Table 2 Codification of companion's stance and roles

Linguistic agent

Interpreter

• The companion acts like an interpreter without intervening in the dialog.

• The companion is as discrete and unobtrusive as possible, avoiding any level of personal involvement, in order to facilitate clear and comprehensible communication.

Active interpreter

• The companion acts as a particularly pro-active interpreter, by actively engaging with the interlocutors prior to interpreting, frequently asking for clarification/confirmation, and using reformulations and transexplanations ^a to support understanding.^b

• The focus remains on points of order or details rather than entering a true mediator role with broader discussions on the meaning of a particular intervention or practice.

Lifeworld agent

Cultural informant

• The companion acts as cultural advisor for the clinician and the patient.

Mediator

• The companion tries to expand, explain, synthesize or adapt the clinician's questions and the patient's answers when the terms/expressions used are different from those used in the patient's or clinician's culture or when the terms are too medical.

Advocate

• The companion acts as an advocate for the patient and seeks to ensure that the patient receives the best care possible, sometimes even opposing the clinician or rejecting questions that he feels minimize the severity of the patient's condition.

• The companion teams up with the patient, even making decisions together – sometimes up to the point of pushing the patient to agree.

• The companion can put additional pressure on the clinician to be more attentive to the patient's condition.

Close informant

• The companion acts as a close caregiver to the patient and spontaneously provides information about the patient (e.g. cultural background, country of origin, type of work, family information, language, habits, etc.).

• The companion corrects or complements answers provided by the patient, since (s)he believes knowing him/her well enough, often without making the patient/clinician aware.

System agent

Bilingual professional

• The companion becomes the clinician: (S)he conducts the interview in his/her own language, referring to the clinician afterwards.

• The companion adds questions or gives additional medical information to the patient.

• The companion may also encourage the patient to follow the physician's directions or disclose information that would be medically useful.

• The companion may source from his/her own medical training, or from experience with the routine of these consultations.

• As explained in more detail in Leanza (2005), this role is the counterpart of that of Advocate: the companion acts as agent or spokesperson of the healthcare system, as if (s)he were a healthcare professional, possibly at the expense of certain values/practices of the own community, and is therefore referred to as a professional.

Monolingual professional

• The companion positions her/himself as a health and/or migration professional at the same level as the clinician and expresses her/his own points of view or hypotheses to the clinician.

• The companion addresses the patient in the patient's language, positioning her/himself as a professional. These exchanges are not translated into the other language.

• As above, the companion acts as agent of the healthcare system, as if (s)he were a healthcare professional, possibly at the expense of certain values/practices of the own community, and is therefore referred to as a professional.

Principal

Answers for patient

• The companion answers the clinician's questions for the patient, reflecting his/her own views and perceptions of the patient, without consulting or involving the latter.

• The companion does this, since (s)he believes knowing the patient well enough

• The focus is on biomedical issues, no other type of information (e.g., cultural elements) is added.

• If the companion adds information that is not solicited by the clinician, that part of the conversation is coded as Close informant.