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Know when to reword questions, clarify answers
When discussing the teaching of non-English-speaking patients with health
care providers, Martine Pierre-Louis, MPH, manager of interpreter services at the University of Washington Medical Center in Seattle, likes to recount a story about a Russian-speaking woman who was questioned about her dietary habits by the nutritionist.
When asked if she ever had anything to eat after dinner, the woman answered "tea." The nutritionist wrote down "tea." Thinking there may be a problem, the interpreter asked the woman, who was at risk for diabetes, to clarify her answer. She explained that she had Russian tea, which included sweets and bread with jam.
"Even when the translation of a particular word is correct, the meaning of words are different from one experience to another. It is important to be able to understand the cultural context that surrounds the words and the terms," says Pierre-Louis.
The illustration reveals the importance of using a trained interpreter whenever possible. A trained interpreter will catch cues the patient gives when they don’t understand and be able to give some cultural information to add insight into what lies behind the confusion. An interpreter might be able to suggest rewording the question in a different way, says Gloria Garcia Orme, RN, BSN, director of patient relations at San Francisco General Hospital.
To overcome language barriers, it isn’t enough to be bilingual; trained interpreters have learned how to listen so they can capture and transmit information completely and accurately making sure not to add or omit anything, explains Pierre-Louis.
Yet, providing education when there is a language barrier requires more than a good interpreter. "When a provider gets ready for an educational session with a patient who does not speak English, it is important to plan out what he or she is going to say. Speaking through an interpreter is stilted; it isn’t natural, and it slows the conversation," says Pierre-Louis. It is a good idea to create a script so that the material is broken into segments that make sense when the provider stops for the translation.
It also helps if a provider knows something about the culture of the population he or she is teaching. "Providers need to work extra hard to teach from the patient’s viewpoint; and when there are cultural and language barriers, it is even more difficult," says Pierre-Louis. (For more information on overcoming cultural barriers to education, see next segment in article series, May 2001 Patient Education Management.)
Keep written materials on hand
Having patient education materials in the patient’s primary language is important, as well. "Patients often need a reference point for information to recall what has been taught and as a reminder to review information that has been discussed with a provider," says Geri Berkvam, RN, FNP, patient and family program coordinator at San Francisco General Hospital.
However, not just any pamphlet will do. When purchasing health materials from a vendor, ask if someone who is bicultural, bilingual, and has health expertise has reviewed them.
If not, have bilingual medical staff review the materials, advises Berkvam. "Also field test the materials with the target population to make sure the information is culturally appropriate and the message is clear," she says.
When selecting non-English materials from outside sources, make sure that the information does not conflict with what is taught at your institution, adds Pierre-Louis. Also, whenever possible, choose topics that are frequently taught to non-English-speaking patients. For example, at the University of Washington Medical Center, pregnant Hispanic women frequently need materials on diabetes.
While the best scenario is to have written materials on hand in the patient’s primary language and an interpreter available, it is not always possible. Although San Francisco General has 16 full-time interpreters who provide services in 10 languages and an on-call local language bank that provides access to 35 more languages, interpreters are not always available when providers need them. The interpreter service handles 50,000 encounters a year.
To help meet the needs of the non-English-speaking patients at this health care facility, employees with bilingual skills who work in
the clinics and on the wards are tested for their language skills and are used for one-on-one encounters with a patient, but they are not trained interpreters, says Garcia Orme.
Currently, a pilot project is under way where Spanish and Cantonese interpreters are accessed via computers for videoconference interpreting sessions. "We will provide interpreting services from our office; this will help with the travel time it takes for the interpreter to walk through the campus," explains Garcia Orme.
At some facilities, there are certain situations where a provider has no choice but to use a family member. If this happens, make sure the family member is not a minor, says Pierre-Louis. Also, explain how important it is to be accurate and repeat what the health care provider says and what the patient says so a correct diagnosis can be made, she says.