Short summary

This study is a mixed method study consisting of a prospective intervention study and a qualitative interview study. Evidence shows that training of interpreters improves treatment and care. However, to our knowledge, no previous studies have examined the impact of a short, introduction program for interpreters. In total 100 interpreters will be included. The intervention will consist of a structured introduction program, targeted interpreters in the Region of Southern Denmark. The program will be developed and managed by experts from the Migrant Health Clinic, OUH and Centre for Survivors of Trauma and Torture.

Rationale

A prerequisite for any kind of care and treatment is that patient and health professionals can understand and talk to each other. According to Section 2 of the Danish Health Act, all citizens in Denmark have the right to equal access to health care (1), but both Danish and international studies indicate that patient safety is threatened among patients with limited language proficiency (2, 3). 

Language barriers are associated with poor patient safety, misunderstood or incorrect diagnoses, low patient satisfaction and longer duration of hospital stay (4-7). This is due to the patient's poor opportunity to describe his own health situation as a result of inadequate or lack of interpretation services (8, 9). Due to the lack of interpretation services, children and family members are used instead. By using family members as an interpreter, there is an increased risk of misunderstandings in treatment, tests, and diagnosis with severe clinical consequences (3, 6, 10). Evidence shows that professional interpreters can help increase the quality of care and treatment for patients with language barriers. Hence, professional interpreters help to ensure the best possible use of healthcare resources (8, 11, 12). Furthermore, evidence shows that access to interpretation services is a necessity to ensure that patients with language barriers have equal access to care and treatment in the health care system (13-16). 

Several studies demonstrate that interpreters' knowledge and skills in language, ethics, and patient confidentiality vary widely (4, 5), and so do health professionals' professional skills in communicating with interpreters (17, 18). Unlike other Nordic countries, there is neither an official education nor a certification system for interpreters in Denmark (19). Nor are there regional or national standards for the use of healthcare interpreters (20). The lack of interpretation quality therefore invites to development and research on interventions that can increase the quality of the available interpretative assistance (21).

AIM

The aim of this project is to improve the quality of the current interpretation services used in the Danish healthcare system and hereby contribute to increase patient safety for patients with language barriers. 

The above aim will be accomplished by:

• Testing the impact of a structured educational program for interpreters.

PATIENT INVOLVEMENT

This PhD project has been prepared in cooperation with a user council consisting of selected patients from the Migrant Health Clinic at Odense University Hospital. The user council concluded that the project target an area were several patients have expressed frustrations in relation to interpreters' general level of competence. The user council therefore expressed great satisfaction with an educational program targeted interpreters in the Danish health care system.

Future results will be discussed continuously with patients from the user council and health professionals from selected departments at Odense University Hospital.

THEORETICAL BACKGROUND

This project takes a positivistic and hermeneutic approach and is thus an interdisciplinary project where both quantitative and qualitative methods are used. The methodology includes a survey using a validated questionnaire, semi-structured interviews, and field observation. The project will contribute with both generalizable data and in-depth descriptions within the field of study, and the complementary methods are expected to nuance and enrichen the research results with new findings and development of new understandings (22, 23). 

The studies are based on theories concerning health perceptions, intercultural communication, and cultural understanding that aim at describing the descriptive and the complex cultural concepts (24-27).

Description of the cohort

In total 100 interpreters will be included from the Region of Southern Denmark. All with different background

Collaborating researchers and departments

Centre for Survivors of Trauma and Torture

• Louise Schwartz 
• Dorte Uhd

HR/Region of Southern Denmark

• Senior Consultant, Tine Hald

Odense University Hospital 

• Hospital Director, Peder Jest

Publications associated with the project

The following papers and report are under preparation:

1. A Danish report showing the overall outcome of the study; “The impact of an introduction program for interpreters in the Region of Southern Denmark.

2. The impact of an introduction program for interpreters in the Danish health care system 

3. “This is the first time I feel acknowledged as an interpreter” – A qualitative study using field observation 

4.  Interpreters perspectives on competences and quality in the health care sector - a qualitative perspective