Spanish Interpreter Services for the Hospitalized Pediatric Patient: Provider and Interpreter Perceptions

BACKGROUND: Many Americans have limited English proficiency (LEP) and difficulty communicating with health care providers, creating inequitable health care delivery. Despite widespread interpreter availability in hospitals, perceptions of interpreter services in the pediatric inpatient setting are largely unknown. OBJECTIVE: To investigate staff perspectives regarding: 1) roles of the interpreter and provider (attending, resident, and nurse) during an encounter, 2) modalities of interpretation, and 3) barriers to services. METHODS: Focus groups were conducted with: 1) hospital-employed Spanish interpreters, 2) Pediatric Hospital Medicine attendings, 3) pediatric and internal medicine-pediatric residents, and 4) medical unit nurses. Sessions were audio-recorded and transcribed. Using Atlas.ti, 2 investigators created the coding scheme, independently coded the data, and achieved consensus. Qualitative methods were used for thematic analysis. RESULTS: Fourteen groups (n = 59 participants) were held: 3 interpreter groups (n = 10), 3 attending groups (n = 14), 2 resident groups (n = 17), and 6 nurse groups (n = 18). Most believed the interpreter's role was to serve as a conduit (provide word-forword interpretation), act as a cultural broker, and maintain transparency (not withhold information). All groups felt providers should interact with families as they would with English-speaking families. In-person interpreters were preferred over telephone and video for being more accurate, efficient, and personable. Barriers to accessing services included time needed for interpretation, overconfidence in language skills, variable family dynamics, and identification of LEP families. CONCLUSIONS: In-person interpreters are highly valued, fulfilling complex roles. However, operational and human factors limit access to services in the hospital. These findings, along with family perspectives, can be used to optimize interpretation experiences.