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The Underuse of Medical Interpretation Services: A Human Factors Analysis of Why They Are Not Used Enough and How Their Usage Can Be Increased
DescriptionLanguage barriers affect care quality and health outcomes for patients who prefer languages other than English (LOE). Although medical interpretation services (MIS) mitigate these disparities, their underutilization persists. Existing studies have not applied the human factors (HF) approach, overlooking system-related barriers, and mainly focused on Spanish-speaking patients in the U.S., limiting their generalizability. We explored systematic barriers to MIS utilization in Canada, aiming to identify systematic factors contributing to MIS underutilization and develop HF-informed recommendations to increase MIS use.


The study site was St. Michael’s Hospital's General Internal Medicine ward in Toronto, which offers on-demand MIS through phone and video. Data sources included policy documents, a survey of clinicians, and contextual inquiries to nurses, health professionals, and interpreters. Data analysis involved process maps and a PETT (People/Environments/Tools/Tasks) scan.


Process maps revealed challenges in requesting technical support, finding a manual, a tablet, a Wi-Fi connection, or a convenient location to set up the interpreter.


PETT scan identified 20 barriers across four PETT categories:

-People: Many patients faced cognitive challenges (e.g., dementia) and sensory issues (e.g., hearing/vision impairment), making MIS use difficult.

-Environments: The video MIS often had connectivity issues and was perceived as unreliable.

-Tools: The single-screen design of the video MIS hampered usability.

-Tasks: Requesting technical assistance was time-consuming, compounded by limited awareness of how to contact the maintenance team.


We developed 14 HF-informed recommendations to address these barriers and classified them by the Hierarchy of Intervention Effectiveness. The findings provide actionable insights to increase MIS usage for LOE patients.
Event Type
Late Breaking Results
TimeWednesday, September 11th3:10pm - 3:20pm MST
LocationFLW Salon B