How interpreters influence patient participation in medical consultations: The confluence of verbal and nonverbal dimensions of interpreter-mediated clinical communication

Abstract

Objective: To investigate i) how the patient's participation in interaction occurs in interpreter-mediated consultations (IMCs) when the doctor provides information to the patient or tries to elicit information from them; ii) how the interpreter's presence in the consultation influences the patient's participation.

Method: We analyzed 20 authentic video-recorded IMCs using the A.R.T. framework, an analytical tool for the study of participation in video recorded interpreter-mediated interactions.

Results: We coded 521 doctor utterances through which doctors either provided information or tried to elicit information from the patient. In 448 of them, the interpreter established a participation and engagement framework (PEF) with the patient while translating the doctor's utterances. In 48 cases the interpreter established a PEF with the doctor and in 25 cases the interpreter avoided establishing a PEF with either of the participants while translating the doctor's utterances.

Conclusion: When the interpreter established a PEF with either of the participants, they used verbal and nonverbal means that created the conditions in interaction in order to enable and/or rectify the patient's participation.

Practice implications: Doctors and interpreters should become more aware of their own and each other's actions in interaction and their influence on the patient's participation in the consultation.

Keywords: A.R.T. Framework; Communication barriers; Interpreter-mediated consultations; Nonverbal communication; Patient involvement; Patient participation; Video recording.