BMC Health Services Research Regulation, modification, and evolution of remote sign language interpreting in Sweden – a work in progress

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The aim of the study is to investigate the interpreters’ experience of the remote interpreting organisation in Sweden and how it evolved since the COVID-19 pandemic. Method Interviews with 26 experienced remote interpreters, representing 19 of Sweden’s 21 counties, were analysed with qualitative content analysis. Results Three themes were revealed in the analysis. The first theme was regulation. It was stated that directives and regulatory decisions concerning provision of remote interpreting services were varied and unclear. Several different platforms were used when interpreting remotely. Some of the services had conducted risk analyses, whereas others had not. The second theme was modification, including adjusting interactions to suit users’ preferences and capabilities, as well as adjustments to work environments and workplaces. The third theme, evolution of remote interpreting, showed that support and training were rare and varied. The organisation of remote interpreting appears to be a work in progress across Sweden, but it is a way of interpreting that is here to stay. Conclusions In Sweden, remote interpreting is a service that varies according to regulations and organisation of the assignments. The service seems to benefit from being more uniform and streamlined across Sweden, although consideration must be given to those involved with the service. COVID-19 Interaction Interpreting Interpreting Agency Interview Organisation Qualitative Content Analysis Remote Interpreting Sign Language 1. Background Sign language interpreting (SLI) became a regular service in Sweden in 1976. In some senses, it is still in its infancy and is undergoing constant evolution and transformation ( 1 ). Due to the COVID-19 pandemic, and because of recent technical developments, opportunities for remote interpreting (RI) have become an option. RI facilitates communication between people who sign (in the case of Sweden, in Swedish sign language, STS) and people who use a spoken language. An interpreter interprets between them from a studio or on-site at the side of one of the interlocutors. SLI has undergone a tremendous shift towards RI in several western countries, not only in Sweden but also, for example, in the US, the UK, the Netherlands, Germany, Finland, and Belgium ( 2 ). In 2020, as the risk of transmission of infection grew, interpreting in Sweden began to shift away from on-site service and towards RI, as the first confirmed case of COVID-19 was reported at the end of 2019, followed by a first lockdown in Sweden in March 2020 ( 3 ). In Sweden, planned RI is funded by the regions with governmental money. Instant RI is categorised under phone calls, which are a part of the Swedish Video relay service ( 4 ) provided directly by the government ( 5 ). The current study focuses on planned RI, carried out by interpreters who are employed by the counties and/or by private companies that work for the regional counties around Sweden. A previous study of RI in Sweden ( 6 ) showed that interpreters reported both positive and negative experiences of working remotely. The interpreters in that study generally considered it easier to work face to face since that enabled a closer connection among the interlocutors. Cooperation among the interlocutors and reliable technical devices were sometimes reported as key factors for RI to work well. RI was considered to be a good option for adapting the work to fit the new environment created by the pandemic. The study points out that the organisation was one factor of RI that influences their work. RI is a rather new kind of interpreting; there was a rapid increase from almost no remote assignments to exclusively RI during the pandemic. Consequently, the way it is organised is not yet fully established. Knowledge about the current state of RI organisation can provide guidance for how to enhance, bolster, and evolve the service going forward. The aim of the current study is therefore to investigate the interpreters’ experience of RI organisation in Sweden and how it evolved since the COVID-19 pandemic. 1.1 Evolution of SLI service in Sweden SLI service in Sweden has evolved over time. SLI for deaf people in Sweden began as a pilot project in 1968 ( 7 ). In 1976, the SLI service became a regular part of the regional counties’ “assistance compensation” ( 8 ). Subsequently, the Handicap Institute (now the Swedish Agency for Participation [MFD]) took over the central responsibility for SLI and issued recommendations for a coordinated interpreting service in 1981. A so-called disability investigation was launched in 1989 to review the interpreting service, which led to an amendment to the Swedish Health and Medical Services Act ( 9 ). SLI was mentioned in the amendment regarding the right to interpreting services under the auspices of the regional counties. The legislative change came into effect in 1994 ( 10 , 11 ). Six follow-ups of the SLI service have been conducted between 1989 and 2000. The Swedish National Audit Office was tasked with reviewing how the regional counties used the funding provided for SLI services ( 12 ), and they identified several shortcomings. A directive for a review of the status of STS ( 13 ) was issued, which stressed that research on several aspects of deaf people’s situation was lacking. The final report on STS ( 14 ) revealed, among other things, that the needs for SLI interpretation were not being adequately met. The SLI liaison was identified as vague. The National Board of Health and Welfare was commissioned to investigate how the regulations regarding liaison SLI were applied by the regional counties ( 15 ). The result of the investigation showed that the system was confusing and difficult to understand. Consequently, an investigation about the regulation, financing, organisation, and supervision of the SLI service was initiated. This investigation proposed a single state agency responsible for the SLI service ( 16 ). It is worth noting that RI is mentioned in this document ( 16 ) as a service that might be offered if possible and justified considering the individual needs of the primary interpreting user ( 16 ). The document emphasises that significant improvements in technology and interpreting competence would be needed for RI to be a possible alternative to on-site interpreting in the future (16 p. 146). However, the investigation was rejected as the budget was not considered sufficient, leading to another investigation ( 17 ). In this investigation, it was emphasised that RI should be offered in situations were deemed appropriate. However, the investigation received criticism from user organisations and was therefore discontinued. Yet another investigation was initiated, which became SOU 2022:11. Due to COVID-19, the SLI service was forced to adapt by increasing the number of RI assignments. During the same period, the follow-up report ( 1 ) was presented, which clearly emphasises the need for an analysis of a remote SLI function covering all regional counties, stating that remote SLI “is, however, still immature and in the early stages of its development” ( 1 , p. 350). Thus, the need to take a closer look at the organisation of RI service has been demonstrated within research ( 6 ) and by Swedish documents. 2. Methods The aim of the current study is to investigate the interpreters’ experience of RI organisation in Sweden and how it evolved since the COVID-19 pandemic. This was investigated by an explorative qualitative study based on interviews with interpreters with experience of RI. An e-mail containing information about the study was sent to all regional counties and private interpreting services in Sweden, and the recipients were asked to forward the e-mail to interpreters who might agree to be interviewed. A total of 26 interpreters contacted the first author and indicated that they wanted to participate in the study. All of them were included. The interpreters represented 19 of the 21 regional counties in Sweden. They worked for both private companies (n = 7) and regional counties (n = 19) (Table 1 ). The participants comprised 22 women and 4 men, which reflects the distribution within the profession of sign language interpreters. The participants were between 27 and 61 years of age and had been working as interpreters between 1.5 and 38 years. Table 1 Characteristics of the informants n = 26 Age, mean (range) 42.7 (27–61) Sex, n Women 22 Men 4 Years in profession, mean (range) 16 (1.5–38) Employment sector Region 19 Private 7 RI experience (assignments per year) Much (> 50) 22 Moderate (16–50) 2 Limited (< 16) 1 Not reported 1 The interpreters were interviewed between October 5, 2021, and June 13, 2022. The Swedish Ethical Review Authority approved this study (Dnr. 2021–02182). Information about the study (both written and oral) was given to all informants beforehand. All informants gave written informed consent to participate before the interview. The interview guide was semi-structured and consisted of three sections: 1) the experiences of the interpreters, 2) the organisation of RI, and 3) the interpreters’ teamwork. The first area has been analysed and results have been published ( 6 ). The current study focuses on the second area, the organisation of RI. The interview guide was piloted before starting the interviews, and small changes were made to clarify the questions. This pilot interview was not included in the study. The first author (CW) conducted all the interviews by telephone. She has about 25 years of experience as a certified interpreter between Swedish and STS. Additionally, she is an associate professor, with substantial experience as an interpreter, interviewer, and researcher. The interviews were recorded and lasted between 60 and 90 minutes. All the interviews were then transcribed verbatim by a secretary. The chosen method was qualitative content analysis ( 18 ). Both authors thoroughly reviewed the transcriptions to familiarise themselves with the material. NVivo 11 (QSR International, Inc., Cambridge, MA, USA) was used for the analysis. In the first step of the analysis, the second author (MM) identified significant meaning units that could address the aim; these units were then condensed. The second step was to create codes from the condensed meaning units while still maintaining the content at a manifest level. The codes were subsequently grouped together and organised into categories ( 19 , 20 ). The first author then reviewed the categories, and both authors discussed the phrasing until consensus was reached. The final step involved both authors independently creating themes, which sometimes necessitated merging multiple categories. A subsequent discussion ensued. This independent work with the themes and the discussion was a way of seeking trustworthiness of the material ( 21 ). An overarching theme was finally identified to capture the whole data material. The checklist Consolidated Criteria for Reporting Qualitative Research (COREQ; 22) was used to ensure that all reporting aspects were included in the manuscript. In the results section, the themes and categories are illustrated by quotes from the informants, indicated by a #. 3. Results Based on the differences among the various counties, it appears that several processes are taking place at several levels. Analysis of the informants’ perspectives on the organisation of RI yields an overarching theme: RI as a work in progress. The overarching theme is an interpretation of the latent content of the data. Results of the analysis are presented under the three themes of Regulation, Modification, and Evolution. These themes illustrate the organisation of RI in Sweden as it has evolved since the COVID-19 pandemic. An overview of the results is presented in Table 2 below. Table 2 Overarching theme; themes and categories Overarching theme: RI a work in progress Themes (3) Categories (7) 1. Regulation 1.1 Unclear directives and decisions 1.2 A range of platforms are used 1.3 Risk analysis varies 2. Modification 2.1 Adjustments of interaction to user preferences and capabilities 2.2 Adjustments to work environments and workplaces 3. Evolution 3.1 Support and training for RI is rare 3.2 RI is a work in progress but is here to stay 3.1 Regulation This theme focuses on how RI is regulated in the regional counties around Sweden. It reveals data that is formulated in three categories: 1) Unclear directives and decisions, 2) A range of platforms are used, and 3) Risk analysis varies. 3.1.1 Unclear directives and decisions RI directives and organisation vary in terms of what the interpreters are and are not allowed to do in their professional work. In addition, responsibilities of RI are not standardised. Directives may vary depending on the type of assignment and whether there is a need to manage the interpreted event at all. For example, in GP visits where the assignment is to interpret a doctor-patient consultation, confidentiality is prioritised. Some platforms are not considered suitable for this type of interpreted event, but other (more secure) platforms may have technical limitations that make the interpretation difficult. It is sometimes unclear what to place first: confidentiality or usability. Some of the interpreters reported that they solved the problem by choosing a less secure platform to make the interpreting possible. It seems that directives were unclear for some of the interpreters: There have been some varying directives, and different interpreters are differently inclined to try to find technical solutions because we were at such different levels from the start, or maybe still are. While some were quite quick to say: yes, but this doesn't work, ... one just found something to solve the situation. ( #14) Besides the question of how to offer RI, there is also the matter of how to perform the service. There seems to be a lack of guidelines, as one interpreter described how she tried, in a non-regulative way, to formalise the remote work to some extent in order to achieve more standardised procedures for RI: I have set up guides on how to set everything up ... but not guidelines, no. ( #14) It is not only the interpreters that are involved in organising and preparing for assignments. Orders for interpreting events are received by a secretary at the interpreter office. The order must include enough information to enable staff to determine whether the assignment can and should be offered remotely or on-site. In addition, the interpreter on the assignment needs sufficient information to prepare for it. The secretary at the interpreter office thus has a significant role, but not a clear task: Then there’s a lot about how it works with the coordinators, making sure they are also on track with remote interpreting, and when it is suitable and when it is not – that’s another issue. And ensuring that enough information comes through in the order to me as an interpreter, which is not always clearly defined whose responsibility it is. So, in the beginning, it was often like that, with some users getting frustrated because the coordinators called three times, and then two different interpreters called. ( #14) RI directives are not totally clear, although the interpreters state that the organisation has evolved. During the COVID-19 pandemic, interpreting was generally conducted as RI instead of face-to-face. The kinds of assessments that were conducted as RI varied greatly. According to the interpreters, RI is performed in a range of different settings and constellations: Doctor visits, yes, but also conversations, personal meetings, conversations with the boss, courses, conferences, board meetings, everything, I would say. Yes, quite different assignments. ( #11 ) A range of encounters that are a common part of the regular SLI service were offered remotely. It seems surprising that RI was so user-friendly that it could be used for so many different assignments– from interpreting in church to providing interpretation on tourist buses. The most common assignments, though, seemed to involve two-person conversations and work meetings. The transition from face-to-face to more RI interpreting started abruptly as the pandemic changed the landscape from interpreting on-site to remote delivery. Due to the pandemic, all assignments became remote, something that was completely new for some organisations: It started with Corona. Because we didn’t offer remote interpreting at all before Corona, we had to adapt during the pandemic. ( #12) By the time we were conducting interviews for this study, outbreaks of COVID-19 had come and gone, and decisions about whether to use on-site versus RI were fluent: Now, during the pandemic, it was a bit different. Just last week, the head of administration came out and said: “We are now only doing interpretation assignments remotely again. We have to decide if there are exceptions because we have an extraordinary situation again.” ( #12) Governmental as well as organisational guidelines appeared to vary, and decisions were influenced by the pandemic situation and informed consensus. Most of the interpreters stated that neither those who need interpreting nor the interpreters or even interpreter centres had the final decision on the way interpreting would be offered during lockdown due to COVID-19. The shifting restrictions during the pandemic give the strongest and final judgement. In less risky times, it is the involved parties and the circumstances that determine whether interpretation will be provided remotely: First and foremost, it is the technical conditions that determine whether it can be done on-site or remotely. Then it’s the nature of the assignment, what needs to be covered, and how the requester or the primary and secondary interpreter users feel about doing it remotely. We always have a dialogue about what is possible. Additionally, from a child’s perspective: is it appropriate to do it remotely if the interpreter user is under 18 years old? These are the factors that influence the decision, I would say. ( #3) A first step towards RI is thus to decide whether to carry out the assignment on-site or remotely, and after that, to determine which platform to use. 3.1.2 A range of platforms are used Not all counties have the same regulations setting out which platform to use. At the beginning of the transition towards more RI, some organisations determined which platforms were safe to use. The responsibility for confidentiality and safety seems to vary; one interpreter stated that the user of the service is the one who makes the final decision on platform: It is the interpretation centre that invites e.g. a workplace, then they get to decide completely what kind of platform to use, because then we just say thank you and tick [that box] off. Then if we run Teams or Zoom or whatever, […]it’s their responsibility. ( #14) However, another interpreter reported that they had strong regulations concerning what platform to use, although the regulations were not consistent as they were dependent on other factors: We have very clear rules for remote interpreting, which platforms we are allowed to interpret in. Although then it is a question of which platform we from the interpreting service can offer to interpret in when we initiate or send a link. Then we can connect on other people’s platforms if we are the ones invited to their meeting. So then there is, yeah, then we don’t follow... then we follow different rules for testing, you could say, [depending on whether] we are the ones who initiate or if we are the ones who are invited. ( #9) Some regional counties have their own platforms that they use for healthcare appointments when they are the ones to invite participants. The specific platforms mentioned are Alltid öppet/CMR-links (Stockholm county), Mitt vårdmöte/FHM (Västra Götaland County), Vidicue (Kronoberg County), and Visibla Care (Örebro County, Västebotten County). Sometimes the regional counties’ accounts did not work well, and the interpreters seemed to solve this in different ways. It seems that the need to perform the work was prioritised over adhering to whatever rules had been set up: When I interpret... well, it’s my private account, but it’s still a neutral one that I don’t use in other contexts. But if I were to interpret via Facetime or via Messenger, Jim Private if you say so, so I think it’s a disadvantage, because then I’m offering the whole– Then maybe it will happen that you become friends on Facebook or – so yes, you invite [that] and it won’t be professional. So [these less private platforms] have only been used on occasion in an emergency situation. ( #21) Several interpreters stated that they have used their personal devices and accounts for interpreting – often when a sudden problem arose. Issues with devices or connections were sometimes solved by using the interpreter’s or the user’s own mobile phone: And we have solved it in all possible ways, sometimes you have brought in a mobile phone and then you have called the hearing person and then you have it on the mobile phone and then you have the other via the computer, you know, they have done everything possible to solve it. ( #2) The interpreters observed that a range of platforms have been used for RI. Most common were Zoom, Teams, and different versions of Skype. Other general platforms that have been used are FaceTime, FHM, Google Duo, Google Hang Out, Google Meet, Messenger, Telia Ace, VMR, Webex, WhatsApp, and university-specific programs. Overall, most interpreters considered Zoom to be the most suitable platform for SLI. In Zoom it is possible to pin the signing party’s video so it is not “moving around” ( #15) , whereas Teams is more difficult to handle: In Teams sometimes the image disappears as soon as they change speakers and it is very problematic when you would sit with the image up as well, plus they dragged. We’ve had problems with logins where you get kicked out of meetings, and yes, there are a lot of headaches to work in Teams. And I’ve also had compatibility problems where I have to start up Teams with a certain internet browser for it to work. And if there has been an update, it also thinks that you should update a lot of other things, so all of a sudden you have a lot of special functions on your computer that you never asked for just because you want to use Teams. ( #15) Several interpreters reported that having such a wide range of platforms was a big issue. They saw a need for one national platform that works for SLI (e.g. possibility to pin, to show a PowerPoint and keep the interpreter’s screen at the same time, high resolution with no glitching) and that is secure. 3.1.3 Risk analysis varies Confidentiality and security were things that some of the regional counties have taken into formal consideration. One way to formally evaluate challenges is to conduct a risk analysis, as some regional counties have done. Evaluation in terms of risk analysis was one way to avoid differences in the RI service according to one interpreter: We have evaluated quite carefully what we think has been good and what has not been good and how we should change things so that we do things more uniformly with each other so that everyone does not do things differently when on assignments and so on. (#17) According to the interpreters, formal risk analysis has first and foremost focused on the safety of platforms: “ thorough clarification of what constitutes secrecy, i.e. correct in terms of security ” ( #12) . Steps to protect privacy with RI were taken in both the office and at home in the interpreters’ private residence, and the employers trusted the interpreters’ assessment of confidentiality during the assignments. To guarantee confidentiality when working from home can be a challenge if other parties also work from home or if family members are home during the assignment. Some counties have offices that the interpreters may work from: It is quite a lot of personal responsibility and that is probably one of the reasons that many people actually go to the interpreting office and sit in the studios there, because you live in cramped quarters, or you have teenage children who are studying at home during the pandemic and so on. So guarantee- I can’t prove, or my boss hasn’t required me to prove, that I’m maintaining confidentiality. But I think that it is part of the interpreter’s ethics and morals that it also applies in this context. So you sit with a headset and the door closed. ( #14) One interpreter gave an example of formalisation of his/her approach, stated in documents from the regional county: No, I have not seen any risk assessment. However, I have seen papers on how to behave as an interpreter, we have been sent what, that you must use their profile picture, it must say the company’s name ... after my name, etc. such things. But I don’t have a risk assessment . ( #25) Thus, some counties have done risk analyses, and some have not. There is an overall discrepancy among interpreting offices around Sweden. 3.2 Modification The theme of modification consists of two categories: 1) Adjustments of interaction to user preferences and capabilities and 2) Adjustments to work environments and workplaces. 3.2.1 Adjustments of interaction to user preferences and capabilities The users’ preferences and capabilities are among the aspects considered when adjusting within RI. In some areas, the regional counties have an ongoing discussion with the users and with representatives of the users about whether and how to arrange RI. One regional county had a workshop with representatives from a user council and discussed aspects of RI. In smaller regional counties, it seems to be easier to have a more direct discussion with the users of the service: The larger the region, the less communication you have with your interpreter users. And the smaller the region the better, so that you can be open and honest... In XXX, which is my largest region, I think that no, the communication does not exist. We also see on social media that the interpreter users in XXX are not particularly satisfied. ( #25) The regional counties had to some extent considered adjustments to users’ preferences. On an individual level, any requests the (signing) user might make to the interpreter agency are met to the extent possible. Furthermore, the interpreters’ estimation of how the users can manage the interpreting is dependent on users’ conditions: Sometimes, as I said, there have been other diseases or other disabilities that make it not work remotely. ( #8) Valuation of additional disabilities or skills influences what interpreters think could be a possible remote assignment. It is easier if the interpreter and users have met before and if they feel comfortable with each other. Some users of the service are considered by the interpreter to need extra adjustments to be able to attend an assignment remotely: And then there are also sometimes certain difficulties, I think if it is, it could be the communication, people who have difficulty understanding what an interpreter is doing at all where you need to be more clear and use more body language, then it becomes a bit flat. So it could be a pure communication aspect that makes you feel that the assignment is not suitable. ( #9 ) One disability mentioned by the interpreters was deafblindness, a condition where people have a combined vision and hearing impairment of such severity that it is hard for the impaired senses to compensate for each other ( 23 ). Although people with deafblindness may have some vision left and can see visual sign language, it could be difficult to decode the signing in RI. However, some of the interpreters stated that people with deafblindness can benefit from RI due to their needs: Some deafblind people who see so well that you can interpret remotely, like that has been an advantage, because you can focus on a person if the lighting conditions and background are right... because then you don’t have to sit in a room with bad lighting conditions, bright colours, so it has sometimes been an advantage for some. ( #2 ) 3.2.2 Adjustments to work environments and workplaces Interpreters carried out RI assignments either at the interpreter office or at home during COVID-19, although the situation varied. In some services, the interpreters were obliged to work from the office. One interpreter stated that, in the critical part of the pandemic, the studio had to be big enough to allow enough space between two interpreters working in the same room. Before the breakout of COVID-19, several interpreter offices had no studio at all, and they had to build one (or several) studios for remote purposes: They have rebuilt an entire room, repainted and made draperies and, yes, lamps and yes, tidied up then. In the office then, or at the interpreter office, there is a real sound-insulated door and everything, so that it is according to all the rules of art there. But I would argue that what got us going was Covid. ( #21 ) The services equipped the studios in different ways. The interpreters described how some RI studios were equipped with ergonomic aspects in mind: a desk that could be raised and lowered so interpreters could choose to stand or sit while working. Standing mats and special ergonomic saddle seats were other adjustments. The interpreters stressed that background screens as well as their clothing were considered with a view to creating contrast. Thus, several adjustments were made to make RI comfortable and suitable for interpreting: Yes exactly, we have, it feels like we have done what we can to make it a good one, ... it has happened gradually as you have worked with it, you have noticed the needs. ( #6 ) Technical adjustments were also made, such as increasing bandwidth and setting up firewalls. In addition, technical devices were updated, new computers were procured, and speaker pucks were added. For assessments performed from home, additional adjustments were made to RI. Some interpreter services fully equipped their interpreters to provide RI from home: [A]t home, each of the interpreters have received a kit with equipment and things to facilitate remote interpreting at home as well. ( #10 ) However, not all interpreters were equipped to the same extent by their service agencies. 3.3 Evolution This third theme consists of two categories: 1) Support and training for RI is rare, and 2) RI is a work in progress but is here to stay. 3.3.1 Support and training for RI is rare Technical support to RI interpreters varied; some had no support at all, whereas others had solid support from an IT office. Several interpreters declared that their needs were their needs were so specific that their work separated them from other departments in the organisation. In turn, having such unique needs in an organisation made it difficult to receive help from the regular IT office: What often becomes – our unit within the region [is served by] the usual IT guys ... who work well with [all departments]. But what often becomes our problem is that we have such specific requirements and needs compared to everyone else. ( #6 ) However, in other organisations the IT office was well informed and extremely helpful. In addition, some organisations have their own support for technical problems as well as their own group with interpreters to facilitate RI: [A]fter all, we have both this region-wide IT and then we also have an internal IT group that works hard with all technical solutions, [and] also calls around and checks which care units and such have the opportunity to take remote assignments. ( #12 ) In several cases the interpreters themselves must both support and train their colleagues for RI. In relation to users of the RI service, the interpreters were often the ones who guided technical set-up and how to use the technical devices. The interpreters have to both solve their own problems and others’ issues related to RI: [W] e got to sit and be the experts and the guinea pigs at the same time ( #3 ). In the beginning of the RI, interpreters’ work involved a great deal of trial and error or consulting colleagues in order to master the new situation. Groups of interpreters were established in several organisations – some coming together occasionally and others more regularly – to provide support, training, information, and useful tips to their colleagues. The support was offered individually and to small and larger groups of interpreters. RI issues might also be brought up as a separate point in the workplace meetings. Thus, interpreters exchanged experiences in more or less regulated ways. Some organisations provided training sessions for RI. One interpreter described an educational effort offered by the interpreter organisation (Swedish Sign Language Interpreters Community; STTF). In addition, several interpreters mentioned that the video relay training they received during their basic training as interpreters facilitated their work in RI. To disseminate information among interpreters and to users of RI, material was written down and organised: We have acquired manuals that are available on a website and we have a special function mailbox where they can send in questions and/or problems that have arisen in remote interpreting. We have called around to interpreter users. At the beginning we sat, when we sat and rearranged all interpreting assignments, we sat and called a care provider, e.g., and explained what they needed and how it worked and also tested with them if they felt unsure. And the same thing with the interpreter users and explained how it would work and so on. ( #10 ) However, in cases where the technology was introduced, information on information on non-technical considerations was lacking: I don’t know if they have gone into the soft values ​​so much, like the order of the meeting, what to think about and so on, I don’t think so, although I don’t know, but I have mostly heard about the technology. ( #14 ) 3.3.2 RI is a work in progress, but is here to stay RI was kickstarted due to COVID-19. Some services included some kinds of remote assignments before, but the pandemic forced the evolution: We were thrown into it all at once, it wasn’t a project that was one, two, three, four months in the future that lurched along at its leisurely pace, but in one week, all of a sudden, everyone started interpreting remotely. ( #13 ) The remote assignments were thus a relatively new and unexplored way to interpret, but they were quickly set up. Improvements and changes were made as time went on, and the service got better and better: [W]e also created an evaluation document which we sent along, asked them to evaluate both technology [and] interpretation. Yes, there were a few different things where we asked how we could improve, and [that was] quite early in the pandemic. ( #23 ) The transition to more RI opens for positive things as a possibility for different regions to cooperate. Interpreters that were not used to working together could help each other. This, together with less travel for interpreters, made it possible to carry out more assignments: [Y]ou can help each other more between regions. That all of a sudden the Stockholm region can actually get in touch and say: Now we have a shortage of interpreters this Thursday, could you help us support and take these jobs? ( #15 ) From the beginning of the pandemic, it was not an option to carry out assignments face to face. However, as the pandemic eased, more assignments were done face to face. Yet those initial actions taken to address the novel situation caused by COVID-19 are now a regular part of the interpreting agencies. In one region, the amount of RI after the pandemic became regulated by the politicians: The decision is in the regional board, so it is the politicians who have made the decision about 20 percent, so it is in our operational goal. It is a goal that we as a business have no way of influencing. ( #12 ) The coming evolution of RI is thus not only an issue for the interpreting agencies, nor does it involve only interpreters’ or users’ preferences; at some places it is it is an issue well beyond the control of interpreters and users. 4. Discussion The results of the current study about the organisation of RI in Sweden as it has evolved since the COVID-19 pandemic show processes that are unevenly regulated with significant variations across the country. The variation concerns regulations, how RI is offered, and working conditions for interpreters. The issue of offering SLI remotely is found in governmental documents from 2011 ( 16 ). In the investigation there was a proposition for a single state agency for SLI service, although it was not realised. The analysis of the results in this study shows that this is very possible in terms of available technology and the fact that regional counties around Sweden can cooperate to provide RI. As the results of this study also stress that there is considerable variation across the country, one united agency could jointly review how to organise RI so that it becomes uniform. A uniform RI service would be necessary, which could provide the service in a way that is more legally certain and equitable across regional boundaries. There are Swedish examples such as the police force, that were organised locally and regionally but have since been transferred to state control. The transfer of organisation creates a more unified and centralised governance of important societal functions. Results from the current study could be seen as revealing a lack of management (cf. 24). In the case of interpreting services, there was a single instance that took full responsibility for the regulation, modification, and evolution. Therefore, the interpreters themselves found solutions along the way. A well-established RI service could strengthen the users’ equal access and options. Services other than interpreter services could offer users an option to freely choose between meeting face to face or remotely. A possibility to choose can empower people, giving them greater control over their lives ( 25 ). The control and power could be transferred from the institution providing the service to the user of the service ( 26 ). For people who use an interpreter service, the option to choose between RI and face-to-face interpreting is limited. To achieve the same degree of access to the society as others enjoy, the possibility to choose between RI or face-to-face could be one way to go. In addition, making it possible to book directly with an interpreter and the party they want to talk to would empower the signing people even further. However, today there is no proper system for that kind of self-administration. The interpreting agency is designed to meet users’ needs. Users of the services provided by regional counties are mainly “childhood deaf, deafblind, adult deaf and hard of hearing” ( 9 ). In the results of this study, it appears that one agency has had a consulting workshop with the user council. However, consultation with user councils were not mentioned by any other informants in the study. This does not mean that there have not been discussions with the user council, but it implies that no such involvement has been noted by those informants. A drawback of the 2003 directive ( 13 ) is it lacked users’ perspectives and research on SLI. In addition, in the governmental document from 2011, it was stated that RI should take users’ perspectives and needs into account ( 11 , p. 23). The service users’ involvement could be developed, and a framework could strengthen sustainability, which could be beneficial for the services (cf. 27). The question is, what are the preferences and thoughts of the users of RI, and how can we avoid the same backlash again? In addition, although the service is provided for its users ( 9 ), RI needs to be doable and the working conditions for the interpreters have to be appropriate (cf. 6). Adjustments for interpreters who work remotely vary widely. A uniform service and equal conditions could have a sustainable impact on interpreters’ everyday work as well as keeping them within the occupation. During the transition to RI due to COVID-19 ( 2 , 6 , 28 , 29 , 30 , 31 ), one might ask how all the new experiences have been considered and have impacted the organisation – what is left of the discussion of RI and what will happen next. It has been shown that training for RI is lacking. A persistent issue concerns how a formal education programme should be organised and what should be included. It is obvious that there is a need to make it easier to navigate the challenges that arise when working with RI. The issue also corresponds to efforts to achieve sustainability and excellence in RI. Thus, there is a need for comprehensive training programmes to address both the technical aspects of RI and the interpersonal skills. In addition, there are several stakeholders and interests involved in the issue of organisation of RI. Another question persists: How can (for example) politicians’ decisions, interpreter agencies, users’ needs, interpreters’ needs, and equality be solved in a democratic and sustainable manner? 4.1 Strengths and limitations This study is based on interpreters’ comments on the organisation or RI in their regional counties. This is both a strength and a limitation. A strength is that we received an unfiltered situational description of reality. From a management perspective, the informants’ observations reflect what permeates the organisation as experienced by those who work in the service. On the other hand, the interpreters might be unaware of all the decisions and consultations that have taken place higher up in the organisation. What can be concluded, though, is that RI, in accordance with SLI from the 2022 investigation, is “still immature and in the early stages of its development” ( 1 , p. 350). Another strength is that the authors approach the study from different angles. While the first author (CW) is a certified interpreter who has worked and done research on RI earlier, the second author (MM) is an associate professor in social work and has worked with council organisations before, although not with interpreting offices per se . This gives an opportunity to generate analysis both from an insider perspective, with a deeper knowledge, and an outsider perspective. The interviews were subsequently conducted with a deep knowledge of the interpreters’ everyday work. In a next step, the first analysis was done by the second author from the outsider perspective. Thus, the analysis has been validated by cooperation between the authors. 5. Conclusions This investigation of RI organisation in Sweden as it has evolved since the COVID-19 pandemic has shown that RI is still a work in progress. The regulation of RI varied greatly among regional counties in Sweden with respect to directives, decisions, and platforms used. A great variety of assignments were carried out remotely, and the restrictions varied as interpreter services adapted to the COVID-19 work environment. The risk of making a transition from on-site interpreting to RI was taken into consideration in some regional counties, whereas others did not do so in a formal way. Modifications of interaction were, to some extent, adjusted to user preferences and capabilities. According to interpreters, work environments and workplaces were adjusted, both by rebuilding studios and by adapting spaces to suit furniture and technically devices. The overall evolution followed the same patterns as the other aspects of organisation: support and training varied, with some having their own technical support and others required to solve their own problems. Common problems were often overcome by cooperating and exchanging helpful tips within the interpreting group. With unclear regulations, the interpreters themselves seemed to be dealing with the rather new situation as well as they could. It is not clear how RI will evolve over time. In some places the issue is outside of the control of interpreters and users, and even of the regional counties. But it is certain that RI in some form is here to stay, at least as one way to receive SLI. Abbreviations RI Remote Interpreting SLI Sign Language Interpreting STS Swedish Sign Language Declarations Ethics approval and consent to participate The Swedish Ethical Review Authority approved this study (Dnr. 2021-02182). Consent for publication Not applicable Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests. Funding The study was funded by Region Örebro County, Sweden. Authors’ contributions CW initiated the study and both authors designed it. CW conducted the interviews with the interpreters. MM took the initial steps in the analysis, which then continued in collaboration between both authors. Quotes were extracted by MM for the results section. CW prepared a draft of the introduction, results, discussion, and conclusion, and MM wrote the draft of the method section. Both authors then revised and approved the final manuscript. Acknowledgements The authors would like to thank all the interpreters that were interviewed for this study. Without your experiences and knowledge it would not have been possible to gain insight on remote assignments in Sweden. Authors’ information Associate professor Camilla Warnicke is a certified interpreter of Swedish and Swedish Sign Language and a deafblind interpreter. She is employed by the Sign Language and Deafblind Interpreter Programme in Örebro and is currently a guest researcher at the BA programme at Stockholm University. She is affiliated with the School of Behavioural, Social and Legal Sciences, Örebro University. Associate professor Marie Matérne is a senior lecturer in social work at Örebro University and a registered health care counsellor. Her main research interest focuses on participation, quality of life, and quality of care within disability research. She has also performed research on management within healthcare during COVID-19. References SOU 2022:11: Action plan for a long-term development of the interpreting service for the deaf, hearing impaired and persons with deafblindness. https://data.riksdagen.se/fil/93C8E059-E8E2-49A4-855E-085662D57F4D (2022). Accessed 8 Aug. 2024. De Meulder M, Pouliot O, Gebruers K. Remote sign language interpreting in times of COVID-19. 2021. University of Applied Sciences Utrecht. Ludvigsson JF. The first eight months of Sweden’s COVID-19 strategy and the key actions and actors that were involved. Acta Paediatrica. 2020;109(12),2459-2471. PTS: Post- and Telecom Agency. https://pts.se/ (2024). Accessed 8 Aug. 2024. Warnicke C, Plejert C. Turn-organisation in mediated phone interaction using Video Relay Service (VRS). Journal of Pragmatics. 2012;44(1),1313-1334. Warnicke C, Matérne M. Sign language interpreters’ experiences of remote interpreting in light of COVID-19 in Sweden. Interpreting and Society: An Interdisciplinary Journal. 2024; 4(2),1–22. Prop. 1968:41: Kungi. Maj:ts proposition no 41 year 1968.https://www.riksdagen.se/sv/dokument-och-lagar/dokument/proposition/kungi-majts-proposition-nr-41-ar-1968_ET3041/html/(1968). Accessed 8 Aug. 2024. SOU 1991:97: A path to participation and influence: Interpreter for the deaf, deaf-blind, adult-deaf, hearing-impaired, and speech-impaired: Interim report.https://lagen.nu/sou/1991:97 (1991). Accessed 8 Aug. 2024. HSL 1982:763: The Health and Medical Care Act. https://www.riksdagen.se/sv/dokument-och-lagar/dokument/svensk-forfattningssamling/halso-och-sjukvardslag-1982763_sfs-1982-763/(1982). Accessed 8 Aug. 2024. Prop. 1992/93:159: Governmental proposition about support and service to certain disabled people. https://data.riksdagen.se/dokument/gg03159(1992). Accessed 8 Aug. 2024. SOU19: Support and service for certain disabled people https://data.riksdagen.se/dokument/GG01SoU19 (2019). Accessed 8 Aug. 2024. Swedish National Audit Office 2002:16: Review of the status of sign language.https://lagen.nu/dir/2003:169 (2002). Accessed 8 Aug. 2024. Dir. 2003:169: Review of the status of sign language. https://www.riksdagen.se/sv/dokument-och-lagar/dokument/kommittedirektiv/oversyn-av-teckensprakets-stallning_grb1169/(2003). Accessed 8 Aug 2024. SOU 2006:54: Sign language and sign language speakers: Review of the status of sign language. https://www.riksdagen.se/sv/dokument-och-lagar/dokument/statens-offentliga-utredningar/teckensprak-och-teckensprakiga-oversyn-av_gub354/ (2006). Accessed 8 Aug. 2024. National Board of Health and Welfare 2008: The concept of everyday interpretation about the regional counties’ responsibility for interpreters for the deaf, deafblind and hard of hearing.https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2008-126-116_rev.pdf(2008). Accessed 8 Aug. 2024. SOU 2011:83: A unified interpreting service.https://www.regeringen.se/contentassets/8c5b259fe9aa46668d881d89d3a19631/en-samlad-tolktjanst-sou-201183/ (2011). Accessed 8 Aug. 2024. Ds. 2016:7: Interpreting service for everyday interpretation. https://www.regeringen.se/rattsliga-dokument/departementsserien-och-promemorior/2016/04/ds-20167/(2016). Accessed 8 Aug 2024. Graneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurse Education Today. 2004;24(2), 105–112. Barrosso J. Social support and long-term survivors of AIDS. Western Journal of Nursing Research. 1997;19:5. Burnard P. A method of analysing interview transcripts in qualitative research. Nurse Education Today. 1991;11(6):461–466. Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qualitative Health Research. 2005;15(9):1277–1288. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care. 2007;19(6), p. 349–357. Nordic Welfare Center. Nordic Definition of Deafblindness: Nordic Welfare Center. https://nordicwelfare.org/wp-content/uploads/2018/03/nordic-definition-of-deafblindness.pdf(2021). Accessed 8 Aug. 2024. Skogsberg M, Jarl G, Materne M. Health care workers’ need for support from managers during the initial phase of the COVID-19 pandemic. BMC Health Services Research. 2022;22:1563. Askheim OP, Starrin, B. Empowerment i teori och praktik. Malmö: Gleerups Utbildning AB, 2007. Rønning R. Brukarmedverkan och empowerment – gammalt vin i nya flaskor? In: Askheim OP, Starrin B, editors, Empowerment i teori och praktik. Malmö: Gleerups Utbildning AB; 2007. p. 33–47. Andreassen TA. Service user involvement and repositioning of healthcare professionals: A framework for examining implications of different forms of involvement. Nordisk Välfärdsforskning| Nordic Welfare Research. 2018; 19;3(1):58–69. Roman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. The occupational health and safety of sign language interpreters working remotely during the COVID-19 pandemic. Preventing Chronic Disease. 2022;19, Article E30. Roman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. Experiences of sign language interpreters and perspectives of interpreting administrators during the COVID-19 pandemic: A qualitative description. Public Health Reports. 2023;138(4),691–704. Sheridan S, O’Donnell J. Irish sign language interpreter workplace wellness during COVID-19: Looking back and moving forward. Journal of Interpretation. 2023;31(1), 1–25. Trumm A, Lau EJS, Farthing S, Breen K. The use of video remote interpreting (VRI) in a medium secure psychiatric setting during the COVID-19 lockdown. The Journal of Forensic Practice. 2023;25(3), 263–275. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 19 Nov, 2024 Read the published version in BMC Health Services Research → Version 1 posted Editorial decision: Revision requested 20 Aug, 2024 Editor assigned by journal 20 Aug, 2024 Submission checks completed at journal 19 Aug, 2024 First submitted to journal 18 Aug, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4932705","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":342631108,"identity":"0ce301ad-4f30-4137-a055-ef9f23da95f9","order_by":0,"name":"Camilla Warnicke","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7ElEQVRIie3QMQrCMBiG4b8InYSs6aJXiAjRQfQqKYW4KDgKCnZqJ3H1GILgXBDawYprxk7dhI4OBU2Dig5RR4e8WVLowwcBMJn+tCib3G9MHvQTYeSFOP4v5kkqRKIvf6Pw4MqVPpDkmGfZnDfayTLHUPa0BKfjjSQekHTYISwetWmaUGwFXEsIKFIDGnEbu/7U3Ql5sfy9nqBzRRZAT7kii+1aEiiveoLVyh6oUCsjRnBFbP0jYKFWkvpAyBUW89Y6jWtdN/C0BK3G26KYzhrOitvOZe41URhYoij7WvKo/v7JvgKTyWQyfeoGOI5ThJMRQKwAAAAASUVORK5CYII=","orcid":"","institution":"Örebro University Hospital, Region Örebro County","correspondingAuthor":true,"prefix":"","firstName":"Camilla","middleName":"","lastName":"Warnicke","suffix":""},{"id":342631109,"identity":"c84e2bea-a14a-418e-ad70-3787e5afa018","order_by":1,"name":"Marie Matérne¹","email":"","orcid":"","institution":"Örebro University","correspondingAuthor":false,"prefix":"","firstName":"Marie","middleName":"","lastName":"Matérne¹","suffix":""}],"badges":[],"createdAt":"2024-08-18 09:21:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4932705/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4932705/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12913-024-11907-y","type":"published","date":"2024-11-19T15:58:03+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69835006,"identity":"6e8cc843-7d92-472e-af0d-c07ad924e6bf","added_by":"auto","created_at":"2024-11-25 16:11:29","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":590439,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4932705/v1/b6143807-2dba-499c-a04c-baf80edf16df.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"BMC Health Services Research Regulation, modification, and evolution of remote sign language interpreting in Sweden – a work in progress","fulltext":[{"header":"1. Background","content":"\u003cp\u003eSign language interpreting (SLI) became a regular service in Sweden in 1976. In some senses, it is still in its infancy and is undergoing constant evolution and transformation (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Due to the COVID-19 pandemic, and because of recent technical developments, opportunities for remote interpreting (RI) have become an option. RI facilitates communication between people who sign (in the case of Sweden, in Swedish sign language, STS) and people who use a spoken language. An interpreter interprets between them from a studio or on-site at the side of one of the interlocutors.\u003c/p\u003e \u003cp\u003eSLI has undergone a tremendous shift towards RI in several western countries, not only in Sweden but also, for example, in the US, the UK, the Netherlands, Germany, Finland, and Belgium (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In 2020, as the risk of transmission of infection grew, interpreting in Sweden began to shift away from on-site service and towards RI, as the first confirmed case of COVID-19 was reported at the end of 2019, followed by a first lockdown in Sweden in March 2020 (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Sweden, planned RI is funded by the regions with governmental money. Instant RI is categorised under phone calls, which are a part of the Swedish Video relay service (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) provided directly by the government (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). The current study focuses on planned RI, carried out by interpreters who are employed by the counties and/or by private companies that work for the regional counties around Sweden.\u003c/p\u003e \u003cp\u003eA previous study of RI in Sweden (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) showed that interpreters reported both positive and negative experiences of working remotely. The interpreters in that study generally considered it easier to work face to face since that enabled a closer connection among the interlocutors. Cooperation among the interlocutors and reliable technical devices were sometimes reported as key factors for RI to work well. RI was considered to be a good option for adapting the work to fit the new environment created by the pandemic. The study points out that the organisation was one factor of RI that influences their work. RI is a rather new kind of interpreting; there was a rapid increase from almost no remote assignments to exclusively RI during the pandemic. Consequently, the way it is organised is not yet fully established. Knowledge about the current state of RI organisation can provide guidance for how to enhance, bolster, and evolve the service going forward. The aim of the current study is therefore to investigate the interpreters\u0026rsquo; experience of RI organisation in Sweden and how it evolved since the COVID-19 pandemic.\u003c/p\u003e \u003cdiv id=\"Sec2\" class=\"Section2\"\u003e \u003ch2\u003e1.1 Evolution of SLI service in Sweden\u003c/h2\u003e \u003cp\u003eSLI service in Sweden has evolved over time. SLI for deaf people in Sweden began as a pilot project in 1968 (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). In 1976, the SLI service became a regular part of the regional counties\u0026rsquo; \u0026ldquo;assistance compensation\u0026rdquo; (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Subsequently, the Handicap Institute (now the Swedish Agency for Participation [MFD]) took over the central responsibility for SLI and issued recommendations for a coordinated interpreting service in 1981. A so-called disability investigation was launched in 1989 to review the interpreting service, which led to an amendment to the Swedish Health and Medical Services Act (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). SLI was mentioned in the amendment regarding the right to interpreting services under the auspices of the regional counties. The legislative change came into effect in 1994 (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Six follow-ups of the SLI service have been conducted between 1989 and 2000.\u003c/p\u003e \u003cp\u003eThe Swedish National Audit Office was tasked with reviewing how the regional counties used the funding provided for SLI services (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and they identified several shortcomings. A directive for a review of the status of STS (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) was issued, which stressed that research on several aspects of deaf people\u0026rsquo;s situation was lacking. The final report on STS (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) revealed, among other things, that the needs for SLI interpretation were not being adequately met. The SLI liaison was identified as vague. The National Board of Health and Welfare was commissioned to investigate how the regulations regarding liaison SLI were applied by the regional counties (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The result of the investigation showed that the system was confusing and difficult to understand.\u003c/p\u003e \u003cp\u003eConsequently, an investigation about the regulation, financing, organisation, and supervision of the SLI service was initiated. This investigation proposed a single state agency responsible for the SLI service (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). It is worth noting that RI is mentioned in this document (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) as a service that might be offered if possible and justified considering the individual needs of the primary interpreting user (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The document emphasises that significant improvements in technology and interpreting competence would be needed for RI to be a possible alternative to on-site interpreting in the future (16 p. 146). However, the investigation was rejected as the budget was not considered sufficient, leading to another investigation (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). In this investigation, it was emphasised that RI should be offered in situations were deemed appropriate. However, the investigation received criticism from user organisations and was therefore discontinued. Yet another investigation was initiated, which became SOU 2022:11.\u003c/p\u003e \u003cp\u003eDue to COVID-19, the SLI service was forced to adapt by increasing the number of RI assignments. During the same period, the follow-up report (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) was presented, which clearly emphasises the need for an analysis of a remote SLI function covering all regional counties, stating that remote SLI \u0026ldquo;is, however, still immature and in the early stages of its development\u0026rdquo; (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, p. 350). Thus, the need to take a closer look at the organisation of RI service has been demonstrated within research (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e) and by Swedish documents.\u003c/p\u003e \u003c/div\u003e"},{"header":"2. Methods","content":"\u003cp\u003eThe aim of the current study is to investigate the interpreters\u0026rsquo; experience of RI organisation in Sweden and how it evolved since the COVID-19 pandemic. This was investigated by an explorative qualitative study based on interviews with interpreters with experience of RI.\u003c/p\u003e \u003cp\u003eAn e-mail containing information about the study was sent to all regional counties and private interpreting services in Sweden, and the recipients were asked to forward the e-mail to interpreters who might agree to be interviewed. A total of 26 interpreters contacted the first author and indicated that they wanted to participate in the study. All of them were included. The interpreters represented 19 of the 21 regional counties in Sweden. They worked for both private companies (n\u0026thinsp;=\u0026thinsp;7) and regional counties (n\u0026thinsp;=\u0026thinsp;19) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The participants comprised 22 women and 4 men, which reflects the distribution within the profession of sign language interpreters. The participants were between 27 and 61 years of age and had been working as interpreters between 1.5 and 38 years.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCharacteristics of the informants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;26\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge, mean (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42.7 (27\u0026ndash;61)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, n\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYears in profession, mean (range)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (1.5\u0026ndash;38)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployment sector\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRI experience (assignments per year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuch (\u0026gt;\u0026thinsp;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate (16\u0026ndash;50)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLimited (\u0026lt;\u0026thinsp;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot reported\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe interpreters were interviewed between October 5, 2021, and June 13, 2022. The Swedish Ethical Review Authority approved this study (Dnr. 2021\u0026ndash;02182). Information about the study (both written and oral) was given to all informants beforehand. All informants gave written informed consent to participate before the interview. The interview guide was semi-structured and consisted of three sections: 1) the experiences of the interpreters, 2) the organisation of RI, and 3) the interpreters\u0026rsquo; teamwork. The first area has been analysed and results have been published (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The current study focuses on the second area, the organisation of RI. The interview guide was piloted before starting the interviews, and small changes were made to clarify the questions. This pilot interview was not included in the study.\u003c/p\u003e \u003cp\u003eThe first author (CW) conducted all the interviews by telephone. She has about 25 years of experience as a certified interpreter between Swedish and STS. Additionally, she is an associate professor, with substantial experience as an interpreter, interviewer, and researcher.\u003c/p\u003e \u003cp\u003eThe interviews were recorded and lasted between 60 and 90 minutes. All the interviews were then transcribed verbatim by a secretary. The chosen method was qualitative content analysis (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Both authors thoroughly reviewed the transcriptions to familiarise themselves with the material. NVivo 11 (QSR International, Inc., Cambridge, MA, USA) was used for the analysis.\u003c/p\u003e \u003cp\u003eIn the first step of the analysis, the second author (MM) identified significant meaning units that could address the aim; these units were then condensed. The second step was to create codes from the condensed meaning units while still maintaining the content at a manifest level. The codes were subsequently grouped together and organised into categories (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). The first author then reviewed the categories, and both authors discussed the phrasing until consensus was reached. The final step involved both authors independently creating themes, which sometimes necessitated merging multiple categories. A subsequent discussion ensued. This independent work with the themes and the discussion was a way of seeking trustworthiness of the material (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). An overarching theme was finally identified to capture the whole data material. The checklist Consolidated Criteria for Reporting Qualitative Research (COREQ; 22) was used to ensure that all reporting aspects were included in the manuscript. In the \u003cspan refid=\"Sec4\" class=\"InternalRef\"\u003eresults\u003c/span\u003e section, the themes and categories are illustrated by quotes from the informants, indicated by a #.\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003eBased on the differences among the various counties, it appears that several processes are taking place at several levels. Analysis of the informants\u0026rsquo; perspectives on the organisation of RI yields an overarching theme: RI as a work in progress. The overarching theme is an interpretation of the latent content of the data. Results of the analysis are presented under the three themes of Regulation, Modification, and Evolution. These themes illustrate the organisation of RI in Sweden as it has evolved since the COVID-19 pandemic. An overview of the results is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e below.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eOverarching theme; themes and categories\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eOverarching theme: RI a work in progress\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThemes (3)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eCategories (7)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Regulation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.1 Unclear directives and decisions\u003c/p\u003e \u003cp\u003e1.2 A range of platforms are used\u003c/p\u003e \u003cp\u003e1.3 Risk analysis varies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Modification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.1 Adjustments of interaction to user preferences and capabilities\u003c/p\u003e \u003cp\u003e2.2 Adjustments to work environments and workplaces\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Evolution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.1 Support and training for RI is rare\u003c/p\u003e \u003cp\u003e3.2 RI is a work in progress but is here to stay\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Regulation\u003c/h2\u003e \u003cp\u003eThis theme focuses on how RI is regulated in the regional counties around Sweden. It reveals data that is formulated in three categories: 1) Unclear directives and decisions, 2) A range of platforms are used, and 3) Risk analysis varies.\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e3.1.1 Unclear directives and decisions\u003c/h2\u003e \u003cp\u003eRI directives and organisation vary in terms of what the interpreters are and are not allowed to do in their professional work. In addition, responsibilities of RI are not standardised. Directives may vary depending on the type of assignment and whether there is a need to manage the interpreted event at all. For example, in GP visits where the assignment is to interpret a doctor-patient consultation, confidentiality is prioritised. Some platforms are not considered suitable for this type of interpreted event, but other (more secure) platforms may have technical limitations that make the interpretation difficult. It is sometimes unclear what to place first: confidentiality or usability. Some of the interpreters reported that they solved the problem by choosing a less secure platform to make the interpreting possible. It seems that directives were unclear for some of the interpreters:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThere have been some varying directives, and different interpreters are differently inclined to try to find technical solutions because we were at such different levels from the start, or maybe still are. While some were quite quick to say: yes, but this doesn't work, ... one just found something to solve the situation. (\u003c/em\u003e \u003cb\u003e#14)\u003c/b\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eBesides the question of how to offer RI, there is also the matter of how to perform the service. There seems to be a lack of guidelines, as one interpreter described how she tried, in a non-regulative way, to formalise the remote work to some extent in order to achieve more standardised procedures for RI:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eI have set up guides on how to set everything up ... but not guidelines, no.\u003c/em\u003e (\u003cb\u003e#14)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIt is not only the interpreters that are involved in organising and preparing for assignments. Orders for interpreting events are received by a secretary at the interpreter office. The order must include enough information to enable staff to determine whether the assignment can and should be offered remotely or on-site. In addition, the interpreter on the assignment needs sufficient information to prepare for it. The secretary at the interpreter office thus has a significant role, but not a clear task:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThen there\u0026rsquo;s a lot about how it works with the coordinators, making sure they are also on track with remote interpreting, and when it is suitable and when it is not \u0026ndash; that\u0026rsquo;s another issue. And ensuring that enough information comes through in the order to me as an interpreter, which is not always clearly defined whose responsibility it is. So, in the beginning, it was often like that, with some users getting frustrated because the coordinators called three times, and then two different interpreters called.\u003c/em\u003e (\u003cb\u003e#14)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eRI directives are not totally clear, although the interpreters state that the organisation has evolved.\u003c/p\u003e \u003cp\u003eDuring the COVID-19 pandemic, interpreting was generally conducted as RI instead of face-to-face. The kinds of assessments that were conducted as RI varied greatly. According to the interpreters, RI is performed in a range of different settings and constellations:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eDoctor visits, yes, but also conversations, personal meetings, conversations with the boss, courses, conferences, board meetings, everything, I would say. Yes, quite different assignments.\u003c/em\u003e (\u003cb\u003e#11\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eA range of encounters that are a common part of the regular SLI service were offered remotely. It seems surprising that RI was so user-friendly that it could be used for so many different assignments\u0026ndash; from interpreting in church to providing interpretation on tourist buses. The most common assignments, though, seemed to involve two-person conversations and work meetings.\u003c/p\u003e \u003cp\u003eThe transition from face-to-face to more RI interpreting started abruptly as the pandemic changed the landscape from interpreting on-site to remote delivery. Due to the pandemic, all assignments became remote, something that was completely new for some organisations:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIt started with Corona. Because we didn\u0026rsquo;t offer remote interpreting at all before Corona, we had to adapt during the pandemic.\u003c/em\u003e (\u003cb\u003e#12)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eBy the time we were conducting interviews for this study, outbreaks of COVID-19 had come and gone, and decisions about whether to use on-site versus RI were fluent:\u003c/p\u003e\u003cp\u003e \u003cem\u003eNow, during the pandemic, it was a bit different. Just last week, the head of administration came out and said: \u0026ldquo;We are now only doing interpretation assignments remotely again. We have to decide if there are exceptions because we have an extraordinary situation again.\u0026rdquo;\u003c/em\u003e (\u003cb\u003e#12)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e Governmental as well as organisational guidelines appeared to vary, and decisions were influenced by the pandemic situation and informed consensus. Most of the interpreters stated that neither those who need interpreting nor the interpreters or even interpreter centres had the final decision on the way interpreting would be offered during lockdown due to COVID-19. The shifting restrictions during the pandemic give the strongest and final judgement. In less risky times, it is the involved parties and the circumstances that determine whether interpretation will be provided remotely:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eFirst and foremost, it is the technical conditions that determine whether it can be done on-site or remotely. Then it\u0026rsquo;s the nature of the assignment, what needs to be covered, and how the requester or the primary and secondary interpreter users feel about doing it remotely. We always have a dialogue about what is possible. Additionally, from a child\u0026rsquo;s perspective: is it appropriate to do it remotely if the interpreter user is under 18 years old? These are the factors that influence the decision, I would say.\u003c/em\u003e (\u003cb\u003e#3)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA first step towards RI is thus to decide whether to carry out the assignment on-site or remotely, and after that, to determine which platform to use.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003e3.1.2 A range of platforms are used\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"BlockQuote\"\u003e \u003cp\u003eNot all counties have the same regulations setting out which platform to use. At the beginning of the transition towards more RI, some organisations determined which platforms were safe to use. The responsibility for confidentiality and safety seems to vary; one interpreter stated that the user of the service is the one who makes the final decision on platform:\u003c/p\u003e \u003cp\u003e \u003cem\u003eIt is the interpretation centre that invites e.g. a workplace, then they get to decide completely what kind of platform to use, because then we just say thank you and tick [that box] off. Then if we run Teams or Zoom or whatever, [\u0026hellip;]it\u0026rsquo;s their responsibility.\u003c/em\u003e (\u003cb\u003e#14)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eHowever, another interpreter reported that they had strong regulations concerning what platform to use, although the regulations were not consistent as they were dependent on other factors:\u003c/p\u003e \u003cp\u003e \u003cem\u003eWe have very clear rules for remote interpreting, which platforms we are allowed to interpret in. Although then it is a question of which platform we from the interpreting service can offer to interpret in when we initiate or send a link. Then we can connect on other people\u0026rsquo;s platforms if we are the ones invited to their meeting. So then there is, yeah, then we don\u0026rsquo;t follow... then we follow different rules for testing, you could say, [depending on whether] we are the ones who initiate or if we are the ones who are invited.\u003c/em\u003e (\u003cb\u003e#9)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eSome regional counties have their own platforms that they use for healthcare appointments when they are the ones to invite participants. The specific platforms mentioned are Alltid \u0026ouml;ppet/CMR-links (Stockholm county), Mitt v\u0026aring;rdm\u0026ouml;te/FHM (V\u0026auml;stra G\u0026ouml;taland County), Vidicue (Kronoberg County), and Visibla Care (\u0026Ouml;rebro County, V\u0026auml;stebotten County).\u003c/p\u003e \u003cp\u003eSometimes the regional counties\u0026rsquo; accounts did not work well, and the interpreters seemed to solve this in different ways. It seems that the need to perform the work was prioritised over adhering to whatever rules had been set up:\u003c/p\u003e \u003cp\u003e \u003cem\u003eWhen I interpret... well, it\u0026rsquo;s my private account, but it\u0026rsquo;s still a neutral one that I don\u0026rsquo;t use in other contexts. But if I were to interpret via Facetime or via Messenger, Jim Private if you say so, so I think it\u0026rsquo;s a disadvantage, because then I\u0026rsquo;m offering the whole\u0026ndash; Then maybe it will happen that you become friends on Facebook or \u0026ndash; so yes, you invite [that] and it won\u0026rsquo;t be professional. So [these less private platforms] have only been used on occasion in an emergency situation.\u003c/em\u003e (\u003cb\u003e#21)\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/p\u003e \u003cp\u003eSeveral interpreters stated that they have used their personal devices and accounts for interpreting \u0026ndash; often when a sudden problem arose. Issues with devices or connections were sometimes solved by using the interpreter\u0026rsquo;s or the user\u0026rsquo;s own mobile phone:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eAnd we have solved it in all possible ways, sometimes you have brought in a mobile phone and then you have called the hearing person and then you have it on the mobile phone and then you have the other via the computer, you know, they have done everything possible to solve it.\u003c/em\u003e (\u003cb\u003e#2)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe interpreters observed that a range of platforms have been used for RI. Most common were Zoom, Teams, and different versions of Skype. Other general platforms that have been used are FaceTime, FHM, Google Duo, Google Hang Out, Google Meet, Messenger, Telia Ace, VMR, Webex, WhatsApp, and university-specific programs.\u003c/p\u003e \u003cp\u003eOverall, most interpreters considered Zoom to be the most suitable platform for SLI. In Zoom it is possible to pin the signing party\u0026rsquo;s video so it is not \u0026ldquo;moving around\u0026rdquo; (\u003cb\u003e#15)\u003c/b\u003e, whereas Teams is more difficult to handle:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eIn Teams sometimes the image disappears as soon as they change speakers and it is very problematic when you would sit with the image up as well, plus they dragged. We\u0026rsquo;ve had problems with logins where you get kicked out of meetings, and yes, there are a lot of headaches to work in Teams. And I\u0026rsquo;ve also had compatibility problems where I have to start up Teams with a certain internet browser for it to work. And if there has been an update, it also thinks that you should update a lot of other things, so all of a sudden you have a lot of special functions on your computer that you never asked for just because you want to use Teams.\u003c/em\u003e (\u003cb\u003e#15)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eSeveral interpreters reported that having such a wide range of platforms was a big issue. They saw a need for \u003cem\u003eone\u003c/em\u003e national platform that works for SLI (e.g. possibility to pin, to show a PowerPoint and keep the interpreter\u0026rsquo;s screen at the same time, high resolution with no glitching) and that is secure.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e3.1.3 Risk analysis varies\u003c/h2\u003e \u003cp\u003e\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003eConfidentiality and security were things that some of the regional counties have taken into formal consideration. One way to formally evaluate challenges is to conduct a risk analysis, as some regional counties have done. Evaluation in terms of risk analysis was one way to avoid differences in the RI service according to one interpreter:\u003c/p\u003e\u003cp\u003e\u003cem\u003e We have evaluated quite carefully what we think has been good and what has not been good and how we should change things so that we do things more uniformly with each other so that everyone does not do things differently when on assignments and so on.\u003c/em\u003e\u003cb\u003e(#17)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAccording to the interpreters, formal risk analysis has first and foremost focused on the safety of platforms: \u0026ldquo;\u003cem\u003ethorough clarification of what constitutes secrecy, i.e. correct in terms of security\u003c/em\u003e\u0026rdquo; (\u003cb\u003e#12)\u003c/b\u003e. Steps to protect privacy with RI were taken in both the office and at home in the interpreters\u0026rsquo; private residence, and the employers trusted the interpreters\u0026rsquo; assessment of confidentiality during the assignments.\u003c/p\u003e\u003cp\u003eTo guarantee confidentiality when working from home can be a challenge if other parties also work from home or if family members are home during the assignment. Some counties have offices that the interpreters may work from:\u003c/p\u003e\u003cp\u003e\u003cem\u003eIt is quite a lot of personal responsibility and that is probably one of the reasons that many people actually go to the interpreting office and sit in the studios there, because you live in cramped quarters, or you have teenage children who are studying at home during the pandemic and so on. So guarantee- I can\u0026rsquo;t prove, or my boss hasn\u0026rsquo;t required me to prove, that I\u0026rsquo;m maintaining confidentiality. But I think that it is part of the interpreter\u0026rsquo;s ethics and morals that it also applies in this context. So you sit with a headset and the door closed.\u003c/em\u003e (\u003cb\u003e#14)\u003c/b\u003e\u003c/p\u003e\u003cp\u003e One interpreter gave an example of formalisation of his/her approach, stated in documents from the regional county:\u003c/p\u003e\u003cp\u003e\u003cem\u003eNo, I have not seen any risk assessment. However, I have seen papers on how to behave as an interpreter, we have been sent what, that you must use their profile picture, it must say the company\u0026rsquo;s name ... after my name, etc. such things. But I don\u0026rsquo;t have a risk assessment\u003c/em\u003e. (\u003cb\u003e#25)\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThus, some counties have done risk analyses, and some have not. There is an overall discrepancy among interpreting offices around Sweden.\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Modification\u003c/h2\u003e \u003cp\u003eThe theme of modification consists of two categories: 1) Adjustments of interaction to user preferences and capabilities and 2) Adjustments to work environments and workplaces.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e3.2.1 Adjustments of interaction to user preferences and capabilities\u003c/h2\u003e \u003cp\u003eThe users\u0026rsquo; preferences and capabilities are among the aspects considered when adjusting within RI. In some areas, the regional counties have an ongoing discussion with the users and with representatives of the users about whether and how to arrange RI. One regional county had a workshop with representatives from a user council and discussed aspects of RI. In smaller regional counties, it seems to be easier to have a more direct discussion with the users of the service:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003eThe larger the region, the less communication you have with your interpreter users. And the smaller the region the better, so that you can be open and honest... In XXX, which is my largest region, I think that no, the communication does not exist. We also see on social media that the interpreter users in XXX are not particularly satisfied. (\u003c/em\u003e\u003cb\u003e#25)\u003c/b\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe regional counties had to some extent considered adjustments to users\u0026rsquo; preferences. On an individual level, any requests the (signing) user might make to the interpreter agency are met to the extent possible. Furthermore, the interpreters\u0026rsquo; estimation of how the users can manage the interpreting is dependent on users\u0026rsquo; conditions:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSometimes, as I said, there have been other diseases or other disabilities that make it not work remotely. (\u003c/em\u003e \u003cb\u003e#8)\u003c/b\u003e \u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eValuation of additional disabilities or skills influences what interpreters think could be a possible remote assignment. It is easier if the interpreter and users have met before and if they feel comfortable with each other. Some users of the service are considered by the interpreter to need extra adjustments to be able to attend an assignment remotely:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eAnd then there are also sometimes certain difficulties, I think if it is, it could be the communication, people who have difficulty understanding what an interpreter is doing at all where you need to be more clear and use more body language, then it becomes a bit flat. So it could be a pure communication aspect that makes you feel that the assignment is not suitable.\u003c/em\u003e (\u003cb\u003e#9\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eOne disability mentioned by the interpreters was deafblindness, a condition where people have a combined vision and hearing impairment of such severity that it is hard for the impaired senses to compensate for each other (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Although people with deafblindness may have some vision left and can see visual sign language, it could be difficult to decode the signing in RI. However, some of the interpreters stated that people with deafblindness can benefit from RI due to their needs:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eSome deafblind people who see so well that you can interpret remotely, like that has been an advantage, because you can focus on a person if the lighting conditions and background are right... because then you don\u0026rsquo;t have to sit in a room with bad lighting conditions, bright colours, so it has sometimes been an advantage for some.\u003c/em\u003e (\u003cb\u003e#2\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e3.2.2 Adjustments to work environments and workplaces\u003c/h2\u003e \u003cp\u003eInterpreters carried out RI assignments either at the interpreter office or at home during COVID-19, although the situation varied. In some services, the interpreters were obliged to work from the office. One interpreter stated that, in the critical part of the pandemic, the studio had to be big enough to allow enough space between two interpreters working in the same room. Before the breakout of COVID-19, several interpreter offices had no studio at all, and they had to build one (or several) studios for remote purposes:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThey have rebuilt an entire room, repainted and made draperies and, yes, lamps and yes, tidied up then. In the office then, or at the interpreter office, there is a real sound-insulated door and everything, so that it is according to all the rules of art there. But I would argue that what got us going was Covid.\u003c/em\u003e (\u003cb\u003e#21\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe services equipped the studios in different ways. The interpreters described how some RI studios were equipped with ergonomic aspects in mind: a desk that could be raised and lowered so interpreters could choose to stand or sit while working. Standing mats and special ergonomic saddle seats were other adjustments. The interpreters stressed that background screens as well as their clothing were considered with a view to creating contrast. Thus, several adjustments were made to make RI comfortable and suitable for interpreting:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eYes exactly, we have, it feels like we have done what we can to make it a good one, ... it has happened gradually as you have worked with it, you have noticed the needs.\u003c/em\u003e (\u003cb\u003e#6\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eTechnical adjustments were also made, such as increasing bandwidth and setting up firewalls. In addition, technical devices were updated, new computers were procured, and speaker pucks were added. For assessments performed from home, additional adjustments were made to RI. Some interpreter services fully equipped their interpreters to provide RI from home:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e[A]t home, each of the interpreters have received a kit with equipment and things to facilitate remote interpreting at home as well.\u003c/em\u003e (\u003cb\u003e#10\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, not all interpreters were equipped to the same extent by their service agencies.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Evolution\u003c/h2\u003e \u003cp\u003eThis third theme consists of two categories: 1) Support and training for RI is rare, and 2) RI is a work in progress but is here to stay.\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e3.3.1 Support and training for RI is rare\u003c/h2\u003e \u003cp\u003eTechnical support to RI interpreters varied; some had no support at all, whereas others had solid support from an IT office. Several interpreters declared that their needs were their needs were so specific that their work separated them from other departments in the organisation. In turn, having such unique needs in an organisation made it difficult to receive help from the regular IT office:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWhat often becomes \u0026ndash; our unit within the region [is served by] the usual IT guys ... who work well with [all departments]. But what often becomes our problem is that we have such specific requirements and needs compared to everyone else.\u003c/em\u003e (\u003cb\u003e#6\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, in other organisations the IT office was well informed and extremely helpful. In addition, some organisations have their own support for technical problems as well as their own group with interpreters to facilitate RI:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e[A]fter all, we have both this region-wide IT and then we also have an internal IT group that works hard with all technical solutions, [and] also calls around and checks which care units and such have the opportunity to take remote assignments.\u003c/em\u003e (\u003cb\u003e#12\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eIn several cases the interpreters themselves must both support and train their colleagues for RI. In relation to users of the RI service, the interpreters were often the ones who guided technical set-up and how to use the technical devices. The interpreters have to both solve their own problems and others\u0026rsquo; issues related to RI: [W]\u003cem\u003ee got to sit and be the experts and the guinea pigs at the same time\u003c/em\u003e (\u003cb\u003e#3\u003c/b\u003e).\u003c/p\u003e \u003cp\u003eIn the beginning of the RI, interpreters\u0026rsquo; work involved a great deal of trial and error or consulting colleagues in order to master the new situation. Groups of interpreters were established in several organisations \u0026ndash; some coming together occasionally and others more regularly \u0026ndash; to provide support, training, information, and useful tips to their colleagues. The support was offered individually and to small and larger groups of interpreters. RI issues might also be brought up as a separate point in the workplace meetings. Thus, interpreters exchanged experiences in more or less regulated ways.\u003c/p\u003e \u003cp\u003eSome organisations provided training sessions for RI. One interpreter described an educational effort offered by the interpreter organisation (Swedish Sign Language Interpreters Community; STTF). In addition, several interpreters mentioned that the video relay training they received during their basic training as interpreters facilitated their work in RI.\u003c/p\u003e \u003cp\u003eTo disseminate information among interpreters and to users of RI, material was written down and organised:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWe have acquired manuals that are available on a website and we have a special function mailbox where they can send in questions and/or problems that have arisen in remote interpreting. We have called around to interpreter users. At the beginning we sat, when we sat and rearranged all interpreting assignments, we sat and called a care provider, e.g., and explained what they needed and how it worked and also tested with them if they felt unsure. And the same thing with the interpreter users and explained how it would work and so on.\u003c/em\u003e (\u003cb\u003e#10\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eHowever, in cases where the technology was introduced, information on information on non-technical considerations was lacking:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eI don\u0026rsquo;t know if they have gone into the soft values ​​so much, like the order of the meeting, what to think about and so on, I don\u0026rsquo;t think so, although I don\u0026rsquo;t know, but I have mostly heard about the technology.\u003c/em\u003e (\u003cb\u003e#14\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section3\"\u003e \u003ch2\u003e3.3.2 RI is a work in progress, but is here to stay\u003c/h2\u003e \u003cp\u003eRI was kickstarted due to COVID-19. Some services included some kinds of remote assignments before, but the pandemic forced the evolution:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eWe were thrown into it all at once, it wasn\u0026rsquo;t a project that was one, two, three, four months in the future that lurched along at its leisurely pace, but in one week, all of a sudden, everyone started interpreting remotely.\u003c/em\u003e (\u003cb\u003e#13\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003e The remote assignments were thus a relatively new and unexplored way to interpret, but they were quickly set up. Improvements and changes were made as time went on, and the service got better and better:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e[W]e also created an evaluation document which we sent along, asked them to evaluate both technology [and] interpretation. Yes, there were a few different things where we asked how we could improve, and [that was] quite early in the pandemic.\u003c/em\u003e (\u003cb\u003e#23\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe transition to more RI opens for positive things as a possibility for different regions to cooperate. Interpreters that were not used to working together could help each other. This, together with less travel for interpreters, made it possible to carry out more assignments:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003e[Y]ou can help each other more between regions. That all of a sudden the Stockholm region can actually get in touch and say: Now we have a shortage of interpreters this Thursday, could you help us support and take these jobs?\u003c/em\u003e (\u003cb\u003e#15\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eFrom the beginning of the pandemic, it was not an option to carry out assignments face to face. However, as the pandemic eased, more assignments were done face to face. Yet those initial actions taken to address the novel situation caused by COVID-19 are now a regular part of the interpreting agencies. In one region, the amount of RI after the pandemic became regulated by the politicians:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e \u003cem\u003eThe decision is in the regional board, so it is the politicians who have made the decision about 20 percent, so it is in our operational goal. It is a goal that we as a business have no way of influencing.\u003c/em\u003e (\u003cb\u003e#12\u003c/b\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eThe coming evolution of RI is thus not only an issue for the interpreting agencies, nor does it involve only interpreters\u0026rsquo; or users\u0026rsquo; preferences; at some places it is it is an issue well beyond the control of interpreters and users.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe results of the current study about the organisation of RI in Sweden as it has evolved since the COVID-19 pandemic show processes that are unevenly regulated with significant variations across the country. The variation concerns regulations, how RI is offered, and working conditions for interpreters. The issue of offering SLI remotely is found in governmental documents from 2011 (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In the investigation there was a proposition for a single state agency for SLI service, although it was not realised. The analysis of the results in this study shows that this is very possible in terms of available technology and the fact that regional counties around Sweden can cooperate to provide RI. As the results of this study also stress that there is considerable variation across the country, one united agency could jointly review how to organise RI so that it becomes uniform. A uniform RI service would be necessary, which could provide the service in a way that is more legally certain and equitable across regional boundaries. There are Swedish examples such as the police force, that were organised locally and regionally but have since been transferred to state control. The transfer of organisation creates a more unified and centralised governance of important societal functions.\u003c/p\u003e \u003cp\u003eResults from the current study could be seen as revealing a lack of management (cf. 24). In the case of interpreting services, there was a single instance that took full responsibility for the regulation, modification, and evolution. Therefore, the interpreters themselves found solutions along the way.\u003c/p\u003e \u003cp\u003eA well-established RI service could strengthen the users\u0026rsquo; equal access and options. Services other than interpreter services could offer users an option to freely choose between meeting face to face or remotely. A possibility to choose can empower people, giving them greater control over their lives (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). The control and power could be transferred from the institution providing the service to the user of the service (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). For people who use an interpreter service, the option to choose between RI and face-to-face interpreting is limited. To achieve the same degree of access to the society as others enjoy, the possibility to choose between RI or face-to-face could be one way to go. In addition, making it possible to book directly with an interpreter and the party they want to talk to would empower the signing people even further. However, today there is no proper system for that kind of self-administration.\u003c/p\u003e \u003cp\u003eThe interpreting agency is designed to meet users\u0026rsquo; needs. Users of the services provided by regional counties are mainly \u0026ldquo;childhood deaf, deafblind, adult deaf and hard of hearing\u0026rdquo; (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In the results of this study, it appears that one agency has had a consulting workshop with the user council. However, consultation with user councils were not mentioned by any other informants in the study. This does not mean that there have not been discussions with the user council, but it implies that no such involvement has been noted by those informants. A drawback of the 2003 directive (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e) is it lacked users\u0026rsquo; perspectives and research on SLI. In addition, in the governmental document from 2011, it was stated that RI should take users\u0026rsquo; perspectives and needs into account (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, p. 23). The service users\u0026rsquo; involvement could be developed, and a framework could strengthen sustainability, which could be beneficial for the services (cf. 27). The question is, what are the preferences and thoughts of the users of RI, and how can we avoid the same backlash again?\u003c/p\u003e \u003cp\u003eIn addition, although the service is provided for its users (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e), RI needs to be doable and the working conditions for the interpreters have to be appropriate (cf. 6). Adjustments for interpreters who work remotely vary widely. A uniform service and equal conditions could have a sustainable impact on interpreters\u0026rsquo; everyday work as well as keeping them within the occupation.\u003c/p\u003e \u003cp\u003eDuring the transition to RI due to COVID-19 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e), one might ask how all the new experiences have been considered and have impacted the organisation \u0026ndash; what is left of the discussion of RI and what will happen next. It has been shown that training for RI is lacking. A persistent issue concerns how a formal education programme should be organised and what should be included. It is obvious that there is a need to make it easier to navigate the challenges that arise when working with RI. The issue also corresponds to efforts to achieve sustainability and excellence in RI. Thus, there is a need for comprehensive training programmes to address both the technical aspects of RI and the interpersonal skills. In addition, there are several stakeholders and interests involved in the issue of organisation of RI. Another question persists: How can (for example) politicians\u0026rsquo; decisions, interpreter agencies, users\u0026rsquo; needs, interpreters\u0026rsquo; needs, and equality be solved in a democratic and sustainable manner?\u003c/p\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Strengths and limitations\u003c/h2\u003e \u003cp\u003eThis study is based on interpreters\u0026rsquo; comments on the organisation or RI in their regional counties. This is both a strength and a limitation. A strength is that we received an unfiltered situational description of reality. From a management perspective, the informants\u0026rsquo; observations reflect what permeates the organisation as experienced by those who work in the service. On the other hand, the interpreters might be unaware of all the decisions and consultations that have taken place higher up in the organisation. What can be concluded, though, is that RI, in accordance with SLI from the 2022 investigation, is \u0026ldquo;still immature and in the early stages of its development\u0026rdquo; (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, p. 350).\u003c/p\u003e \u003cp\u003eAnother strength is that the authors approach the study from different angles. While the first author (CW) is a certified interpreter who has worked and done research on RI earlier, the second author (MM) is an associate professor in social work and has worked with council organisations before, although not with interpreting offices \u003cem\u003eper se\u003c/em\u003e. This gives an opportunity to generate analysis both from an insider perspective, with a deeper knowledge, and an outsider perspective. The interviews were subsequently conducted with a deep knowledge of the interpreters\u0026rsquo; everyday work. In a next step, the first analysis was done by the second author from the outsider perspective. Thus, the analysis has been validated by cooperation between the authors.\u003c/p\u003e \u003c/div\u003e"},{"header":"5. Conclusions","content":"\u003cp\u003eThis investigation of RI organisation in Sweden as it has evolved since the COVID-19 pandemic has shown that RI is still a work in progress. The regulation of RI varied greatly among regional counties in Sweden with respect to directives, decisions, and platforms used. A great variety of assignments were carried out remotely, and the restrictions varied as interpreter services adapted to the COVID-19 work environment. The risk of making a transition from on-site interpreting to RI was taken into consideration in some regional counties, whereas others did not do so in a formal way.\u003c/p\u003e \u003cp\u003eModifications of interaction were, to some extent, adjusted to user preferences and capabilities. According to interpreters, work environments and workplaces were adjusted, both by rebuilding studios and by adapting spaces to suit furniture and technically devices.\u003c/p\u003e \u003cp\u003eThe overall evolution followed the same patterns as the other aspects of organisation: support and training varied, with some having their own technical support and others required to solve their own problems. Common problems were often overcome by cooperating and exchanging helpful tips within the interpreting group.\u003c/p\u003e \u003cp\u003eWith unclear regulations, the interpreters themselves seemed to be dealing with the rather new situation as well as they could. It is not clear how RI will evolve over time. In some places the issue is outside of the control of interpreters and users, and even of the regional counties. But it is certain that RI in some form is here to stay, at least as one way to receive SLI.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eRI Remote Interpreting\u003c/p\u003e\n\u003cp\u003eSLI Sign Language Interpreting\u003c/p\u003e\n\u003cp\u003eSTS Swedish Sign Language\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch3\u003eEthics approval and consent to participate\u003c/h3\u003e\n\u003cp\u003eThe Swedish Ethical Review Authority approved this study (Dnr. 2021-02182).\u003c/p\u003e\n\u003ch3\u003eConsent for publication\u003c/h3\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch3\u003eAvailability of data and materials\u003c/h3\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003ch3\u003eCompeting interests\u003c/h3\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003ch3\u003eFunding\u003c/h3\u003e\n\u003cp\u003eThe study was funded by Region \u0026Ouml;rebro County, Sweden.\u0026nbsp;\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026rsquo; contributions\u003c/h3\u003e\n\u003cp\u003eCW initiated the study and both authors designed it. CW conducted the interviews with the interpreters. MM took the initial steps in the analysis, which then continued in collaboration between both authors. Quotes were extracted by MM for the results section. CW prepared a draft of the introduction, results, discussion, and conclusion, and MM wrote the draft of the method section. Both authors then revised and approved the final manuscript.\u003c/p\u003e\n\u003ch3\u003eAcknowledgements\u003c/h3\u003e\n\u003cp\u003eThe authors would like to thank all the interpreters that were interviewed for this study. Without your experiences and knowledge it would not have been possible to gain insight on remote assignments in Sweden.\u003c/p\u003e\n\u003ch3\u003eAuthors\u0026rsquo; information\u0026nbsp;\u003c/h3\u003e\n\u003cp\u003eAssociate professor Camilla Warnicke is a certified interpreter of Swedish and Swedish Sign Language and a deafblind interpreter. She is employed by the Sign Language and Deafblind Interpreter Programme in \u0026Ouml;rebro and is currently a guest researcher at the BA programme at Stockholm University. She is affiliated with the School of Behavioural, Social and Legal Sciences, \u0026Ouml;rebro University.\u003c/p\u003e\n\u003cp\u003eAssociate professor Marie Mat\u0026eacute;rne is a senior lecturer in social work at \u0026Ouml;rebro University and a registered health care counsellor. Her main research interest focuses on participation, quality of life, and quality of care within disability research. She has also performed research on management within healthcare during COVID-19.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eSOU 2022:11: Action plan for a long-term development of the interpreting service for the deaf, hearing impaired and persons with deafblindness. https://data.riksdagen.se/fil/93C8E059-E8E2-49A4-855E-085662D57F4D (2022). 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Accessed 8 Aug. 2024. \u003c/li\u003e\n\u003cli\u003eNational Board of Health and Welfare 2008: The concept of everyday interpretation about the regional counties\u0026rsquo; responsibility for interpreters for the deaf, deafblind and hard of hearing.https://www.socialstyrelsen.se/globalassets/sharepoint-dokument/artikelkatalog/ovrigt/2008-126-116_rev.pdf(2008). Accessed 8 Aug. 2024. \u003c/li\u003e\n\u003cli\u003eSOU 2011:83: A unified interpreting service.https://www.regeringen.se/contentassets/8c5b259fe9aa46668d881d89d3a19631/en-samlad-tolktjanst-sou-201183/ (2011). Accessed 8 Aug. 2024. \u003c/li\u003e\n\u003cli\u003eDs. 2016:7: Interpreting service for everyday interpretation. https://www.regeringen.se/rattsliga-dokument/departementsserien-och-promemorior/2016/04/ds-20167/(2016). Accessed 8 Aug 2024. \u003c/li\u003e\n\u003cli\u003eGraneheim UH, Lundman B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. 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Nordisk V\u0026auml;lf\u0026auml;rdsforskning| Nordic Welfare Research. 2018; 19;3(1):58\u0026ndash;69. \u003c/li\u003e\n\u003cli\u003eRoman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. The occupational health and safety of sign language interpreters working remotely during the COVID-19 pandemic. Preventing Chronic Disease. 2022;19, Article E30. \u003c/li\u003e\n\u003cli\u003eRoman G, Samar V, Ossip D, McKee M, Barnett S, Yousefi-Nooraie R. Experiences of sign language interpreters and perspectives of interpreting administrators during the COVID-19 pandemic: A qualitative description. Public Health Reports. 2023;138(4),691\u0026ndash;704. \u003c/li\u003e\n\u003cli\u003eSheridan S, O\u0026rsquo;Donnell J. Irish sign language interpreter workplace wellness during COVID-19: Looking back and moving forward. Journal of Interpretation. 2023;31(1), 1\u0026ndash;25. \u003c/li\u003e\n\u003cli\u003eTrumm A, Lau EJS, Farthing S, Breen K. The use of video remote interpreting (VRI) in a medium secure psychiatric setting during the COVID-19 lockdown. The Journal of Forensic Practice. 2023;25(3), 263\u0026ndash;275. \u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"COVID-19, Interaction, Interpreting, Interpreting Agency, Interview, Organisation, Qualitative Content Analysis, Remote Interpreting, Sign Language","lastPublishedDoi":"10.21203/rs.3.rs-4932705/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4932705/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe sign language interpreting service has undergone a tremendous change due to COVID-19 as remote interpreting has become a more frequent alternative to the on-site face-to-face format. The aim of the study is to investigate the interpreters\u0026rsquo; experience of the remote interpreting organisation in Sweden and how it evolved since the COVID-19 pandemic.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e \u003cp\u003eInterviews with 26 experienced remote interpreters, representing 19 of Sweden\u0026rsquo;s 21 counties, were analysed with qualitative content analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThree themes were revealed in the analysis. The first theme was regulation. It was stated that directives and regulatory decisions concerning provision of remote interpreting services were varied and unclear. Several different platforms were used when interpreting remotely. Some of the services had conducted risk analyses, whereas others had not. The second theme was modification, including adjusting interactions to suit users\u0026rsquo; preferences and capabilities, as well as adjustments to work environments and workplaces. The third theme, evolution of remote interpreting, showed that support and training were rare and varied. The organisation of remote interpreting appears to be a work in progress across Sweden, but it is a way of interpreting that is here to stay.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eIn Sweden, remote interpreting is a service that varies according to regulations and organisation of the assignments. The service seems to benefit from being more uniform and streamlined across Sweden, although consideration must be given to those involved with the service.\u003c/p\u003e","manuscriptTitle":"BMC Health Services Research Regulation, modification, and evolution of remote sign language interpreting in Sweden – a work in progress","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-09-16 11:20:25","doi":"10.21203/rs.3.rs-4932705/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-08-20T11:06:55+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-08-20T09:50:27+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-08-19T06:46:56+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2024-08-18T09:20:08+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c69b5820-a56f-4e90-a6e8-f8e2d3da56c4","owner":[],"postedDate":"September 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-11-25T16:04:20+00:00","versionOfRecord":{"articleIdentity":"rs-4932705","link":"https://doi.org/10.1186/s12913-024-11907-y","journal":{"identity":"bmc-health-services-research","isVorOnly":false,"title":"BMC Health Services Research"},"publishedOn":"2024-11-19 15:58:03","publishedOnDateReadable":"November 19th, 2024"},"versionCreatedAt":"2024-09-16 11:20:25","video":"","vorDoi":"10.1186/s12913-024-11907-y","vorDoiUrl":"https://doi.org/10.1186/s12913-024-11907-y","workflowStages":[]},"version":"v1","identity":"rs-4932705","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4932705","identity":"rs-4932705","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}