Module 5: Culture, Language Barriers, and Interpreters

Cultural Differences

“The nature and scope of diverse cultural perspectives on health and illness, and beliefs about disease etiology, treatment efficacy, truth telling, and decisional authority concerning health care have serious implications for the application of ethical guidelines for scientific research.”(1)

Most researchers have been taught from a predominantly western perspective regarding health and disease.  Although cultural competency is often emphasized as part of any education in research methodology, it is an inescapable fact that the framework through which the researcher observes the world is fundamentally built upon a set of assumptions about health and disease that are built in to the culture in which he or she was educated.  For this reason, researchers must carefully consider the local culture in which they seek to conduct a project.  Is the ambient cultural view of health closely tied to religious beliefs?  How are doctors or other health specialists perceived?  Is the concept of ‘fate’ connected to physical health?  What are the prevailing conversational norms and how do these affect what questions are appropriate to ask?  These are just a few of the questions a good researcher will consider when designing a research protocol in a community that has different cultural practices than their own.  Without such considerations, the entire basis for an informed analysis of the researcher’s hypothesis is invalidated.(2)

The Researcher as an Outsider

When entering a community, the researcher is almost always an outsider.  “Gender, racial identity, social class and shared experience can affect the research process and willingness of respondents to talk to the researchers.”  However, these need not be detrimental: differences between the researcher, the study participants, and the interpreter can actually be beneficial by giving all parties involved the opportunity to articulate their feelings about their different life experiences.  The one potential exception to this is gender: sometimes, due to the prevailing cultural norms of a community, gender may be an impediment to interaction.(3)  It is important for researchers to understand the cultural significance of gender roles in the community so that they might respect them to the best of their ability.

Language Barriers: Partnering with Interpreters

One of the most difficult parts of conducting methodologically sound research in a developing community is the language barrier that may exist between the researcher and the participants.  Combined with the probable presence of significant cultural differences, the language barrier deserves a great deal of attention and consideration on the part of the researcher if it is to be circumvented effectively.  Partnering with interpreters is a great way to overcome these differences, provided that the partnership is well thought out and performed properly.  Rather than being a mere translation device, interpreters should be “actively participative” in the research process for a variety of reasons:(4)

• Interpreters often have a better understanding of the cultural norms of the community than the researcher. They are in a good position to advise the researcher on culturally appropriate ways to initiate contact with participants, interact with participants, or ask questions of participants.

• Oftentimes, words or concepts in one language do not translate directly to another language. This may be due to a simple lack of direct synonyms or a more complex reason involving cultural differences in concepts. For example, some languages have fewer than twenty words for emotion; The English language has thousands. A good interpreter can help the researcher adapt his or her questions to fit not only the semantic specificities of the language, but the cultural aspects of the language as well.

• Interpreters are present for almost all interactions between the researcher and the participants, and must work in collaboration with the researcher to ensure that they do not confound the results of the study. If the interpreter and the researcher do not partner closely, the interpreter may not be as able to follow the research protocol properly, which could potentially invalidate some of the conclusions the researcher draws from his or her results.

• Study items sometimes need to be redesigned or subtly changed based on an interpreter’s input, so it is important that the interpreter and the researcher work together closely to find the most effective ways of communicating meaning and intent across the language barrier.

Special Considerations in Interpretation

Finding the right balance with an interpreter is not always easy.  “Concepts of health and illness are socially constructed,”(5) and although the interpreter and the researcher can communicate in the same language, there may be vast cultural differences that lead to each party understanding the same concept or interaction in very different ways.  In addition, there are several potential issues that may come about as a result of the omnipresent nature of interpreters throughout the research process.

• The effects of interactions between the interpreter and the participant:

  • Sometimes interpreters take issue with participant responses to questions. If the participant feels that he or she is being judged, he or she may be less willing to answer questions in an open and honest manner. It is important that the researcher and the interpreter work together to ensure that this does not occur.(6)

  • Interpreters “often introduce their own beliefs and personal agendas into the interaction.” This may occur entirely unintentionally, but it is important to avoid wherever possible, as it may influence the course of an interview and affect the participant’s responses, thereby becoming a confounding variable.

• Paraphrasing may result in omissions or erroneous substitutions of terms.

• There may be different levels of comprehension among the parties involved in the discussion. (7)

• The nature of confidentiality becomes more complicated because “researchers are sometimes inclined to use interpreters or are forced to cope with next of kin and significant others who cannot be easily kept at a distance during interview sessions.”(8) These new actors must be aware of how crucial confidentiality is to the research process, and the researcher must do everything in his or her power to protect the participant from having the confidentiality of their responses violated.

Footnotes

(1) Marshall, P. A.  “Ethical Challenges in Study Design and Informed Consent for Health Research in Resource-Poor Settings”  Special Topics in Social, Economic and Behavioral Research No. 5, 12. 

(2) Pitchforth, E. & van Teijlingen, E.  “International Public Health Research Involving Interpreters: A Case Study From Bangladesh” BMC Public Health, Vol. 5, No. 71. 2005.

(3)  Ibid.

(4)  Ibid.

(5)  Ibid.

(6)   Ibid.

(7) Marshall, P. A.  “Ethical Challenges in Study Design and Informed Consent for Health Research in Resource-Poor Settings”  Special Topics in Social, Economic and Behavioral Research No. 5. 

(8) Erinosho, O., ed.  “Ethics for Public Health Research in Africa” Proceedings of an International Workshop in collaboration with the Special Program for Research and Training in Tropical Diseases (TDR) of the World Health Organization, with the support of the Federal Ministry of Health, Abuja, Nigeria, April 21-23, 2008. pp. 37.