An intersectional inequalities perspective of interpreter-mediated health care encounters
Piacentini, T., O’Donnell, C., Phipps, A., Jackson, I. & Stack, N. (2019) Moving beyond the ‘language problem’: developing an understanding of the intersections of health, language and immigration status in interpreter-mediated health encounters, Language and Intercultural Communication, 19:3, 256-271, DOI: 10.1080/14708477.2018.1486409
This qualitative study illustrates how the application of an intersectional lens to the analyses of qualitative data can reveal limitations of health care interventions that aim to improve access to care. In this case, the intersectional lens showed that privileging the ‘language problem’ in the encounter between health professionals and non-English speaking patients was neglecting other dimensions of inequality and impacted negatively on health care access. The authors suggest new ways to address these limitations and promote equitable access to care. They used the findings to develop training materials for health care providers and interpreters.
This paper emerged from a larger research project that explored the development of ethical approaches to healthcare interpreting. The larger study explored the different experiences of practitioners, interpreters and migrants in interpreted consultations across a range of community and home-based encounters. One of the study’s long-term aims was to use these narratives to develop training and support materials for primary care and interpreting service providers. However, in the process of conducting that work, the researchers became interested in the extent to which an intersectional approach made visible the multiple hidden inequalities associated with immigration status and migratory journey and their interconnections with language. These inequalities influence and shape the experience of interpreted health encounters. and ultimately health care provision and help-seeking behaviours.
The study took place in Scotland and involved individual and group interviews with a small sample (N=19) of service users (asylum seekers, refugees, and migrant workers from EU and non-EU states), health care professionals (midwives, health visitors, and sexual health specialists), and interpreters (professionals and volunteers) on their experiences of interpreter-mediated, intercultural communication. The interview schedule covered broad themes such as training, role of interpreters, expectations of care, concerns about equity of access and the constraints, challenges and opportunities of multilingual clinical encounters. An intersectional lens was applied at the stage of coding and analysis.
The study found that interpreter-mediated encounters (re)produce health-related inequalities in varying ways for the different groups making up the ‘non-English speaking’ patient population. Language differences intersect with migratory journey and immigration status, ethnicity, and socio-demographic variables, including social class. Moreover, wider narratives of (un)deservingness and ‘otherness’ combine with diverse socio-cultural positionings of the three parties in the interaction (professional/practitioner, service user, interpreter) to shape the subjective experience of service users, their appraisal of services, and their willingness to use them.
Based on these findings, the authors suggest that service providers recognise and accommodate asylum seekers’ increased reliance on them for information about services, rights, and entitlements. The findings were integrated into a comprehensive set of FREE resources made available online. This includes 5 short films (available in Vimeo, You Tube and MP4 formats and in DVD format) and accompanying learning materials and supporting documents on how to use the resource. The Project Website provides a repository for the material and links to useful related sites: https://www.gla.ac.uk/research/az/gramnet/research/trainingmodel/