Ad hoc interpreters acted as gatekeepers, answering on patients' behalf and controlling what reached the clinician

Description #

The study found that ad hoc interpreters took on a gatekeeping role, controlling what information passed between patient and clinician by responding to questions on the other party's behalf rather than relaying them. This gatekeeping occurred primarily when the interpreters were themselves health care workers, and the authors interpret it (drawing on Davidson, 2000) as making the interpreter an active participant in diagnosis. This is a qualitative mechanism by which informal interpreting can distort the information base for a psychiatric diagnosis.

"In our study, interpreters sometimes took on the role of gatekeeper by controlling what information was conveyed to the clinician from the patient, and vice versa. Interpreters did this by either responding to clinicians' questions on behalf of patients or responding to patients' questions on behalf of clinicians." (Kilian, 2021, p. 34)

"He concluded that interpreters do not simply act as 'neutral' machines of semantic conversion, nor simply as cultural brokers, but are active participants in the process of diagnosis." (Kilian, 2021, p. 34)

"It is interesting, then, that such gatekeeping by interpreters mainly occurred in our study in instances where interpreters were also health care workers." (Kilian, 2021, p. 35)

Methods Context #

What? #ⓘ

The observable: recurring instances in the recorded consultations where the interpreter answered for, or withheld utterances from, the patient or clinician, coded as a "gatekeeper" role.

"Interpreters at times took on the role of gatekeeper by controlling what information is conveyed to the clinician and patient. Interpreters did this by either responding to clinicians' questions on behalf of patients or by responding to patients' questions on behalf of clinicians." (Kilian, 2021, p. 32)

How? #ⓘ

Conversation Analysis of 13 video-recorded consultations, identifying facilitators and inhibitors of the consultation goals, supplemented by content analysis of 18 semi-structured interviews; verbatim transcription with cross-checked forward/back translation.

"We used Conversation Analysis (CA) to analyze the interpreter-mediated sessions that were video-recorded. . . . A facilitator is any action used by any of the three parties that makes an overall positive contribution to the goals of the psychiatric consultation, while an inhibitor consists of any action that has a negative impact on the goals of the consultation (Friedland & Penn, 2003)." (Kilian, 2021, p. 29)

Who? #ⓘ

isiXhosa-speaking psychiatric inpatients consulting English/Afrikaans-speaking registrars through bilingual nurse, social-worker, and cleaner ad hoc interpreters at a Western Cape public psychiatric hospital with no formal interpreting service.

"Patients were proficient in isiXhosa (one of the 11 official languages of South Africa), the clinicians (all registrars) were English or Afrikaans speakers (as their first language), while the health care workers (nurses and social worker) and cleaners were fluent in both the patients' and clinician's language." (Kilian, 2021, p. 29)

Other Notes #

The authors note the gatekeeping was concentrated among interpreters who were also health care workers, possibly because they felt more empowered or more pressed by time constraints to "aid" the diagnostic process (p. 35).

Caveats #

• Study did not assess how clinician and interpreter demographics shaped the interpreter roles observed The authors state it was outside the scope of the study to assess how clinician and interpreter demographic characteristics influenced the roles interpreters took on. Because all interpreters were female and most registrars were female and white, the role dynamics observed may be confounded by these characteristics, and the study cannot attribute the observed roles specifically to the interpreting arrangement versus participant demographics.
• Small exploratory single-site sub-study of 13 consultations at one South African psychiatric hospital limits generalizability The authors describe this as a small exploratory sub-study nested in a larger project, based on 13 video-recorded consultations and 18 interviews at a single public psychiatric hospital in the Western Cape, South Africa, with ad hoc (informal) interpreters and no formal interpreting service. The findings characterize interpreter roles in this specific resource-constrained, informal-interpreting setting; they should not be read as effect estimates and may not generalize to settings with trained/professional interpreters or other clinical contexts.