The challenge of communication in interpreted consultations in diabetes care: a mixed methods study.

BACKGROUND The experience of diabetes care for individuals from minority ethnic groups, particularly individuals of Bangladeshi origin, shows they are at a significant disadvantage. AIM To identify the challenges of interpreted consultations for healthcare providers and to explain the disadvantage experienced by patients from minority groups who have diabetes. DESIGN AND SETTING Comparison of 12 interpreted consultations with 24 consultations involving fluent English speakers in four primary healthcare centres in Tower Hamlets, east London, UK. METHOD Content analysis of video recordings of routine diabetes review consultations in primary care, involving 36 patients, nine nurses or healthcare assistants, and six interpreters. RESULT Interpreted consultations were as long as same-language consultations but patients said less. The incidence of misunderstandings was similar but patients in interpreted consultations asked fewer questions. Indicators of social distance in interpreted consultations included less humour and less discussion of the patient's feelings or personal circumstances. Patients in interpreted consultations were less likely to raise issues unrelated to diabetes, to discuss their own ideas about health, or to talk about clinical parameters. Providers commonly addressed English-speaking patients directly but usually addressed patients through interpreters using the third person. Interpreters sometimes changed the meaning or did not translate speech, and they added their own comments. CONCLUSION The findings explain some of the known problems of diabetes care for individuals from ethnic minorities. Effective training for interpreters and care providers is needed to reduce social distance and to facilitate patients' involvement in self-management.