A conversation analysis of verbal interactions and social processes in interpreter-mediated primary care encounters.

Language asymmetry between patients with limited English proficiency and health care providers increases the complexity of patient-provider communication. In this research, we used conversation analysis to examine the content and processes of five triadic clinical communication encounters between Spanish-speaking adult patients, English-speaking nurse practitioners, and clinic-based interpreters. Data collection included audio-recordings of the triadic clinical encounters and self-administered post-encounter surveys of the nurse practitioners and interpreters. Our findings revealed communication trouble spots that, when directly addressed by the interactants, facilitated processes of negotiating relationships, and coming to a mutual understanding. Exemplars labeled Making Assumptions; Colloquialisms as Signaling Potential for Trouble; Repairing a Mis-Statement; and Turn-Taking, Silences, and Laughter illustrated how the parties identified and navigated such trouble spots. The final exemplar, Attaining Intersubjectivity, represented a successful multi-lingual triadic communication. While the role of the interpreter often is seen as a conduit of information from one language to another, in practice they also enacted roles of communication collaborators and coconstructors. Future interdisciplinary research can include closer examination of occurrences of communication trouble spots and further exploration of how interpretermediated communication is conceptualized and problematized in diverse clinical settings, to promote language interpretation policies and practices that contribute to reducing health disparities among limited-English-proficient populations.