Mandarin speakers say they value phone and video calls but have some requests
Kaiser Permanente researchers wanted to know why patients with a primary language other than English are less likely to use telemedicine visits, so they asked Mandarin speakers about their experiences. In a study published in the Journal of General Internal Medicine, the patients report challenges with dialects and ensuring accurate translation.
Kaiser Permanente Northern California (KPNC) has long had a robust telephone and video visit program, which expanded to a majority of patient visits during the COVID-19 pandemic; it remains an option many patients use for convenience. Telehealth visits can include language translation services if needed, as do in-person visits.
The qualitative study involved interviews with 20 Mandarin-speaking patients who had used telemedicine with translation services. Overall, the patients confirmed that they value being able to have a remote visit with their primary care provider, said lead author Loretta Hsueh, PhD, an assistant professor of psychology at the University of Illinois, Chicago. Hsueh carried out the research while she was a research fellow at the Kaiser Permanente Division of Research.
“Overall, the sentiment was, ‘We love telemedicine, this is great,’” Hsueh said. “When we asked more specific questions, we learned some interesting things about nuances with translation and interpersonal relations that can affect the patient’s experience.”
A major theme, the researchers learned, was the potential for a mismatch of dialect or Mandarin proficiency among interpreters. The patient and interpreter may speak different dialects, or come from different regions of China, affecting their cultural attitudes toward one another.
Translation in both Mandarin and Cantonese are among the language offerings for KPNC patients with a Chinese background.
In communicating about a technical medical topic, it is important for the patient and interpreter to be aligned in their language skills, the patients said.
Some patients who know more English preferred to use it for the simpler parts of the conversation and rely on the interpreter to assist with more complex or medically technical words. But some of those interviewed worried it would be impolite to interrupt the conversation to explain their communication preference.
Another concern in medical translation, Hsueh said, is safety —the interpreter is obligated to ensure the patient and doctor understand one another accurately. “There’s always a balance between patient autonomy and patient safety,” she said. The study authors recommended that patients be empowered to use English when they can, but also suggested further research on how to balance autonomy and safety.
The participants asked for patience on the part of both the medical provider and translator to work out language barrier issues.
“We think of translation as a somewhat technical service, but what we heard from patients is that it is a very human process, and that human part of the translation is surprisingly prominent in their care experience,” said senior author Mary Reed, DrPH, a DOR research scientist.
The interviewees asked for interpreters to acknowledge the potentially awkward nature of having a stranger as a third party in a medical visit, Hsueh said. They also asked for more Chinese-language written materials, both printed and online, and more bilingual support staff.
Complexities of translation
Research that provides insights into the user experience is essential to both patients and clinicians, said co-author Silvia Teran, MD, an ob/gyn with The Permanente Medical Group. “I rely on translation services to provide care to members from all backgrounds,” Teran said.
Teran is also medical director of health engagement and health education, which focuses on how patients best receive information. “It’s very important to learn more about how to effectively provide these services to our members in all the care formats we have available,” she said.
The researchers recommended additional training for care providers and translators to handle the unique communication challenges in interpreter-mediated care for Mandarin-speaking patients. They also raised concerns about using artificial intelligence in medical interpretation, because of the potential for culturally inaccurate or discriminatory translations.
The interviews provide health care systems such as Kaiser Permanente with important information about the patient experience with the growing medium of telemedicine, but also illustrate the complexity involved, Reed said. “Translation is more complicated than we realize,” she said.
The study was funded by The Permanente Medical Group Delivery Science Fellowship Program, the National Institute of Diabetes and Digestive and Kidney Diseases, the DOR Health Care Delivery and Policy Section, and the Agency for Healthcare Research and Quality.
Additional co-authors were Jie Huang, PhD, Andrea Millman, MA, and Anjali Gopalan, MD, of the Division of Research; Michael Zheng, MS, formerly of the Division of Research; Rahul Parikh, MD, of The Permanente Medical Group; and Reysha Patel, BA, of the University of California, Riverside School of Medicine.
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About the Kaiser Permanente Division of Research
The Kaiser Permanente Division of Research conducts, publishes and disseminates epidemiologic and health services research to improve the health and medical care of Kaiser Permanente members and society at large. It seeks to understand the determinants of illness and well-being, and to improve the quality and cost-effectiveness of health care. Currently, DOR’s 600-plus staff is working on more than 450 epidemiological and health services research projects. For more information, visit divisionofresearch.kaiserpermanente.org or follow us @KPDOR.
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