Using a Translator in Integrated Care Settings

  • Jose Ribas-Roca
  • Pracha Eamranond


Failure to address limited English proficiency (LEP) is one of the main reasons leading to health disparities among Latinos. Translators in the clinical setting facilitate communication between providers and patients with LEP. In this chapter we talk about the effect of choosing to utilize a translator or not and its relationship to the quality of communication, patient/physician satisfaction, and health-related outcomes.

We describe the different types of interpreters available and compare the advantages and disadvantages of each type, patient and physician preferences, and the quality of interpretation they provide. Our hope is to provide a framework from which the provider will be able to decide the form of interpretation most appropriate for each particular circumstance.

We also explore specific themes on using a translator for mental health encounters. We will provide some information relevant to everyday interpreter use and tips to make more effective use of interpreters in integrated care settings.

We then comment on different policies and systems approaches that have been tried in order to improve communication with Hispanic patients and improve interpreter utilization. Finally, we share some insights found in the literature from the translators themselves about improving communication with Latino LEP patients.


Translation Latinos Integrated care Mental health care Behavioral health integration 


  1. Aranguri, C., Davidson, B., & Ramirez, R. (2006). Patterns of communication through interpreters: A detailed sociolinguistic analysis. Journal of General Internal Medicine, 21(6), 623–629.CrossRefPubMedPubMedCentralGoogle Scholar
  2. Baker, D. W., Baker, D. W., Parker, R. M., Williams, M. V., Coates, W. C., & Pitkin, K. (1996). Use and effectiveness of interpreters in an emergency department. JAMA, 275(10), 783–788.CrossRefPubMedGoogle Scholar
  3. Barkin, S., Balkrishnan, R., Manuel, J., & Hall, M. A. (2003). Effect of language immersion on communication with Latino patients. North Carolina Medical Journal, 64(6), 258–262.PubMedGoogle Scholar
  4. Bauer, A. M., & Alegria, M. (2010). Impact of patient language proficiency and interpreter service use on the quality of psychiatric care: A systematic review. Psychiatric Services, 61(8), 765–773.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Bischoff, A., Bovier, P. A., Rrustemi, I., Gariazzo, F., Eytan, A., & Loutan, L. (2003). Language barriers between nurses and asylum seekers: Their impact on symptom reporting and referral. Social Science & Medicine, 57(3), 503–512.CrossRefGoogle Scholar
  6. Burbano O’Leary, S. C., Federico, S., & Hampers, L. C. (2003). The truth about language barriers: One residency program’s experience. Pediatrics, 111(5 Pt 1), e569–e573.CrossRefPubMedGoogle Scholar
  7. Casas, R., Guzmán-Vélez, E., Cardona-Rodriguez, J., Rodriguez, N., Quiñones, G., Izaguirre, B., et al. (2012). Interpreter-mediated neuropsychological testing of monolingual Spanish speakers. The Clinical Neuropsychologist, 26(1), 88–101.CrossRefPubMedGoogle Scholar
  8. Costantino, G., Malgady, R. G., & Primavera, L. H. (2009). Congruence between culturally competent treatment and cultural needs of older Latinos. Journal of Consulting and Clinical Psychology, 77(5), 941–949.CrossRefPubMedGoogle Scholar
  9. Cunningham, H., Cushman, L. F., Akuete-Penn, C., & Meyer, D. D. (2008). Satisfaction with telephonic interpreters in pediatric care. Journal of the National Medical Association, 100(4), 429–434.CrossRefPubMedGoogle Scholar
  10. Derose, K. P., & Baker, D. W. (2000). Limited English proficiency and Latinos’ use of physician services. Medical Care Research and Review, 57(1), 76–91.CrossRefPubMedGoogle Scholar
  11. Diamond, L. C., Tuot, D. S., & Karliner, L. S. (2012). The use of Spanish language skills by physicians and nurses: Policy implications for teaching and testing. Journal of General Internal Medicine, 27(1), 117–123.CrossRefPubMedGoogle Scholar
  12. Drennan, G., & Swartz, L. (2002). The paradoxical use of interpreting in psychiatry. Social Science & Medicine, 54(12), 1853–1866.CrossRefGoogle Scholar
  13. Eamranond, P. P., Davis, R. B., Phillips, R. S., & Wee, C. C. (2009). Patient-physician language concordance and lifestyle counseling among Spanish-speaking patients. Journal of Immigrant and Minority Health, 11(6), 494–498.CrossRefPubMedGoogle Scholar
  14. Escott, S., Lucas, B., & Pearson, D. (2009). Lost in translation: Using bilingual simulated patients to improve consulting across language barriers. Education for Primary Care, 20(2), 93–98.CrossRefPubMedGoogle Scholar
  15. Eytan, A., Bischoff, A., Rrustemi, I., Durieux, S., Loutan, L., Gilbert, M., et al. (2002). Screening of mental disorders in asylum-seekers from Kosovo. The Australian and New Zealand Journal of Psychiatry, 36(4), 499–503.CrossRefPubMedGoogle Scholar
  16. Fagan, M. J., Diaz, J. A., Reinert, S. E., Sciamanna, C. N., & Fagan, D. M. (2003). Impact of interpretation method on clinic visit length. Journal of General Internal Medicine, 18(8), 634–638.CrossRefPubMedPubMedCentralGoogle Scholar
  17. Fernandez, A., Schillinger, D., Grumbach, K., Rosenthal, A., Stewart, A. L., Wang, F., et al. (2004). Physician language ability and cultural competence. An exploratory study of communication with Spanish-speaking patients. Journal of General Internal Medicine, 19(2), 167–174.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Fernandez, Y., Garcia, E., Franks, P., Jerant, A., Bell, R. A., & Kravitz, R. L. (2011). Depression treatment preferences of Hispanic individuals: Exploring the influence of ethnicity, language, and explanatory models. Journal of the American Board of Family Medicine, 24(1), 39–50.CrossRefGoogle Scholar
  19. Gany, F., Leng, J., Shapiro, E., Abramson, D., Motola, I., Shield, D. C., et al. (2007a). Patient satisfaction with different interpreting methods: A randomized controlled trial. Journal of General Internal Medicine, 22(Suppl 2), 312–318.Google Scholar
  20. Gany, F., Kapelusznik, L., Prakash, K., Gonzalez, J., Orta, L. Y., Tseng, C. H., et al. (2007b). The impact of medical interpretation method on time and errors. Journal of General Internal Medicine, 22(Suppl 2), 319–323.Google Scholar
  21. Gany, F., Leng, J. C., Winston, G., Tseng, C. H., Qin, A., & Changrani, J. (2011). Diabetes care and language discordance among Chinese and Latino primary care patients. Ethnicity & Disease, 21(4), 473–479.Google Scholar
  22. Gonzalez, R., Vasquez, V., & Mikkelson, H. (1991). Prerequisites for court interpreting. Durham, NC: Carolina Academic Press.Google Scholar
  23. Gray, B., Hilder, J., & Donaldson, H. (2011). Why do we not use trained interpreters for all patients with limited English proficiency? Is there a place for using family members? Australian Journal of Primary Health, 17(3), 240–249.CrossRefPubMedGoogle Scholar
  24. Gray, B., Hilder, J., & Stubbe, M. (2012). How to use interpreters in general practice: The development of a New Zealand toolkit. Journal of Primary Health Care, 4(1), 52–61. A1-8.PubMedGoogle Scholar
  25. Greenhalgh, T., Robb, N., & Scambler, G. (2006). Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective. Social Science & Medicine, 63(5), 1170–1187.CrossRefGoogle Scholar
  26. Haffner, L. (1992). Translation is not enough. Interpreting in a medical setting. The Western Journal of Medicine, 157(3), 255–259.PubMedPubMedCentralGoogle Scholar
  27. Hewitt, W. E., & Lee, R. J. (1996). Behind the language barrier, or “You say you were eating an orange?”. State Court Journal, 20(1), 23–31.Google Scholar
  28. Hornberger, J. C., Gibson, C. D., Jr., Wood, W., Dequeldre, C., Corso, I., Palla, B., et al. (1996). Eliminating language barriers for non-English speaking patients. Medical Care, 34(8), 845–856.CrossRefPubMedGoogle Scholar
  29. Hudelson, P. (2005). Improving patient-provider communication: Insights from interpreters. Family Practice, 22(3), 311–316.CrossRefPubMedGoogle Scholar
  30. Juckett, G., & Unger, K. (2014). Appropriate use of medical interpreters. American Family Physician, 90(7), 476–480.PubMedGoogle Scholar
  31. Karliner, L. S., Perez-Stable, E. J., & Gildengorin, G. (2004). The language divide. The importance of training in the use of interpreters for outpatient practice. Journal of General Internal Medicine, 19(2), 175–183.CrossRefPubMedPubMedCentralGoogle Scholar
  32. Kline, F., Acosta, F. X., Austin, W., & Johnson, R. G., Jr. (1980). The misunderstood Spanish-speaking patient. The American Journal of Psychiatry, 137(12), 1530–1533.CrossRefPubMedGoogle Scholar
  33. Kuo, D., & Fagan, M. J. (1999). Satisfaction with methods of Spanish interpretation in an ambulatory care clinic. Journal of General Internal Medicine, 14(9), 547–550.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Laws, M. B., Heckscher, R., Mayo, S. J., Li, W., & Wilson, I. B. (2004). A new method for evaluating the quality of medical interpretation. Medical Care, 42(1), 71–80.CrossRefPubMedGoogle Scholar
  35. Leyva, M., Sharif, I., & Ozuah, P. O. (2005). Health literacy among Spanish-speaking Latino parents with limited English proficiency. Ambulatory Pediatrics, 5(1), 56–59.CrossRefPubMedGoogle Scholar
  36. Lion, K. C., Thompson, D. A., Cowden, J. D., Michel, E., Rafton, S. A., Hamdy, R. F., et al. (2012). Impact of language proficiency testing on provider use of Spanish for clinical care. Pediatrics, 130(1), e80–e87.CrossRefPubMedGoogle Scholar
  37. Locatis, C., Williamson, D., Gould-Kabler, C., Zone-Smith, L., Detzler, I., Roberson, J., et al. (2010). Comparing in-person, video, and telephonic medical interpretation. Journal of General Internal Medicine, 25(4), 345–350.CrossRefPubMedPubMedCentralGoogle Scholar
  38. Marcos, L. R., Uruyo, L., Kesselman, M., & Alpert, M. (1973a). The language barrier in evaluating Spanish-American patients. Archives of General Psychiatry, 29(5), 655–659.Google Scholar
  39. Marcos, L. R., Alpert, M., Urcuyo, L., & Kesselman, M. (1973b). The effect of interview language on the evaluation of psychopathology in Spanish-American schizophrenic patients. The American Journal of Psychiatry, 130(5), 549–553.Google Scholar
  40. Mazor, S. S., Hampers, L. C., Chande, V. T., & Krug, S. E. (2002). Teaching Spanish to pediatric emergency physicians: Effects on patient satisfaction. Archives of Pediatrics & Adolescent Medicine, 156(7), 693–695.CrossRefGoogle Scholar
  41. Morales, L. S., Cunningham, W. E., Brown, J. A., Liu, H., & Hays, R. D. (1999). Are Latinos less satisfied with communication by health care providers? Journal of General Internal Medicine, 14(7), 409–417.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Napoles, A. M., Santoyo-Olsson, J., Karliner, L. S., O’Brien, H., Gregorich, S. E., & Pérez-Stable, E. J. (2010). Clinician ratings of interpreter mediated visits in underserved primary care settings with ad hoc, in-person professional, and video conferencing modes. Journal of Health Care for the Poor and Underserved, 21(1), 301–317.CrossRefPubMedPubMedCentralGoogle Scholar
  43. Norris, W. M., Wenrich, M. D., Nielsen, E. L., Treece, P. D., Jackson, J. C., & Curtis, J. R. (2005). Communication about end-of-life care between language-discordant patients and clinicians: Insights from medical interpreters. Journal of Palliative Medicine, 8(5), 1016–1024.CrossRefPubMedGoogle Scholar
  44. O’Neil, J. D., Koolage, W. W., & Kaufert, J. M. (1988). Health communication problems in Canadian Inuit communities. Arctic Medical Research, 47(Suppl 1), 374–378.PubMedGoogle Scholar
  45. Price, J. (1975). Foreign language interpreting in psychiatric practice. The Australian and New Zealand Journal of Psychiatry, 9(4), 263–267.CrossRefPubMedGoogle Scholar
  46. Rivadeneyra, R., Elderkin-Thompson, V., Silver, R. C., & Waitzkin, H. (2000). Patient centeredness in medical encounters requiring an interpreter. The American Journal of Medicine, 108(6), 470–474.CrossRefPubMedGoogle Scholar
  47. Roat, C., & CAFP. (2005). Addressing language access issues in your practice: A toolkit for physicians and their staff members Google Scholar
  48. Schenker, Y., Wang, F., Selig, S. J., Ng, R., & Fernandez, A. (2007). The impact of language barriers on documentation of informed consent at a hospital with on-site interpreter services. Journal of General Internal Medicine, 22(Suppl 2), 294–299.CrossRefPubMedPubMedCentralGoogle Scholar
  49. Sleath, B. L., & Williams, J. W., Jr. (2004). Hispanic ethnicity, language, and depression: Physician-patient communication and patient use of alternative treatments. International Journal of Psychiatry in Medicine, 34(3), 235–246.CrossRefPubMedGoogle Scholar
  50. Stolk, Y., Ziguras, S., Saunders, T., Garlick, R., Stuart, G., & Coffey, G. (1998). Lowering the language barrier in an acute psychiatric setting. The Australian and New Zealand Journal of Psychiatry, 32(3), 434–440.CrossRefPubMedGoogle Scholar
  51. Valdini, A., Early, S., Augart, C., Cleghorn, G. D., & Miles, H. C. (2009). Spanish language immersion and reinforcement during residency: A model for rapid acquisition of competency. Teaching and Learning in Medicine, 21(3), 261–266.CrossRefPubMedGoogle Scholar
  52. VanderWielen, L. M., Enurah, A. S., Rho, H. Y., Nagarkatti-Gude, D. R., Michelsen-King, P., Crossman, S. H., et al. (2014). Medical interpreters: Improvements to address access, equity, and quality of care for limited-eEnglish-proficient patients. Academic Medicine, 89(10), 1324–1327.CrossRefPubMedGoogle Scholar
  53. Vasquez, C., & Javier, R. A. (1991). The problem with interpreters: Communicating with Spanish-speaking patients. Hospital & Community Psychiatry, 42(2), 163–165.Google Scholar
  54. Vega, W. A., Rodriguez, M. A., & Ang, A. (2010). Addressing stigma of depression in Latino primary care patients. General Hospital Psychiatry, 32(2), 182–191.CrossRefPubMedGoogle Scholar
  55. Villalobos, B., Bridges, A. J., Anastasia, E. A., Ojeda, C. A., Rodriguez, J. H., Gomez D. (2015). Effects of language concordance and interpreter use on therapeutic alliance in Spanish-speaking integrated behavioral health care patients, University of Arkansas.Google Scholar
  56. Welty, E., Yeager, V. A., Ouimet, C., & Menachemi, N. (2012). Patient satisfaction among Spanish-speaking patients in a public health setting. Journal for Healthcare Quality, 34(5), 31–38.CrossRefPubMedGoogle Scholar
  57. Yawman, D., McIntosh, S., Fernandez, D., Auinger, P., Allan, M., & Weitzman, M. (2006). The use of Spanish by medical students and residents at one university hospital. Academic Medicine, 81(5), 468–473.CrossRefPubMedGoogle Scholar
  58. Zun, L. S., Sadoun, T., & Downey, L. (2006). English-language competency of self-declared English-speaking Hispanic patients using written tests of health literacy. Journal of the National Medical Association, 98(6), 912–917.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jose Ribas-Roca
    • 1
  • Pracha Eamranond
    • 1
  1. 1.Lawrence General HospitalLawrenceUSA

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