said.
If the patient offers views or ideas counter to your training and knowledge, acknowledge what is being said and attempt to work within the patient’s explanation without jeopardizing the message that needs to be conveyed (see Module 3, “Cultural Competency”).
Assess Patient Understanding
At the end of the interaction, review the material with the client to ensure nothing has been missed or misunderstood. Ask if the patient has any questions.
Although working with interpreters is a challenge, it is often essential for effective communication of appropriate messages. Much of the interview will be the same as when working with a patient speaking the same language as the interviewer. However, additional time should be allowed, and there should be a greater reliance on observing nonverbal cues.