Through the Screen: Meaning, Mediation, and Trust in Video Remote Interpretation for Pediatric Care — A Multi-Stakeholder Analysis

Language barriers in healthcare continue to affect the quality of communication for patients with limited English proficiency (LEP). Although professional interpretation services are widely used, less is known about how communication unfolds when interpretation is mediated through video remote interpretation (VRI), particularly in pediatric subspecialty care. This study examines how patients, providers, and language services leaders experience communication during VRI-mediated clinical encounters and identifies themes related to interpretation quality, understanding, and meaning negotiation. Grounded in Communication Accommodation Theory, this study uses a qualitative, multi-method design to examine communication within technology-mediated interpreted encounters. Clinical visits were observed in a pediatric neurology clinic serving Spanish-speaking caregivers of children with complex conditions. Semi-structured interviews were conducted with healthcare providers, language services leaders, and Spanish-speaking caregivers to capture diverse perspectives on interpreted communication. Data were analyzed using an iterative thematic analysis to identify recurring patterns across observations and interviews. The findings reveal that interpreted communication in VRI encounters is shaped by three interrelated domains: interpretive experience and meaning transformation, structural reliance, uncertainty, and risk, and monitoring and adaptive response. Across stakeholder groups, participants described how interpretation actively reshapes meaning, creates conditions of reliance and uncertainty within communication, and prompts both patients and providers to continuously monitor and adjust their communication behaviors to sustain understanding. These findings contribute a conceptual framework that reconceptualizes interpreted clinical communication as a mediated, interactional process rather than a simple translation mechanism. By illuminating how meaning is transformed, how reliance and risk are embedded within communication structures, and how participants adapt in real time, this study provides a foundation for future research on language access and communication within technology-mediated healthcare environments.