Date of Award

August 2023

Degree Type


Degree Name

Doctor of Philosophy



First Advisor

W. Hobart Davies

Second Advisor

Amy Olen

Committee Members

Jacqueline Nguyen, Bonita Klein-Tasman, Christine Larson, Charles Rothschild


cultural expression of distress, distress, interpreted medical encounters, medical interpreting, pediatric care


Effective communication between families and pediatric clinicians is essential for mitigating family stress and improving quality of care. Families who speak a primary language other than English must contend with the added stress of language barriers during stressful encounters, which could impact the quality of patient care and health outcomes. Trained medical interpreters facilitate communication, including distress expressions, during interpreted medical encounters (IME). Little is known about how interpreters identify distress and what factors impact distress identification during IME. This project describes how interpreters identify distress of families during IME, and how they identify cultural nuances in distress expression and communication of families during IME. Special attention is placed on factors that influence why and how interpreters identify distress expression, such as their intersecting social identities and lived personal and professional experiences. Interpreters from the current study collectively reported that families in IME expressed distress in various ways: through visual, auditory, interpersonal, and contextual cues. Interpreters also perceived that distress expression among Spanish-speaking families in IME is diverse and simultaneously culture-specific and universal, influenced by cultural norms specific to the families’ intersecting social identities. Therefore, cultural concepts of distress and more covert culture bound expressions of distress (e.g., withdrawal) should be considered when evaluating family distress. Medical care teams inclusive of health care clinicians and medical interpreters should continue to cultivate their own cultural and emotional intelligence to better understand cultural concepts of distress among families from multiply minoritized backgrounds in the health care system. Clinicians and medical interpreters may benefit from collaboratively working together to better identify and respond when families are distressed.