Title: Improving uptake, experience and implementation of interpreting services in primary care: a mixed methods study with South Asian communities in England.
Funder: Department of Health and Social Care

Abstract: Research question: What influences uptake, experience and implementation of interpreting services in primary care? Background: Uptake of interpreting services in primary care is fundamental to ensure patients and clinicians understand each other and to avoid exacerbating inequalities in healthcare access. There is currently no up-to-date evidence on language support uptake or experience in this context. Overall aim: To develop a comprehensive understanding of uptake, experience and implementation of interpreting services in primary care in England. Aims/objectives/ methods for each work package: Work package 1 (National interview survey and qualitative interviews to understand patient experience and uptake). Aim: To understand the current uptake and experience of interpreting services among South Asian linguistic minority groups in England. We focus on people from Pakistani, Indian and Bangladeshi backgrounds due to higher healthcare need (exacerbated by COVID) and because their languages combined are the UK’s most commonly spoken languages after English. Objectives: • What are the barriers and facilitators to uptake? • How do users of the services describe their experiences of different types of language support (e.g. face-to-face, remote, informal)? How do non-users access primary care/ experience language support? • What is the association between uptake of interpreting services and healthcare access, patient satisfaction, patient characteristics and self-reported health? Methods: Community-based national interview survey (n=600) and qualitative interviews (n=30). Work package 2 (GP case studies, stakeholder qualitative interviews and document gathering to understand implementation of services). Aim: To investigate how interpreting services are currently delivered/implemented in primary care. Objectives: • How do front-line staff experience the use and delivery of interpreting services in primary care? • What barriers and facilitators are encountered in the implementation of interpreting services in primary care, and how are these shaped by the local context? • How do commissioners and policy-makers plan the delivery of these services (including planning for their cost)? Methods: Comparative case studies with GP practices (n=4), qualitative interviews with frontline staff (n=20), interpreters (n=12), providers of interpreting services (n=5) and commissioners/ policy-makers (n=15-20) and document gathering. Work package 3 (Pathways to impact: stakeholder engagement and policy workshop to finalise and disseminate guidance). Aim: To work with commissioners, policy-makers and government (via a cross-party think tank, Policy Connect), to finalise/disseminate guidance for multiple stakeholders that will improve use of interpreting services in primary care. Objectives: • What aspects of the planning and delivery of interpreting services do policy-makers/ commissioners think are working well? • What areas need to be improved? (e.g. suggestions for a minimum dataset to support benchmarking and quality improvement). Methods: Integration of findings from work packages 1 and 2 and policy workshop. Timelines for project delivery: 24 months. Impact and dissemination: This study will result in updated guidance for commissioners, frontline staff and interpreters, as well as influence patient education and policy to improve patient uptake and experience of interpreting services in primary care and, ultimately, patient outcomes.

Lay abstract: AIM: To work with South Asian communities, healthcare professionals and people working in the NHS to understand how interpreting services work for patients with limited English language skills in GP practices in England to improve access to quality healthcare for all. BACKGROUND: The UK has a growing and ageing population of people for whom English is not their first language. Interpreters provide a service for patients and doctors to help them understand each other when they do not speak the same language. This is to make sure that people who find it difficult to communicate with a doctor because of a language barrier have no disadvantages compared with people for whom communication is easier. Unfortunately, there is evidence that not speaking English well is related to worse patient outcomes. GPs are often the first point of contact when people have a healthcare need. This means that good interpreting services are key to making sure everyone gets the same level of care. Yet, these services are under-used, and it is not clear why. We will seek to understand the experiences of people from Pakistani, Indian and Bangladeshi backgrounds because their languages combined are the UK’s most commonly spoken languages after English and because of higher healthcare needs. DESIGN AND METHODS: We will use a number of different ways to develop a clearer picture about interpreting services in GP practices. We will understand whether people can access interpreting services at their GP practice, how they experience interpreting services and how interpreting services work (or not) for them. There are three linked work packages (WPs): WP1 (Public survey and qualitative interviews) aims to understand uptake and experience of interpreting services in South Asian groups in England. For example, how do patients from these groups get access to interpreting services? How do they describe their experiences of these services? We will conduct a large-scale survey across England (N=600) to find out what makes it more likely (or not) that someone uses an interpreting service. We will also interview 30 patients (who have/ have not used interpreting services) in more depth about their experiences. WP2 (GP case studies, qualitative interviews/document gathering) aims to investigate how interpreting services are delivered in GP practices. For example, how do GPs/ receptionists find using these services? We will work closely with four GP practices and gather views from the people who work there (e.g. GPs/receptionists), from interpreters and providers of interpreting services, and from those involved in organising services (e.g. people in the NHS who decide how services will run). Our work will involve gathering information (e.g. documents/guidance) to understand how interpreting services work in GP practices as well as interviewing people (N~60 in total) about their experiences. WP3 (Combination of WP1 and WP2 and a policy workshop) aims to work with NHS England to develop and share updated guidance about delivery of interpreting services in primary care. PATIENT AND PUBLIC INVOLVEMENT: Recognising the importance of involving users of language support services in this research we have embedded public involvement in developing this proposal. A PPI co-applicant/lead (patient, carer and Bengali interpreter) is the key point of contact for our patients/public members.

Research activity codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE