Training interpreters in diabetes education

Nutrition Research Newsletter, Nov, 2006

Ongoing, accurate communication is important for patients with diabetes, whose care has become more complex in recent years and more reliant on patient participation and self-care. Patient-centered interactions are challenging when there are significant language barriers between patients and their healthcare providers. Unfortunately, much of the work to accommodate patients in their primary language has not fallen on trained interpreters, but on nursing staff and other employees who speak the language but often have no training in interpreting and no current knowledge about diabetes. Skilled interpretation is essential for patients with diabetes because vital concepts in diabetes can be difficult to translate.

The need for skilled interpreters has increased in native communities where diabetes is now a major health problem and elderly individuals are not fluent in English. To facilitate effective diabetes outcomes for individuals and families, the Navajo Nation Division of Health Special Diabetes Project coordinated the development of standardized translations of diabetes terminology to serve as a resource and reference for training healthcare interpreters to communicate and educate their clients with confidence and effectiveness. To improve the understanding and ability of Navajo-speaking healthcare workers who act as ad hoc interpreters for diabetes patients, the researchers developed a case-based training program, and in a small pilot project, compared the performance of participants after an interactive didactic workshop with that of participants who were provided similar material to study independently.

An English/Navajo diabetes curriculum was designed around case studies that addressed four everyday situations in which translators are often involved. Translations of concepts and terminology were consensus driven and supported by the knowledge and experience of the principal investigator, the diabetes specialist, and the Navajo language specialist, along with the medical interpreters and research assistants. The four case studies were developed as everyday clinic scenarios involving a newly diagnosed patient, a poorly controlled patient, and those needing explanations regarding retinopathy screening and nephropathy screening and treatment.

Twenty-two participants were recruited and randomly assigned to either the workshop format or the independent study format. Inclusion criteria were fluency in Navajo, high school diplomas, and easy access to a videotape player. Eleven of the subjects participated in a 2-day didactic workshop while the remaining 11 were given a separate video tape adapted from the workshop for independent study. Pre- and postintervention questionnaires were administered, and the participant's interpreting skills were assessed from audiotapes made by each participant before and four months after the training.

Workshop participants noted significant improvements in their knowledge and comfort level in interpretation of diabetes concepts but not about unrelated topics. However, the independent study group perceived less improvement in all areas when compared with the workshop group. Formal, in-person training for interpreters working with diabetes patients should be considered by all programs, clinics, and diabetes educators in which foreign language speaking patients are common.

M. McCabe, D. Gohdes, F. Morgan, et al. Training Effective Interpreters for Diabetes Care and Education. The Diabetes Educator; 32:714-720 (September/October 2006). [Correspondence: Melvina McCabe, MD, Department of Family and Community Medicine, MSC 09 5040, University of New Mexico, Albuquerque, NM 87131. E-mail: mmccabe@salud.unm.edu.]