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Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective

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  • Greenhalgh, Trisha
  • Robb, Nadia
  • Scambler, Graham

Abstract

We report a qualitative study of accounts of interpreted consultations in UK primary care. The study sought to explore how three Habermasian tensions between (a) system and lifeworld, (b) communicative and strategic action, and (c) interpersonal and macropolitical spheres played out in the triadic consultation between clinician, interpreter and patient. In a total of 69 individual interviews and two focus groups, we collected narratives from service users (through interpreters or bilingual researchers), interpreters and doctors and other staff in general practice. We recorded, transcribed and analysed these, taking the story as the main unit of analysis. Our data suggest that the preconditions for communicative action are rarely met in the interpreted consultation. The interpreter's presence makes a dyadic interaction into a triad, adding considerable complexity to the social situation and generating operational and technical challenges. Lack of trust, intense pressure of time, mismatch of agendas (biomedical versus lifeworld), firm expectations of a specific outcome (e.g. referral, prescription) and profound power imbalances all promote strategic action (i.e. speech that seeks consciously or unconsciously to manipulate an outcome) rather than communicative action (i.e. sincere efforts to achieve understanding, and reach consensus) by all parties. In consultations interpreted by family members (an option traditionally seen as 'second best' by policy makers), the social situation is very different. Family members are generally trusted, share the lifeworld agenda, and shift the power balance in the patient's favour. The interpreter occupies multiple social roles, including translator, interpersonal mediator, system mediator, educator, advocate, and link worker. The essence of professionalism in interpreting is shifting judiciously between these potentially conflicting roles. We discuss the implications of our findings for communication with limited English speakers in healthcare consultations and for realizing contemporary policy goals such as concordance, shared decision-making, empowerment, and choice.

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  • Greenhalgh, Trisha & Robb, Nadia & Scambler, Graham, 2006. "Communicative and strategic action in interpreted consultations in primary health care: A Habermasian perspective," Social Science & Medicine, Elsevier, vol. 63(5), pages 1170-1187, September.
    • Handle: RePEc:eee:socmed:v:63:y:2006:i:5:p:1170-1187
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    2. van Bijleveld, G.G. & Dedding, C.W.M. & Bunders-Aelen, J.F.G., 2014. "Seeing eye to eye or not? Young people's and child protection workers' perspectives on children's participation within the Dutch child protection and welfare services," Children and Youth Services Review, Elsevier, vol. 47(P3), pages 253-259.
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    4. Laura Harzheim & Mariya Lorke & Christiane Woopen & Saskia Jünger, 2020. "Health Literacy as Communicative Action—A Qualitative Study among Persons at Risk in the Context of Predictive and Preventive Medicine," IJERPH, MDPI, vol. 17(5), pages 1-27, March.
    5. Leanza, Yvan & Boivin, Isabelle & Rosenberg, Ellen, 2010. "Interruptions and resistance: A comparison of medical consultations with family and trained interpreters," Social Science & Medicine, Elsevier, vol. 70(12), pages 1888-1895, June.
    6. Lo, Ming-Cheng Miriam & Bahar, Roxana, 2013. "Resisting the colonization of the lifeworld? Immigrant patients' experiences with co-ethnic healthcare workers," Social Science & Medicine, Elsevier, vol. 87(C), pages 68-76.
    7. Bell, Susan E., 2019. "Interpreter assemblages: Caring for immigrant and refugee patients in US hospitals," Social Science & Medicine, Elsevier, vol. 226(C), pages 29-36.
    8. MacFarlane, Anne & Dzebisova, Zhanna & Karapish, Dmitri & Kovacevic, Bosiljka & Ogbebor, Florence & Okonkwo, Ekaterina, 2009. "Arranging and negotiating the use of informal interpreters in general practice consultations: Experiences of refugees and asylum seekers in the west of Ireland," Social Science & Medicine, Elsevier, vol. 69(2), pages 210-214, July.
    9. Kilian, Sanja & Swartz, Leslie & Dowling, Tessa & Dlali, Mawande & Chiliza, Bonginkosi, 2014. "The potential consequences of informal interpreting practices for assessment of patients in a South African psychiatric hospital," Social Science & Medicine, Elsevier, vol. 106(C), pages 159-167.
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