Abstract
BACKGROUND: In multilingual healthcare settings, language mediators play a critical role in facilitating communication between patients and providers who do not share a common language. Existing research has developed theoretical role typologies for professional interpreters- such as conduit, clarifier, cultural broker, and advocate. It remains unclear how these roles apply to semi-professional language mediators (i.e., individuals with some training but no formal certification), increasingly relied upon in Germany. The lack of institutional oversight, combined with culturally diverse patient-provider dynamics, introduces role ambiguity and potential ethical conflicts. This study investigates how semi-professional language mediators define their roles and navigate role-related conflicts within healthcare encounters. METHODS: We conducted qualitative interviews with 25 participants (10 language mediators and 15 physicians who regularly act as language mediators), reflecting a range of linguistic, cultural, and professional backgrounds. Interviews focused on competencies, experiences, and role perceptions. Data were collected in German, transcribed, and analyzed using qualitative content analysis, guided by an established interpreter role typology. RESULTS: The four role types-conduit, clarifier, cultural broker, and advocate-were all identified in the data. However, participants described their work as highly fluid, shifting between roles depending on situational demands. While neutrality (conduit) was emphasized as institutionally desirable, mediators frequently intervened to clarify, adapt, or advocate based on patients' needs and cultural expectations. This balancing act created tensions between professional boundaries and ethical obligations, especially in emotionally charged or culturally complex situations. DISCUSSION: The findings suggest the need for clearer role awareness and targeted training to prepare semi-professional language mediators for the complexities they encounter in healthcare settings. There is a need for targeted, certified training that goes beyond language skills to include cultural competence, emotional communication, and ethical considerations, including the awareness of different roles. Addressing these training needs is essential to improving the quality of care for linguistically and culturally diverse populations.