The migrant women’s AOD study employed both professional interpreters and a range of bilingual workers from different backgrounds to assist with various aspects of the project. The profiles, advantages and disadvantages of each group are outlined below.
Professional interpreters
Eleven female interpreters were employed for the study, in the qualitative phase where they assisted with the interviews and focus group sessions (see Table
2), and also during the quantitative phase of the project.
Quality assurance was the main advantage in working with professional interpreters; to provide confidence that what was being asked was interpreted into the participant’s language as accurately as possible. This was particularly helpful during the qualitative phase of the project when broad themes were being explored and questions piloted for the upcoming survey. In some cases during the quantitative phase of the project, interpreters provided the only opportunity for some women to participate when there was no match between the potential participant and any of the bilingual/bicultural workers on the project.
The main disadvantage encountered with busy professional interpreters was inflexibility with scheduling appointments and their inability to actively participate in the research due to the contractual obligations and legislative framework under which they are employed. In some cases it proved difficult to locate a specific language interpreter at a time convenient to the participant, or the interpreter would be delayed by another appointment. At other times, participants forgot or needed to reschedule the appointment due to family commitments which necessitated renegotiating the interview time for everyone involved, and potentially incurred cancellation fees. In some new and emerging language groups accredited interpreters did not exist and the women who spoke these languages would therefore be excluded from the research if alternative options for interpreting were not available. As these were often the very women the research was trying to reach, any requirement to use only professional interpreters would have had a negative impact on the project findings overall.
A number of unknown impacts of using interpreters in a project such as this one were revealed that require further research. In general, interpreters were older women, well established and resident in Australia longer than the participants they interpreted for. It is unknown whether this impacted on the information relayed. There may have been a greater potential for social desirability bias if younger women did not want to appear ignorant or to be breaking cultural norms to older, respected women. On the other hand, because the interpreters did not necessarily belong to the same social community as the participants they may have been perceived as more neutral and encouraging greater freedom for participants to say what they felt [
22].
Scheduling conflicts, inflexibility and costs encouraged us to explore alternative options for interpreting. While professional interpreters fulfil the technical requirements, for some research projects it may not be logistically feasible to use them on an ongoing basis. Apart from the financial constraints facing research projects with minority groups, accredited interpreters are not available for participant recruitment, in-depth conversations to explore cultural meanings, or to provide background information on events in the local community that could impact on participation or responses; this is the role of a bilingual/ bicultural worker.
Bilingual workers
Nineteen bilingual/bicultural workers were recruited through the networks of WHFS as, unlike interpreters, there is no agency in Western Australia that brokers such groups. All workers recruited had either a health or social service background as they needed to feel comfortable discussing issues around alcohol and other drug use which is a highly sensitive and stigmatised topic for some cultural groups. This, combined with the training they received, was essential to help reduce the chance of interviewers skipping or skirting around certain questions that would be normally uncomfortable to discuss [
1,
9,
27,
34].
We tried to ensure most workers had a similar background to the participants, culturally and linguistically, but also in the time they had been in Australia and their level of settlement. Other researchers have suggested that sharing a similar background helps participants build better rapport with the interviewers and increases the likelihood of discussing sensitive topics more openly [
22].
All bilingual workers attended a training session which was conducted by the principal researcher. Training covered administration of the survey, issues of confidentiality, asking but not coercing participants, aspects of personal safety when administering the questionnaire, how to respond to participants who became distressed and the criteria for referral to Women’s Health Services for further assistance if required. In addition, each question in the survey was reviewed as to its meaning, and why it was important to ask the question. After the training session, workers were given a small number of surveys, usually five, to complete with women from their own communities, and they were then debriefed to discuss any issues arising during the interview process and to answer outstanding questions. The debriefing process also provided feedback to help better understand the meaning of responses [
18]. The bilingual workers were then given the option of completing further surveys with other women from their community.
The bilingual/bicultural workers fell into three broad categories in terms of their background. The advantages and disadvantages of using bilingual/bicultural workers of different backgrounds were noted in the research project and are explored here.
Students
The first group were students on placement at WHFS while completing Certificate or Diploma level courses in Community Services at local Technical and Further Education (TAFE) centres. These were all mature age students, who had primarily come to Australia as humanitarian entrants. Their community language competency was ascertained by the fact that all of the students had completed high school or tertiary courses in their own countries of origin and often had worked for many years in their country of origin or in refugee camps. Their English language competency was ascertained to be of a sufficient level as they were completing post-secondary qualifications in Perth.
Most students involved in the research project had very good community networks, which provided access to women who would not normally be involved in a project such as this. The students felt they were doing something useful both for themselves and their community, and that the experience of interviewing was of practical utility for their chosen field of study. The student interviewers commented that they enjoyed the survey experience overall, and most were able to easily complete the required number of questionnaires, often more. In many cases the interview process helped to highlight issues that had been covered in their course work, such as confidentiality, the role of the worker, maintaining boundaries, dealing with ethical issues, and self-care. Students were asked to reflect on the positive and negative aspects of being involved in this type of research project during regular group debriefing sessions when they also had opportunities to individually discuss their experiences of the interview process [
15]. Discussions covered a wide range of issues such as difficulties in recruitment of potential participants, ways of avoiding social desirability bias, and some of the challenges of working with members of their own ethnic community. Several students described community expectations for them to “fix the system” in which new arrivals and their families were struggling, with community women expecting an almost immediate response to the issues they raised in a much shorter time frame than possible. Students also had to deal with criticism that the survey was largely about alcohol and drug issues, especially as consumption of drugs or alcohol is frowned upon by many new arrival groups.
From an organisational perspective, the student placements were time consuming to supervise and organise, especially as they needed to have multiple tasks to occupy them between their research-based commitments. As an agency, WHFS facilitates many student placements each semester, especially for those who have English as a second language who often need extra support and encouragement to complete their required placement hours. Increasing the opportunities for students to gain exposure and experience in dealing with alcohol and drug issues was seen as assisting CaLD women to gain knowledge and experiences that could be used both informally and formally within their own communities. However, not all students had good community networks, especially those who had recently arrived in Australia. Another disadvantage, as other researchers have found [
35], is that students often leave a project at the end of a semester or year to return home, gain employment or simply continue on with the next stage of their course. Thus, there is the need to recruit more students if a project runs over several semesters. This was also our experience in using students.
Overseas trained health professionals
Another broad category of bilingual/bicultural workers was overseas trained health professionals, including doctors, nurses and psychologists who, as new permanent residents of Australia, were in the process of requalifying to work in their chosen profession in Western Australia. The majority of these overseas trained health and social welfare professionals were either humanitarian entrants or spousal visa holders and were facing numerous barriers to re-qualification. Their community language competency was ascertained by the fact that all of these professionals had studied at tertiary level in their own countries and had many years of professional experience in their country of origin prior to moving to Australia. Their English language competency was ascertained to be of a sufficient level as they were all studying for a higher level English exam (IELTS) in order to undertake the process to register as a health or social welfare professional in Western Australia.
The advantage of this group was their excellent grasp of health related issues as well as concepts such as confidentiality which meant that the focus of their training was primarily on questionnaire administration. In addition, these health professionals had better referral skills, and could handle potential problematic situations better than the student group who had only limited client-related experience. Given their professional backgrounds, this group needed far less supervision and support than the student bilingual workers. Because some of the women were also enrolled in post graduate studies, participating in the study proved a useful means for them to gain practical research experience for their own upcoming research project.
The women recruited through the professional network were employed casually on an hourly rate, and for many this was their first paid job in Australia. From an administrative perspective, the main disadvantage using this group was the additional time required to orientate them to the Australian employment system, which in many cases, was considerably more time consuming than survey administration and the associated follow-up supervision related to the actual project.
Conclusions on using bilingual workers
In summary, the advantage of working with bilingual workers was that they could help in participant recruitment, could provide the opportunity for participants to clarify questions, potentially allowing more comprehensive data to be collected [
27], could work with the researchers about understanding the cultural meanings of questions and answers, and were able to give background information on the events in the local community. The bilingual/bicultural workers recruited participants through their own social networks of family, friends, and community members who met the selection criteria. Due to recruitment challenges with some ethnic minority communities, the temptation to use convenience samples that consist of community leaders, spokespersons and/or ethnic specific service providers is common. While it may be appealing to recruit a small number of carefully selected, easily accessed participants, concerns around selection bias must be acknowledged. Specific language proficiency or working for a community association does not necessarily mean that an individual represents a particular culture or is likely to reflect the majority of views in a community [
13]. Although most people can easily identify a community to which they belong, agreeing on a spokesperson for that community, especially if they are to represent them in a community consultation or answer questions on their behalf, is much more difficult [
36]. This is a particular concern for the most marginalised and isolated individuals, including refugees, who may be represented by a range of professionals such as lawyers, case workers, aid workers or interpreters that frequently speak on their behalf [
33]. The opinions migrant and refugee women are often excluded when community spokespersons are used. It was important for WHFS to gather the views and priorities of newly arrived women who were either accessing the service or potentially could access the service. By working with bilingual/bicultural workers the project gained information from women that normally would not have participated in this type of research.
Working with the bilingual/bicultural workers to discuss and pilot the questionnaire was very beneficial. Words and phrases were more likely to have a shared meaning and be more easily understood by women from different cultures. Other researchers have also noted this [
7,
20]. Early in the study translating the questionnaire and consent forms was considered. However, as others have found [
20], translations may not be an effective use of resources as participants can be illiterate in their own language and English or illiterate in their own language and literate in English. Working with bilingual/bicultural workers who read the questionnaire aloud overcame this difficulty.
We tried to ensure most of the bilingual/bicultural workers had a similar background to study participants, culturally or linguistically, as well as in the time they had been in Australia and their level of settlement. The matching of gender, ethnicity, and language is often desirable for cultural reasons, especially if sensitive topics such as alcohol and other drug use are under discussion and there is a strong possibility of social desirability bias [
37]. Matching can include considerations of age, socio-economic status, status within the community, as well as matching of beliefs and views [
1,
8,
9,
12]. Although in many cases ethnic matching may be desirable, with sensitive material participants may not report or could under-report attitudes, beliefs and practices that are different to the norms and values of the interviewer, either for fear of offending the interviewer or other imagined repercussions that could arise from discussing stigmatised behaviour [
1,
2] Although we had tried to ensure similar backgrounds, it was difficult to ascertain the role/status of the bilingual/bicultural workers in their communities and how this may have influenced the results [
22]. During debriefing sessions these issues were discussed as well as whether an interviewer unknown to the participants would be better. Some interviewers felt that participants may have been more honest with a stranger as there would be less pressure to give a socially acceptable response. However, when discussing social desirability bias more in depth with the workers, most of them felt that on the whole the women interviewed gave more honest answers with them than they would have done with a stranger. One explanation was that survey participants knew these women interviewers well and had discussed with them previously some of the issues highlighted in the questionnaire.
When working with more vulnerable groups, another difficulty in matching characteristics of participants with those of a bilingual/bicultural worker is that often the worker may be experiencing the same difficulties as the participants [
20]. The worker may have little social support or time to conduct the interviews but may wish to take the job as it is extra money in to the household or for a variety of other reasons such as not wanting to offend the researcher [
20]. This happened with two of the bilingual/bicultural workers. Researchers need to be aware that bilingual interviewers may say they are able to do this type of work because of cultural considerations around politeness and respecting those in perceived positions of power rather than because they have the time to undertake what is often quite difficult work.
An unforeseen benefit of using bilingual/bicultural workers was increasing the knowledge and experience of these women in raising issues about alcohol and other drug use, a much stigmatised topic in many ethnic communities. This knowledge and experience could be used both informally within their own communities and formally in their employment as these women were either planning or currently working in the health or social service sectors. This has also been found by other researchers [
16].
Of surprise was that the majority of the interviews took place in English or a mixture of English and a community language. This is likely to be due to the arrival of a number of English speaking African community members at the time of the research. As the various English dialects spoken by these communities can be difficult to understand by Australian English speakers, interpreters or bilingual workers were essential in order to obtain information from these women. However, it has been noted by other researchers [
16,
17,
19] that interviews often take place in two or even three languages with participants and interviewers switching between the languages. This may be an influence of acculturation, or that some concepts are more easily articulated in one language over another, or that English is the usual language of communication between the worker and the participant as they are in an English speaking country. The reasons for two or more languages being used in interviews and how that impacts on the quality of information gathered needs to be further explored.
The main disadvantage of using bilingual/bicultural workers was the time required to train, supervise and debrief them. For those workers who were new to the Australian employment system, arranging casual employment contracts and payment was time consuming. The interviews themselves were also time consuming to conduct and this has been noted by other researchers [
21]. The time required is often not solely interview related as there is often an expectation of a general exchange of news, or to share beverages and/or food before or after the interview itself. While this can help build rapport, which ultimately provides more detailed information, this time needs to be taken into account as the number of planned interviews in a given time frame may be lower than originally anticipated. Table
4 summarises the advantages and disadvantages of using bilingual/bicultural workers and interpreters.
Table 4
Advantages and disadvantages of different types of bilingual workers used in the study
Professional Interpreters
| Verified fluency in English and community language | Expensive |
| Well organised service for booking interpreters | No facility to help with participant recruitment |
| | Difficult to find interpreters for some languages |
| | Some problems with interpreters answering for participants |
Bilingual/Bicultural Students
| Provides practical experience for students in their field of study | Required intense supervision |
| Often have good community networks to recruit interview participants | Limited professional experience on which to draw if client became distressed |
| Often speak community languages where there is limited access to interpreters | Potential for social desirability bias as most women interviewed knew the student personally |
| | Level of language proficiency in community language was not accredited |
Overseas- trained Health Professionals
| Level of fluency in community language often recognised by an overseas university | Required some supervision |
| Good understanding of confidentiality, boundaries & referral processes | Required intensive assistance with aspects of the Australian employment system |
| Good professional experience on which to draw if participant became distressed | Potential for social desirability bias as most women surveyed knew them personally |
| Often have experience in / interest in research, so already understand research protocols | |
| Good community networks to find women to interview | |
Community- sector Bilingual Workers
| Good understanding of confidentiality, boundaries, referral processes | Heavy workload, so difficult to find time to interview new arrivals |
| Good professional experience on which to draw if participant became distressed | Potential for social desirability bias as most women surveyed already knew them |
| Good community networks | |
| Require minimal supervision | |
In reflecting on the elements of better practice in working with bilingual/bicultural workers outlined in Table
1, this study successfully incorporated most of these. The most difficult issue was limiting the number of bilingual interviewers in order to increase the dependability and credibility of the data gathered [
19]. This is much easier to achieve in qualitative research where there are generally smaller numbers of participants. In this study 19 bilingual/bicultural workers were involved with the initial piloting and then administration of the questionnaire to 268 women. The large number of workers helped reduce selection bias and improve the heterogeneity of the snowball sample, as there was a broad range of snowball initiation points with limited links in each of the chains associated with the initiation point [
33,
38,
39]. However, having so many interviewers, even to administer a questionnaire with few open questions, may have impacted on the quality of the data collected. The logistics of using bilingual/bicultural workers to collect data from larger numbers of participants does usually mean that more workers are needed in order to complete the project within a reasonable time frame. Other researchers have worked with more than one or two bilingual/bicultural interviewers [
21,
40], however there is little discussion in the literature on the logistics of administering questionnaires to larger multicultural groups who require bilingual/bicultural workers or interpreters in order to participate in research. This is an issue in many parts of Australia for health services that require quality information from all groups in a community, not just those with good English fluency. This is an area for future research.
Other impacts of using bilingual/bicultural workers in a project such as this would benefit from further research. One is gauging the refusal rate. The bilingual/bicultural workers had difficulty assessing how many potential participants refused to participate in the survey. For some potential participants it would socially unacceptable to give a direct refusal to the workers, so not showing up, making a reasonable excuse such as a sick child, or being busy were all reported as reasons for not being able to complete the survey. It was difficult to determine a refusal rate given these circumstances.
Another potential limitation was the impact of using bilingual/bicultural workers recruited from different sources. We did not detect any variations in the responses between different groups of bilingual/bicultural workers, for example whether all interviews done by one group yielded a particular result. However, we did not check this by reinterviewing participants using another category of bilingual workers, so this could be a short coming of the study which may have impacted on the quality of the data collected.
Not all the bilingual/bicultural workers surveyed women exclusively from their own ethnic language community, even though that had been the original expectation of the researchers. The workers had a much broader concept of community, incorporating other migrant women who they interacted with in places such as schools or churches. Given that almost 29 per cent of residents in the Perth metropolitan area have migrated from another country [
41], it is to be expected that workers would know women from the wider migrant group, not just those from their own ethnic community. How this impacted on the data collected in the survey is unclear and could be further explored.
Recruitment difficulties and language issues both pose significant challenges to researchers working with culturally and linguistically diverse (CaLD) communities, and may even result in failure to include certain groups in research projects if these challenges prove insurmountable. This limits consideration of the individual and collective experiences of hard to reach groups. Substantial costs associated with preparing translated materials or employing professional interpreting services may also be incurred, imposing significant financial constraints on research budgets and further limiting the appeal of working with migrant groups [
32]. Nevertheless, there is a clear need for health research with marginalised groups, so cost effective strategies need to be developed to maximise access and promote cross-cultural linkages between research teams and participants.
Although there is a significant body of literature describing the use of bilingual/bicultural workers in qualitative research [
14,
18], literature that discusses working with bilingual/bicultural workers for questionnaire administration in quantitative studies, especially for participants with no or minimal literacy, is a relatively new area. With that in mind, this paper can contribute to this area of research.