Strategies to Increase Professional Interpreting in Clinical Settings: A Systematic Review.

Importance: Clinicians frequently communicate without professional interpreters when caring for patients who use languages other than English for medical care, despite evidence that such partnering improves health outcomes. Objective: To systematically review the evidence for targeted behavior change strategies to increase professional interpreting in medical settings. Evidence Review: The CINAHL, Embase, PubMed, Ovid MEDLINE, and Web of Science databases were searched on July 28, 2023, and September 2, 2024, for English-language peer-reviewed articles assessing all interventional and observational studies that included outcomes related to professional interpreting in medical settings. Two reviewers conducted each screening stage. The study design, implementation strategies, sample, and outcomes were extracted, and standardized criteria were applied to assess risk of bias. The data were synthesized according to the Capability, Opportunity, Motivation-Behavior (COM-B) model to map implementation strategies to behavior change targets. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline was followed. Findings: Of the 17 952 records identified, 40 were eligible for inclusion, representing 39 interventions. Most of the 39 studies used a pre-post design (21 [54%]) or quality improvement methodologies (15 [38%]). Heterogeneity in implementation strategies and outcome ascertainment precluded meta-analysis. Most studies had risk of bias due to unmeasured confounding; only 7 (18%) had low risk of bias. In addition, most studies (37 [95%]) described an increase in at least 1 professional interpreting measure. Ten studies (26%) assessed a single implementation strategy, and the 29 remaining studies (74%) assessed an intervention bundle with multiple strategies. Interventions frequently included strategies that provided clinician education (20 [51%]), increased clinician access to professional interpreting (18 [46%]), implemented standardized policies and procedures for professional interpreting (12 [31%]), and involved modifications to the electronic health record (14 [36%]). Mapped to the COM-B model, implementation strategies targeted clinician capability (32 interventions [82%]), opportunity (28 [72%]), and motivation (22 [56%]). Conclusions and Relevance: In this systematic review of targeted behavior change strategies to increase professional interpreting for clinician communication with patients using languages other than English for medical care, a wide variety of implementation strategies with high heterogeneity in outcome assessment were identified. Given clear improvement in patient health outcomes, there is a critical need to understand the discrete impact of specific strategies and how best to measure outcomes to inform efforts to increase professional interpreting in health systems.