Strategies to Increase Professional Interpreting in Clinical Settings: A Systematic Review

Area of Science:

• Health Services Research
• Implementation Science
• Medical Communication

Background:

• Effective communication is crucial for patient health outcomes, yet clinicians frequently care for patients with limited English proficiency without professional interpreters.
• This gap in care can lead to disparities and suboptimal health outcomes for non-English speaking populations.

Purpose of the Study:

• To systematically review evidence on targeted behavior change strategies aimed at increasing the use of professional interpreters in medical settings.
• To identify effective implementation strategies and map them to behavior change targets using the Capability, Opportunity, Motivation-Behavior (COM-B) model.

Main Methods:

• A comprehensive systematic review of databases (CINAHL, Embase, PubMed, Ovid MEDLINE, Web of Science) was conducted for English-language peer-reviewed articles.
• Interventional and observational studies reporting outcomes related to professional interpreting in medical settings were included. Data were synthesized using the COM-B model.
• Risk of bias was assessed, and findings were reported following PRISMA guidelines.

Main Results:

• Of 17,952 records, 40 studies (39 interventions) were eligible. Most studies used pre-post designs or quality improvement methods.
• While most interventions (95%) showed an increase in professional interpreting measures, heterogeneity in strategies and outcome assessment precluded meta-analysis.
• Common strategies included clinician education (51%), improved access to interpreters (46%), standardized policies (31%), and EHR modifications (36%), targeting clinician capability, opportunity, and motivation.

Conclusions:

• A wide array of implementation strategies exist to increase professional interpreter use, but outcome assessment is highly heterogeneous.
• Despite improvements in interpreting measures, there's a critical need to understand the specific impact of individual strategies.
• Further research is needed to refine outcome measurement and inform effective implementation of professional interpreting services in healthcare systems to improve patient health outcomes.