title: Shrinking the language accessibility gap: a mixed methods evaluation of telephone interpretation services in a large, diverse urban health care system.
abstract: BACKGROUND
  Language interpretation services for patients who are not proficient in a country's official language(s) are essential for improving health equity across diverse populations, and achieving clinical safety and quality for both patients and providers. Nevertheless, overall use of these services remains low, regardless of how they are delivered. In Toronto, Ontario, one of the most ethnically diverse urban centres, the regional local health integration network which oversees the highest concentration of health care organizations servicing 1.2 million residents, partnered with key stakeholders to make Over-the-Phone (OPI) interpretation services broadly and economically available in 170 different languages to its diverse network of health care organizations. This evaluation aimed to assess patients' and providers' experiences with OPI in these varied settings and the impact (if any) on alternative interpretation services and on health service delivery access and quality.
  
  
  METHODS
  This study used a two-phased sequential exploratory mixed-methods approach to evaluate the initiative. Phase I was comprised of semi-structured interviews with representatives from the program stakeholders; these findings were applied to identify appropriate survey questions and response categories, and provided context and depth of understanding to Phase II results. Phase II included web-based and self-administered surveys for both providers and patients engaging with OPI.
  
  
  RESULTS
  Both providers and patients identified a broad range of positive impacts OPI had on health care service delivery quality and access, and high levels of satisfaction with OPI, in a variety of health care settings. Providers also revealed a marked decrease in the use of ad-hoc, nonprofessional strategies for interpretation after the implementation of OPI, and noted it had either no impact on their workload or had decreased it overall.
  
  
  CONCLUSIONS
  OPI is clearly not the sole answer to the complex array of health care needs and access gaps that exist for persons without proficiency in their country's official language. Nevertheless, this evaluation provides compelling evidence that OPI is a valuable component, and that it may contribute to a broader range of positive impacts, and within a broader range of health care settings, than previously explored.
authors.affiliation: LiKaShing Knowledge Institute, Centre for Research on Inner City Health, 209 Victoria Street, Toronto, Ontario, M5C 1 N8, Canada. DowborT@smh.ca.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Dowbor
authors.affiliation: LiKaShing Knowledge Institute, Centre for Research on Inner City Health, 209 Victoria Street, Toronto, Ontario, M5C 1 N8, Canada. ZergerS@smh.ca.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Zerger
authors.affiliation: LiKaShing Knowledge Institute, Centre for Research on Inner City Health, 209 Victoria Street, Toronto, Ontario, M5C 1 N8, Canada. PedersenC@smh.ca.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Pedersen
authors.affiliation: LiKaShing Knowledge Institute, Centre for Research on Inner City Health, 209 Victoria Street, Toronto, Ontario, M5C 1 N8, Canada. DevottaK@smh.ca.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Devotta
authors.affiliation: Health Integration Network of Toronto Central, 425 Bloor Street East, Toronto, Ontario, M4X 1 L7, Canada. Rachel.Solomon@lhins.on.ca.
authors.forename: Rachel
authors.initials: R
authors.lastname: Solomon
authors.affiliation: Health Integration Network of Toronto Central, 425 Bloor Street East, Toronto, Ontario, M4X 1 L7, Canada. Kendyl.Dobbin@lhins.on.ca.
authors.forename: Kendyl
authors.initials: K
authors.lastname: Dobbin
authors.affiliation: LiKaShing Knowledge Institute, Centre for Research on Inner City Health, 209 Victoria Street, Toronto, Ontario, M5C 1 N8, Canada. O'CampoP@smh.ca.|Dalla Lana School of Public Health, University of Toronto, Health Sciences Building, 6th floor, 155 College Street, Toronto, Ontario, M5T 3 M7, Canada. O'CampoP@smh.ca.
authors.forename: Patricia
authors.initials: P
authors.lastname: O'Campo
mesh_terms: D000328:Adult; D003144:Communication Barriers; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009864:Ontario; D019982:Organizational Case Studies; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014175:Translating; D019037:Urban Health Services