The Open Nursing Journal




ISSN: 1874-4346 ― Volume 13, 2019

Ukrainian-Speaking Migrants’ Concerning the Use of Interpreters in Healthcare Service: A Pilot Study



Emina Hadziabdic*
Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Sweden

Abstract

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. A descriptive survey using a 51-item structured self-administered questionnaire of 12 Ukrainian-speaking migrants’ and analyzed by the descriptive statistics. The findings were to have an interpreter as an objective communication and practical aid with personal qualities such as a good knowledge of languages and translation ability. In contrast, the clothes worn by the interpreter and the interpreter’s religion were not viewed as important aspects. The findings support the method of a developed questionnaire and recruitment strategy, which in turn can be used in a larger planned investigation of the same topic in order to arrange a good interpretation situation in accordance with persons’ desire irrespective of countries’ different rules in healthcare policies regarding interpretation.

Keywords: Canada, language barriers, pilot study, structured self-administered questionnaire, ukrainian-speaking migrants, use of interpreters.


Article Information


Identifiers and Pagination:

Year: 2016
Volume: 10
First Page: 1
Last Page: 7
Publisher Id: TONURSJ-10-1
DOI: 10.2174/1874434601610010001

Article History:

Received Date: 20/03/2015
Revision Received Date: 02/06/2015
Acceptance Date: 15/06/2015
Electronic publication date: 15/2/2016
Collection year: 2016

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open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (https://creativecommons.org/licenses/by-nc/4.0/legalcode), which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, SE- 351 95 Växjö, Sweden; Tel: +46 470 70 80 37; Fax: +46 470 363 10; Email: emina.hadziabdic@lnu.se





INTRODUCTION

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 [1Statistics Canada. Immigration and ethnocultural diversity in Canada. Available from: http://www12.statcan.gc.ca/ nhs-enm/2011/as-sa/99-010-x/99-010-x2011001-eng.pdf 2013 [cited 4th December 2013];]. Thus, language is often considered crucial in all healthcare services [2Leininger MM, McFarland MR. Culture care diversity and universality: a worldwide nursing theory. 2nd ed. London: Jones and Bartlett 2006.]. Previous studies have documented that language barriers lead to miscommunication, which in turn leads to healthcare inequality [3Akhavan S. Midwives' views on factors that contribute to health care inequalities among immigrants in Sweden: a qualitative study. Int J Equity Health 2012; 11: 47.
[http://dx.doi.org/10.1186/1475-9276-11-47]
], increasing risks to patient safety [4Divi C, Koss R, Schmaltz S, Loeb J. Language proficiency and adverse events in US hospitals: a pilot study. Int J Qual Health Care 2007; 19(2): 60-7.
[http://dx.doi.org/10.1093/intqhc/mzl069]
] and obstructing access to healthcare [5Boateng L, Nicolaou M, Dijkshoorn H, Stronks K, Agyemang C. An exploration of the enablers and barriers in access to the Dutch healthcare system among Ghanaians in Amsterdam. BMC Health Serv Res 2012; 12: 75.
[http://dx.doi.org/10.1186/1472-6963-12-75]
]. 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 [2Leininger MM, McFarland MR. Culture care diversity and universality: a worldwide nursing theory. 2nd ed. London: Jones and Bartlett 2006.]. A previous study in Canada [6Higginbottom GM, Richter S, Ortiz L, et al. Does the FAMCHAT tool enhance the ethno-cultural dimensions of nursing assessment at the royal Alexandra hospital? final report to royal Alexandra hospital foundation and Canadian nurses foundation. Available from: https://era.libra ry.ualberta.ca/public/view/Item/uuid:0b44fd0a-ac4b-40ee-bfa9-934 c0f1adf8e. 2010 [cited: 4th December 2013];
[http://dx.doi.org/10.1186/1756-0500-7-71]
] 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 [1Statistics Canada. Immigration and ethnocultural diversity in Canada. Available from: http://www12.statcan.gc.ca/ nhs-enm/2011/as-sa/99-010-x/99-010-x2011001-eng.pdf 2013 [cited 4th December 2013];], 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 [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
] and Micronesian-speaking migrants in the United States (US) [8Ramsey KW, Davis J, French G. Perspectives of Chuukese patients and their health care providers on the use of different sources of interpreters. Hawai'i J Med Pub Health 2012; 71(9): 249-52.]. The findings were in opposite, Arabic-speaking migrants in Sweden found that they preferred using a professional interpreter [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
] and Micronesian-speaking migrants in the United States found that they preferred using a family member or friend as interpreter [8Ramsey KW, Davis J, French G. Perspectives of Chuukese patients and their health care providers on the use of different sources of interpreters. Hawai'i J Med Pub Health 2012; 71(9): 249-52.]. There are also previous qualitative studies of Bosnian/Croatian/Serbian [9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
] and Arabic [10Hadziabdic E, Hjelm K. Arabic-speaking migrants' experiences of the use of interpreters in healthcare: a qualitative explorative study. Int J Equity Health 2014; 13(1): 13-49.
[http://dx.doi.org/10.1186/1475-9276-13-49]
] speaking in Sweden, Bosnian/Croatian/Serbian-speaking and Russian-speaking migrants Ireland [11MacFarlane A, Dzebisova Z, Karapish D, Kovacevic B, Ogbebor F, Okonkwo E. Arranging and negotiating the use of informal interpreters in general practice consultations: Experiences of refugees and asylum seekers in the west of Ireland. Soc Sci Med 2009; 69(2): 210-4.
[http://dx.doi.org/10.1016/j.socscimed.2009.04.022]
]. Informants in those studies [9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
-11MacFarlane A, Dzebisova Z, Karapish D, Kovacevic B, Ogbebor F, Okonkwo E. Arranging and negotiating the use of informal interpreters in general practice consultations: Experiences of refugees and asylum seekers in the west of Ireland. Soc Sci Med 2009; 69(2): 210-4.
[http://dx.doi.org/10.1016/j.socscimed.2009.04.022]
] 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 [12Rhodes P, Nocon A. A problem of communication? Diabetes care among Bangladeshi people in Bradford. Health Soc Care Community 2003; 11(1): 45-54.
[http://dx.doi.org/10.1046/j.1365-2524.2003.00398.x]
, 13Edwards R, Temple B, Alexander C. Users' experiences of interpreters: the critical role of trust. Interpreting 2005; 7: 77-95.
[http://dx.doi.org/10.1075/intp.7.1.05edw]
] with expectations to empathize with them and understand and relate to their situations [13Edwards R, Temple B, Alexander C. Users' experiences of interpreters: the critical role of trust. Interpreting 2005; 7: 77-95.
[http://dx.doi.org/10.1075/intp.7.1.05edw]
]. Internationally, there are differences concerning the legal right a person has to access across language barriers. In Sweden there is law [14Svensk författningssamling 1986:223 Available from: http://www.riksdagen.se/sv/Dokument-Lagar/Lagar/Svenskforfattningssamling/ _sfs-1986-223/ 2013 [cited: 17th December 2013];] 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 [15Department of Health. The Equality and Human Rights Grou Guidance on Developing Local Communication Support Services and Strategies Available from: http://www.dh.gov.uk/prod_consum_dh/ groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082350.pdf. 2004. cited 18th August 2010] and in Canada there is no legislative framework requiring the provision of interpretation service to all people [16Bowen Sarah. Language barriers to access to health care. Health Canada. Available from: http://www.hc-sc.gc.ca/hcs-sss/pubs/ acces/2001-lang-acces/gen-eng.php 2006 [cited: 17th December 2013];]. 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.

Aim

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.

MATERIALS AND METHODOLOGY

Design

A descriptive survey using a structured self-administered questionnaire [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009.] concerning Ukrainian-speaking migrants’ attitudes to the use of interpreters in healthcare was used to pilot-test the translated questionnaire, and whether the participant recruitment strategy is workable, acceptable and manageable. It is planned to use the lessons from the pilot study to assess the feasibility of developing a stronger, larger investigation on the same subject [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009.].

Setting

A Canadian province with the second largest percentage of Ukrainians, where 10% of the populations were Ukrainians, was studied. The participants lived in a metropolitan region with many immigrants, both newcomers and older immigrants; in addition, the city has the largest Ukrainian population in Canada [1Statistics Canada. Immigration and ethnocultural diversity in Canada. Available from: http://www12.statcan.gc.ca/ nhs-enm/2011/as-sa/99-010-x/99-010-x2011001-eng.pdf 2013 [cited 4th December 2013];].

Sample

A convenience sampling of Ukrainian-speaking adults (over 18 years) who use interpreters in healthcare with different gender, age, educational level and length of residence in Canada participated in the pilot study.

To come into contact with participants the author used snowball sampling by asking a voluntary representative at a Ukrainian adult education facility for immigrants to distribute questionnaires to participants who met the study’s inclusion criteria. A prepared envelope with written information and a questionnaire were given by the representative to the voluntary participants so they could answer when appropriate. The written information included data about the aim of the study, focusing on the use of an interpreter in healthcare encounters from their perspective, the implementation of the study and the ethical considerations. Thus, the questionnaire was to be returned in an envelope to the representative at the adult education facility for immigrants which in turn sent it to the author. The authors’ contact details were included in case the participants had any questions. Participants did not have to write their names if they did not want to.

Fifty questionnaires were distributed in March 2013 at an adult education facility for immigrants. In total 12 persons returned the questionnaire giving a response rate of 24%. All were in residence in Canada from 1994 to 2012 (median 1996) with a high education level.

Data Collection

Data were collected using a 51-item questionnaire with permission from the developer of the original version [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
]. The original survey was grounded on four previous qualitative studies [9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
, 18Hadziabdic E, Albin B, Heikkilä K, Hjelm K. Healthcare staffs perceptions of using interpreters: a qualitative study. Prim Health Care Res Dev 2010; 1(3): 1-11.-20Hadziabdic E, Albin B, Heikkila K, Hjelm K. Family members' experiences of the use of interpreters in healthcare. Prim Health Care Res Dev 2014; 15(2): 156-69.
[http://dx.doi.org/10.1017/S1463423612000680]
] (for more details see [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
]). The questionnaire was used to investigate attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare and it included some additional background data questions. This type of survey is useful in obtaining data directly from participants and is effective in capturing values and attitudes [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009.].

The questionnaire was originally written in Swedish (for more details see [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
]) and was translated and adapted into English by three researchers, experienced in the use of interpreters in a healthcare setting and in quantitative methods [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009., 21Mallinckrodt B, Wang C-C. Quantitative methods for verifying semantic equivalence of translated research instruments: a chinese version of the experiences in close relationships scale. J Couns Psychol 2004; 51(3): 368-79.
[http://dx.doi.org/10.1037/0022-0167.51.3.368]
-23Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2013.]. After the preliminary individual translation and adaptation, the researchers compared documents and agreed on a final document. The translated questionnaires’ sent to a bilingual person (English and Ukrainian) who was selected for her fluency in English and Ukrainian (her mother tongue is Ukrainian), familiarity with both cultures and a professional background (she works as a language teacher) [21Mallinckrodt B, Wang C-C. Quantitative methods for verifying semantic equivalence of translated research instruments: a chinese version of the experiences in close relationships scale. J Couns Psychol 2004; 51(3): 368-79.
[http://dx.doi.org/10.1037/0022-0167.51.3.368]
, 24Maneesriwongul W, Dixon JK. Instrument translation process: a methods review. J Adv Nurs 2004; 48(2): 175-86.
[http://dx.doi.org/10.1111/j.1365-2648.2004.03185.x]
]. The translation from English to Ukrainian was certified as accurate by a bilingual person fluent in both English and Ukrainian and familiarity with both cultures that led to no correction of language [21Mallinckrodt B, Wang C-C. Quantitative methods for verifying semantic equivalence of translated research instruments: a chinese version of the experiences in close relationships scale. J Couns Psychol 2004; 51(3): 368-79.
[http://dx.doi.org/10.1037/0022-0167.51.3.368]
-23Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2013.].

The survey was arranged in three areas with statements about the use of interpreters in healthcare: as a communication aid (21 items); the professional and personal qualities of an interpreter (19 items); modes of interpretation and the type of interpreter (11 items). The 51 items are rated on four-point Likert scale, ranging from 1 (strongly disagree) to 4 (strongly agree), i.e. the higher the values, the stronger the agreement [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
]. The questionnaire took on average approximately 15 min to complete. Since the participants mostly answered with only two values, either disagreeing or agreeing, the answers with strong disagreement and agreement were summed with these to give dichotomous variables showing either a pessimistic or an optimistic view [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
].

Data Analysis

Completed surveys were coded, cleaned and computerized. Descriptive statistics, in terms of frequencies and percentages [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009.] were used to analyze the three areas of the use of interpreters with the help of SPSS version 20 SPSS Inc, Chicago, IL, US.

Ethical Considerations

The common ethical principles [25World Health Organization. World Medical Association Declaration of Helsinki. Available from: http://www.wma.net/en/30publications/ 10policies/b3/index.html.pdf?print-media-type&footer-right=[page]/[toPage] 2008.] were followed. The participants received written information in Ukrainian about the study, confidentiality and the right to withdraw. The questionnaires were anonymous, coded by number, and the analysis and presentation of the data were done on a group level which conceals the participants’ identity in order to ensure confidentiality. All the collected data were stored in a locked space at the author’s workplace, accessible only to the author. According to the common ethical principles [25World Health Organization. World Medical Association Declaration of Helsinki. Available from: http://www.wma.net/en/30publications/ 10policies/b3/index.html.pdf?print-media-type&footer-right=[page]/[toPage] 2008.] approval by an official research ethics committee was not required because the research study posed no physical or mental risk to the participants and did not treat participants’ personal data.

RESULTS

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.

DISCUSSION

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 [12Rhodes P, Nocon A. A problem of communication? Diabetes care among Bangladeshi people in Bradford. Health Soc Care Community 2003; 11(1): 45-54.
[http://dx.doi.org/10.1046/j.1365-2524.2003.00398.x]
, 13Edwards R, Temple B, Alexander C. Users' experiences of interpreters: the critical role of trust. Interpreting 2005; 7: 77-95.
[http://dx.doi.org/10.1075/intp.7.1.05edw]
] and a previous quantitative study concerning Micronesian-speaking migrants in the United States [8Ramsey KW, Davis J, French G. Perspectives of Chuukese patients and their health care providers on the use of different sources of interpreters. Hawai'i J Med Pub Health 2012; 71(9): 249-52.]. Thus, the pilot study finding is in contrast to previous qualitative studies from European migrants’ perspective in Sweden [9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
] and in Ireland [11MacFarlane A, Dzebisova Z, Karapish D, Kovacevic B, Ogbebor F, Okonkwo E. Arranging and negotiating the use of informal interpreters in general practice consultations: Experiences of refugees and asylum seekers in the west of Ireland. Soc Sci Med 2009; 69(2): 210-4.
[http://dx.doi.org/10.1016/j.socscimed.2009.04.022]
], 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 [12Rhodes P, Nocon A. A problem of communication? Diabetes care among Bangladeshi people in Bradford. Health Soc Care Community 2003; 11(1): 45-54.
[http://dx.doi.org/10.1046/j.1365-2524.2003.00398.x]
]. In contrast, the advantages of using professional interpreters included significantly reducing errors of potential clinical significance [26Glenn F, Milagros A, Pizzo CB, Richard B, Hua L. Patient safety/original research: errors of medical interpretation and their potential clinical consequences: a comparison of professional versus ad hoc versus no interpreters. Ann Emerg Med 2012; 60: 545-53.
[http://dx.doi.org/10.1016/j.annemergmed.2012.01.025]
] and better patient reports on quality treatment [27Jimenez N, Moreno G, Leng M, Buchwald D, Morales LS. Patient-reported quality of pain treatment and use of interpreters in spanish-speaking patients hospitalized for obstetric and gynecological care. J Gen Intern Med 2012; 27(12): 1602-8.
[http://dx.doi.org/10.1007/s11606-012-2154-x]
]. 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 [14Svensk författningssamling 1986:223 Available from: http://www.riksdagen.se/sv/Dokument-Lagar/Lagar/Svenskforfattningssamling/ _sfs-1986-223/ 2013 [cited: 17th December 2013];] to access interpreting and translation services in all contacts with authorities; in contrast, the legal right is unclear in the UK [15Department of Health. The Equality and Human Rights Grou Guidance on Developing Local Communication Support Services and Strategies Available from: http://www.dh.gov.uk/prod_consum_dh/ groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4082350.pdf. 2004. cited 18th August 2010] and absent in Canada [16Bowen Sarah. Language barriers to access to health care. Health Canada. Available from: http://www.hc-sc.gc.ca/hcs-sss/pubs/ acces/2001-lang-acces/gen-eng.php 2006 [cited: 17th December 2013];]. 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 [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
, 9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
, 10Hadziabdic E, Hjelm K. Arabic-speaking migrants' experiences of the use of interpreters in healthcare: a qualitative explorative study. Int J Equity Health 2014; 13(1): 13-49.
[http://dx.doi.org/10.1186/1475-9276-13-49]
, 20Hadziabdic E, Albin B, Heikkila K, Hjelm K. Family members' experiences of the use of interpreters in healthcare. Prim Health Care Res Dev 2014; 15(2): 156-69.
[http://dx.doi.org/10.1017/S1463423612000680]
].

Table 1

Attitudes concerning the communication aid from the Ukrainian-speaking migrants perspective.




A result in accordance with a previous quantitative study concerning Arabic-speaking persons in Sweden [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
], 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’ [9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
, 13Edwards R, Temple B, Alexander C. Users' experiences of interpreters: the critical role of trust. Interpreting 2005; 7: 77-95.
[http://dx.doi.org/10.1075/intp.7.1.05edw]
], healthcare staff [18Hadziabdic E, Albin B, Heikkilä K, Hjelm K. Healthcare staffs perceptions of using interpreters: a qualitative study. Prim Health Care Res Dev 2010; 1(3): 1-11.] and family members [20Hadziabdic E, Albin B, Heikkila K, Hjelm K. Family members' experiences of the use of interpreters in healthcare. Prim Health Care Res Dev 2014; 15(2): 156-69.
[http://dx.doi.org/10.1017/S1463423612000680]
]. Feeling trust in interpreters was perceived as a benefits for cross-cultural communication [28Fatahi N, Nordholm L, Mattsson B, Hellström M. Experiences of Kurdish war-wounded refugees in communication with Swedish authorities through interpreter. Patient Educ Couns 2010; 78(2): 160-5.
[http://dx.doi.org/10.1016/j.pec.2009.03.010]
] and for providing quality healthcare [29Greenhalgh T, Robb N, Scambler G. Communicative and strategic action in interpreted consultations in primary health care: a Habermasian perspective. Soc Sci Med 2006; 63(5): 1170-87.
[http://dx.doi.org/10.1016/j.socscimed.2006.03.033]
, 30Robb N, Greenhalgh T. “You have to cover up the words of the doctor”: the mediation of trust in interpreted consultations in primary care. J Health Organ Manag 2006; 20(5): 434-55.
[http://dx.doi.org/10.1108/14777260610701803]
]. 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 [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
, 9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
, 10Hadziabdic E, Hjelm K. Arabic-speaking migrants' experiences of the use of interpreters in healthcare: a qualitative explorative study. Int J Equity Health 2014; 13(1): 13-49.
[http://dx.doi.org/10.1186/1475-9276-13-49]
, 20Hadziabdic E, Albin B, Heikkila K, Hjelm K. Family members' experiences of the use of interpreters in healthcare. Prim Health Care Res Dev 2014; 15(2): 156-69.
[http://dx.doi.org/10.1017/S1463423612000680]
]. A new finding compared to the quantitative study among Arabic-speaking migrants in Sweden [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
] 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 [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
]. 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 [31Kammarkollegiet. God tolksed. Vägledning för auktoriserade tolkar [Good interpreting practice] Guidance for authorized interpreters]. Kammarkollegiet [National Judicial Board for Public Lands and Funds]. Available from: http://www.kammarkollegiet.se/ sites/default/files/god_tolksed.pdf 2010 [cited: 17th December 2013];].

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 [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009.]; 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 [23Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2013.]. To minimize the risk of bias, the questionnaire was to be return to the volunteer representative, who then sent it author.

Table 2
Attitudes concerning the professional and personal qualities of an interpreter from the Ukrainian-speaking migrants’ perspective.


Table 3
Attitudes concerning the modes of interpretation and the type of interpreters from the Ukrainian-speaking migrants’ perspective.


Developing a new structured self-administered questionnaire in another language requires as much work as developing an original questionnaire [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009., 22Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 4th ed. Oxford: Oxford University Press 2008.
[http://dx.doi.org/10.1093/acprof:oso/9780199231881.001.0001]
]. 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 [21Mallinckrodt B, Wang C-C. Quantitative methods for verifying semantic equivalence of translated research instruments: a chinese version of the experiences in close relationships scale. J Couns Psychol 2004; 51(3): 368-79.
[http://dx.doi.org/10.1037/0022-0167.51.3.368]
-23Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2013.]. 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 [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009., 21Mallinckrodt B, Wang C-C. Quantitative methods for verifying semantic equivalence of translated research instruments: a chinese version of the experiences in close relationships scale. J Couns Psychol 2004; 51(3): 368-79.
[http://dx.doi.org/10.1037/0022-0167.51.3.368]
-23Polit DF, Beck CT. Essentials of nursing research: appraising evidence for nursing practice. 8th ed. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins 2013.]. The small number of participants and limited sample sizes restricted the ability of the study to generalize from the findings [17Bowling A. Research methods in health: investigating health and health services. 3rd ed. Maidenhead: McGraw-Hill Open University Press 2009.]. Though these limitations, the investigation results support the findings from previous quantitative [7Hadziabdic E, Albin B, Hjelm K. Arabic-speaking migrants' attitudes, opinions, preferences and past experiences concerning the use of interpreters in healthcare: a postal cross-sectional survey. BMC Res Notes 2014; 7(71)
[http://dx.doi.org/10.1186/1756-0500-7-71]
] and qualitative [9Hadziabdic E, Heikkila K, Albin B, Hjelm K. Migrants' perceptions of using interpreters in health care. Int Nurs Rev 2009; 56(4): 461-9.
[http://dx.doi.org/10.1111/j.1466-7657.2009.00738.x]
, 10Hadziabdic E, Hjelm K. Arabic-speaking migrants' experiences of the use of interpreters in healthcare: a qualitative explorative study. Int J Equity Health 2014; 13(1): 13-49.
[http://dx.doi.org/10.1186/1475-9276-13-49]
] studies of a different cultural and language migrant group and provide a deeper understanding of the Ukrainian speaking person’s attitudes of using interpreters.

Conclusion

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.

CONFLICT OF INTEREST

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

ACKNOWLEDGeMENTs

The author is grateful to Dr. Alan Crozier, professional translator, for linguistic revision of the draft. I also thank persons, Professor Katarina Hjelm, Associate Professor Björn Albin† and Lidia Simcisin who helped with translations of the questionnaire. This study was performed with grants from the Crafoord Foundation, Sweden.

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