Table 3.

Inadequate interpreter services

Sub-theme	Quote
Interpreter services accessibility
Access to professional interpretation services	PT 4 said: “When I’ve been [hospitalized], [health staff] (…) They’ve gotten Spanish-speaking [interpreters] from the hospital.”
Interpretation services not offered	CL 1 noted: “They only [offered an interpreter] the first time, and the other two times, they didn’t ask us.”
In-person interpretation benefits
Body-language and gestures aid communication	CG 1 noted: “It’s not just speaking, it’s the gestures, the face, that’s what the other person grasps when you’re speaking so it’s not the same to speak to a wall.”
In-person interpretation services facilitated trust and comfort	PT 5 expressed: “You are looking directly at the person who is translating for you. You trust the person who is translating, and you feel more comfortable saying things.”
In-person interpretation challenges
In-person interpretation was characterized by shortages and delays.	PT 7 noted: “The problem is that sometimes they call [an interpreter], and look, and look, and they can’t find any.”
Virtual interpretation benefits
Immediacy and convenience	PT 9 commented: “In the tablet, you just push the buttons and the interpreter appears (…) the person is saying everything the doctor was saying; it’s almost as if I was in person.”
Reduced risk of infection transmission	CG 3 noted: “I think that it’s a good idea to use the internet for these visits. Why? There is less risk of infection for the translator, for us, and for the doctor (…) In the beginning, we were all in agony because of the risks.”
Virtual interpretation drawbacks
Technological and connectivity issues causing inefficiency	CG 4 remarked: “The call drops after a while, so we have to call again and wait for them to answer, and the new interpreter has to get involved in the conversation again, and you lose track of what you were talking about.”
Interpreter inaccuracy	PT 4 noted: “The person on the other side of the line translating in Spanish what I am saying needs to translate what [one says] correctly because you say one thing, and they say something different.”
Nuances from gesticulations lost	CL 2 commented: “Telemedicine is fabulous when you don’t require further communication. Otherwise, you risk losing the expressions of the patient and their movements. When you’re on the screen, it’s flavorless, and in our language, we use a lot of hand gestures and bodily movements, so how can the person on the screen interpret all that?”
Interruptions while interpreting	PT 16 commented: “The nurse was consulting me, and they were translating for me via iPad through a video call. The person that was translating, I think that she wasn’t focused. You could hear dogs barking, and she wasn’t translating the best way possible because I understand a little bit of English.”
Older patients not comfortable with technology and virtual interpretation	PT 3 noted: “An older person doesn’t feel very comfortable with a computer (…) elderly people like to have [an in-person interpreter]. On the other hand, if you give them an iPad, I am sure that the majority feel that it’s a machine.”
Patient privacy concerns	CG 5 commented: “There were times (…) when we had to turn [the tablet] over so they wouldn’t see my mother. For instance, if her gown fell or something, we didn’t want them to see my mother like that.”
Interpretation during decision-making
Professional interpreters help facilitate decision-making.	CL 2 noted: “Normally, during these decision-making sessions, there is an interpreter present. In my experience, the interpreter is not allowed to leave until the patient is inside the surgery room. They’re with the patient until a certain point because there are a lot of questions they’re asking, which require decisions.” PT 10 expressed: “The assistance of an interpreter in a situation like that one makes it a lot easier. Yes, a lot easier. It’s important, and it gives you confidence regarding the decision you are making.”
Professional interpreters can relieve family members of responsibility to serve as interpreters.	CL 2 commented: “I support the use of interpreters to lift the responsibility of a bad interpretation from a relative (…) There is no middle ground when using a relative (…) You may lose confidence [in] what was said, or it may not be as effective. Especially the responsibility if there are any mistakes.”