Self-Study Modules for Effective TB Interviewing
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.
When Is an Interpreter Required?
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.
Choosing 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.2 However,
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.
Types of Interpretation
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.
How to Communicate Through an Interpreter
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
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.
- This information may vary by individual health