Interpreter-mediated transplant education: A qualitative study of nurses' experiences and competence needs

For kidney transplant recipients, education is vital for developing knowledge and health literacy skills necessary for successful post-transplant outcomes. However, as the transplant population has become increasingly multicultural and multilingual, a gap has emerged between the growing diversity of patients and the educational resources designed to support them. Understanding nurses' perspectives and competence needs is essential for accurately estimating time and resources required to enhance their capabilities. This study therefore explores transplant nurses' experiences, perceived competence, and competence needs when providing post-transplant education to immigrant transplant recipients.

We used a qualitative explorative design with focus group interviews. Twenty-nine nurses from three wards participated in five focus groups. Interviews were analysed using thematic analysis.

Analysis resulted in three main themes: (1) Communication barriers when using an interpreter- participants experienced uncertainty, disrupted conversations, and inability to verify understanding. The nurses lacked formal training in interpreter-mediated communication and communication strategies; (2) Balancing cultural insecurity, respect and expectations-cultural insecurity led nurses to avoid sensitive topics, struggle with differing expectations, and lack the knowledge and confidence to adapt information to diverse contexts; (3) Transplant education in a limited time window -fixed interpreter schedules created patient vulnerability, as patients could not access the ongoing, informal information exchange available to Norwegian-speaking patients. Lack of translated materials intensified pressure and responsibility on the nurses.

Nurses articulated a need for formal training in interpreter-mediated communication and tools like teach-back in multilingual contexts. They also requested cultural competence training to navigate sensitive topics and adapt educational materials to diverse cultural contexts.

The findings demonstrate that achieving health literacy and health equity in transplant care requires moving beyond individual-focused interventions towards system-level changes. Future interventions must address health literacy responsiveness and cultural sensitivity to ensure equitable care and optimal outcomes for all transplant recipients.