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Dr. Elaine Hsieh

Professor, Communication
University of Oklahoma

TEL: 405-325-3154
Email: Elaine Hsieh

DISSERTATION

Bilingual Health Communication and Medical Interpreters:

Managing Role Performances and Communicative Goals

 

This study examines medical interpreters’ communicative strategies in naturalistic settings, explores the roles medical interpreters assume in health care settings, and provides a theory of bilingual health communication that accounts for individuals’ (e.g., providers, patients, and interpreters) communicative behaviors in provider-patient interactions. This study includes data collected through participant observation of interpreter-mediated provider-patient interactions and individual/dyadic in-depth interviews with medical interpreters, which were analyzed through grounded theory methods. In total, 42 participants were recruited for this study, including 26 medical interpreters who represented 17 languages. The study examines interpreters’ communicative strategies and role performances through three perspectives. First, I explore interpreters’ self-perceived roles (i.e., conduit, advocate, manager, and professional) through their narratives, developing an insider perspective of how these roles were conceptualized and practiced by interpreters. Second, I investigate interpreters’ conflicts in role performances and conflict resolutions. By demonstrating interpreters’ sense of role conflicts, I examine the sources of conflicts (i.e., others’ communicative practices, changes in participant dynamics, institutional constraints, and unrealistic expectations) in interpreters’ role performances and classified interpreters’ resolutions to these conflicts. Finally, based on the typology of roles (i.e., conduit, co-diagnostician, patient advocate, institutional manager, and professional) presented in the study, I analyze interpreters’ roles and their corresponding communicative goals and strategies. The theory of bilingual health communication is presented to explain the effectiveness and appropriateness of the communicative strategies adopted by different individuals involved in medical encounters. In addition to demonstrating interpreters as active participants in provider-patient interactions, I theorize how the communicative goals of other speakers, institutions, and interpreters themselves can motivate interpreters to deviate from the original text in their interpretation. More importantly, I propose that interpreters act as stage managers, defining the stages for other participants, providing necessary props for the participants’ appropriate performance, and controlling the stages to avoid provider-patient conflicts. Finally, I discuss how the study of interpreter-mediated interactions can contribute to the field of communication studies.


The main objective of this study is to develop a bilingual health communication model for physicians and patients who do not share the same language and/or culture. The long-term objectives include (a) developing communication models and training programs for health care providers to work with different types of interpreters (e.g., professional interpreters, telephone interpreters, bilingual health care staff, and patients’ family members) without compromising the quality of care, which also may reduce the cost of care significantly; (b) understanding physician’s and patients’ expectations, perceptions, and evaluations of the performances and roles of medical interpreters; and (c) developing training programs for interpreters to provide effective and quality interpreting services.


This study incorporates a micro-level analysis of the roles and performances of Chinese-English medical interpreters with a macro-level, cross-cultural analysis of the practices and beliefs of medical interpreters across various cultures. The research questions will be both theory-driven and data-driven. Compared to previous research on medical interpreters, this study has the following strengths: (a) developing a theory about bilingual health communication, (b) gaining an insider-perspective on the strategies used by medical interpreters, and (c) using different methods to obtain the culturally-specific beliefs of medical interpreting as well as the cross-cultural data on the practices and beliefs of medical interpreting.

 

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