Canada is a growing multilingual country representing 20.6% of immigrants, where 6.5% of all immigrants reported not being able to communicate in either English or French (Canada’s official languages), and this group is growing [1]. Thus, language is often considered crucial in all healthcare services [2]. Previous studies have documented that language barriers lead to miscommunication, which in turn leads to healthcare inequality [3], increasing risks to patient safety [4] and obstructing access to healthcare [5]. In order to address language barriers between patient and healthcare professionals, and thus increase equity and quality of healthcare, it is mostly accepted that some form of interpretation should be provided [2]. A previous study in Canada [6] showed that some healthcare professionals can have 20 requests per day for interpretation services, and the requirements cover some eight to ten languages. Thus, the finding calls for an appropriate interpreter’s service in Canada’s healthcare system. Therefore, this study aims to study Ukrainian-speaking immigrants’ attitudes to the use of interpreters in Canadian healthcare. The majority of all immigrants in Canada are from Europe, and persons of Ukrainian origin represent Canada’s ninth largest immigrant group [1], making it the world’s third largest Ukrainian population outside Ukraine itself and Russia.

No previous study gathering quantitative information about European migrants’ attitudes to the use of interpreters in Canadian healthcare encounters has been found. However, there is a previous quantitative study of Arabic-speaking migrants in Sweden [7] and Micronesian-speaking migrants in the United States (US) [8]. The findings were in opposite, Arabic-speaking migrants in Sweden found that they preferred using a professional interpreter [7] and Micronesian-speaking migrants in the United States found that they preferred using a family member or friend as interpreter [8]. There are also previous qualitative studies of Bosnian/Croatian/Serbian [9] and Arabic [10] speaking in Sweden, Bosnian/Croatian/Serbian-speaking and Russian-speaking migrants Ireland [11]. Informants in those studies [9-11] mostly preferred a professional interpreter who were highly skilled in medical terminology and language, with professional attitude. Those findings were contrary to previous qualitative studies, mainly of people of East Asian origin in the UK, where participants preferred to use family members as interpreters [12, 13] with expectations to empathize with them and understand and relate to their situations [13]. Internationally, there are differences concerning the legal right a person has to access across language barriers. In Sweden there is law [14] that all people who may communicate in another language in contact with healthcare services are permitted to access interpretations services. In contrast, in the UK the law is vague concerning what language rights individuals have [15] and in Canada there is no legislative framework requiring the provision of interpretation service to all people [16]. Due to these legal differences between countries in access to interpretation service, it is important to investigate Ukrainian-speaking migrants’ attitudes to the use of interpreters in Canadian healthcare to understand how migrants’ opportunities and worries regarding interpreters may vary both within and across cultural/linguistic populations and to understand the significances of different attitudes for planning responsive services group in order to deepen our understanding of the Ukrainian speaking person’s attitudes of using interpreters to obtain a more complete understanding of the problem area. Furthermore, this pilot study is intended to test the translated questionnaire and whether the participant recruitment strategy is workable, acceptable and manageable in order to use the findings to assess the feasibility of conducting a stronger, larger investigation on the same subject.

The aim of this pilot study was to investigate Ukrainian-speaking migrants’ attitudes to the use of interpreters in healthcare service in order to test a developed questionnaire and recruitment strategy.

The main study findings were that having an interpreter with a good knowledge of languages and translation ability as an objective communication aid and a practical aid an important aspect (see Tables 1-3). However, personal qualities such as the clothes worn by the interpreter and the interpreter’s religion were not seen as the important aspects. Participants felt more trust in family members as interpreters than having an unknown person acting as interpreter.

This pilot study, to my knowledge, is first study to investigate Ukrainian-speaking individuals’ attitudes to the use of interpreters in Canadian healthcare service. The findings showed that it was important that an interpreter act as an objective communication and practical aid and having personal qualities such as a good knowledge of languages and translation ability. Other personal characteristics such as the clothes worn by the interpreter and the interpreter’s religion were not viewed as important aspects. Ukrainian-speaking migrants’ felt more trust in family members as interpreters than an unknown person acting as interpreter.

The finding of the pilot study was that Ukrainian-speaking individuals experienced trust in using a family member/friend as interpreter more than an unknown person as interpreter, and they could not see any risk in using family members as interpreters in a healthcare encounter. This finding is supported by previous qualitative studies, mainly of Eastern Asian migrants in the UK [12, 13] and a previous quantitative study concerning Micronesian-speaking migrants in the United States [8]. Thus, the pilot study finding is in contrast to previous qualitative studies from European migrants’ perspective in Sweden [9] and in Ireland [11], where participants described the family member’s inability to fully grasp the language and preferred to use a professional interpreter. Advantages of using family members as interpreters included greater privacy, support in the consultation and a shared understanding of advice and instructions [12]. In contrast, the advantages of using professional interpreters included significantly reducing errors of potential clinical significance [26] and better patient reports on quality treatment [27]. The dissimilarities between studies concerning the preferred type of interpreter could be explained by the countries’ different policy rules regarding interpretation in healthcare. In Sweden it is a legal right [14] to access interpreting and translation services in all contacts with authorities; in contrast, the legal right is unclear in the UK [15] and absent in Canada [16]. However, the finding emphasizes the importance of ensuring optimal communication in the interpretation situation when family members act as interpreters, regardless of the country’s legal rights and the person’s background, in order not to compromise patients’ clinical safety [7, 9, 10, 20].

A result in accordance with a previous quantitative study concerning Arabic-speaking persons in Sweden [7], was that confidence in the interpreter was not associated to the professional interpreter’s religion. Otherwise, the qualities of interpreters experienced by Ukrainian participants were mostly in agreement with previous qualitative studies of patients’ [9, 13], healthcare staff [18] and family members [20]. Feeling trust in interpreters was perceived as a benefits for cross-cultural communication [28] and for providing quality healthcare [29, 30]. This aspect is important to consider when arranging the interpretation, to adjust to the possibilities of the interpretation context and the patient’s background characteristics [7, 9, 10, 20]. A new finding compared to the quantitative study among Arabic-speaking migrants in Sweden [7] was that all participants described the willingness of healthcare professionals to book an interpreter when needed. It seems reasonable to assume that differences between studies could be due to the translation of the questionnaire used for the investigation in different areas, or participants did not read the statement correctly because it was negatively formulated to test opinion [7]. Furthermore, it can be explained by variations in terms of the expectations, requirements and availability of interpretation services that exist in Canadian and Swedish healthcare organizations [31].

A strength of this pilot study is that the participants were recruited with snowball sampling from a particular organization representing the province and metropolis with the largest Ukrainian population in Canada [17]; participants were of different ages, length of residence in Canada and with high education levels. There are several limitations to this study. A weakness of the recruitment procedure of contacting representatives of adult education could be seen as a threat to the dependency of the participants and may influence the outcome of the pilot study. The relationship between the volunteer and the participants, such as their different hierarchical, cultural and sociodemographic backgrounds, may have led some respondents to feel less trust, to practice and self-censorship, and to be afraid to express their views [23]. To minimize the risk of bias, the questionnaire was to be return to the volunteer representative, who then sent it author.

Developing a new structured self-administered questionnaire in another language requires as much work as developing an original questionnaire [17, 22]. The goal of the translation of data was to achieve semantic equivalence so as to preserve the underlying meaning of the original expression rather than the exact wording [21-23]. The first step was that the translation of data started with the selection of a translators’ team who worked independently to complete a draft translation of the source questionnaire, including the instructions. Second, for translation from Swedish to English, the team included native Swedish speakers with expertise in developing questionnaires, good English ability, familiarity with both cultures and the theoretical keystones of the concept. Third, for translation from English to Ukrainian, was chosen independent native Ukrainian speaker with expertise in translation and familiarity with both cultures. Finally, the questionnaire was pilot-tested by Ukrainian-speaking persons for accuracy in the transcriptions with no language corrections; nevertheless, the newly structured self-administered questionnaire should be tested in a full psychometric evaluation with a large sample of respondents [17, 21-23]. The small number of participants and limited sample sizes restricted the ability of the study to generalize from the findings [17]. Though these limitations, the investigation results support the findings from previous quantitative [7] and qualitative [9, 10] studies of a different cultural and language migrant group and provide a deeper understanding of the Ukrainian speaking person’s attitudes of using interpreters.

This pilot study supported a previous quantitative study from another migrant group with a different cultural and language background in a country with legal right in access to interpretation service. Similarities found were the view of an interpreter as an objective communication aid with a good knowledge of languages and good translation ability. Experiences differed as to whether the interpreter should share the same religion as the patient and willingness of healthcare professionals to book an interpreter. The findings support the method in terms of the questionnaire and recruitment strategy is workable, acceptable and manageable for participants, so that it can be used in a larger psychometric evaluation of the same topic with a large sample of participants. The implications of the pilot study, the nurses need to be of aware of differences between countries concerning the legal right a person has to access across language barriers affected some of the expectations and requirements of the use of interpreters among immigrants to enhance the receptivity and utilization of trained language interpreters.

The author confirms that this article content has no conflict of interest.