All-domain complexity of video remote interpreting in maternity care

Abstract Inadequate interpreting services contribute to maternal health disparities among women who require support. Video remote interpreting (VRI) has been promoted as a solution, yet its implementation and sustained uptake remain uneven and poorly understood. This study draws on the non-adoption, abandonment, scale-up, spread and sustainability (NASSS) framework to examine the challenges shaping VRI use in the UK National Health Service’s (NHS) maternity care. It analyses a dataset involving women requiring interpreting support and their families, support workers, maternity care professionals, interpreters, bilingual health advocates, language service providers, trainers and a commissioner. The data sources included interviews, surveys, ethnographic observations, a focus group and documentary materials. The qualitative data were analysed using reflexive thematic analysis and were integrated with descriptive statistics across NASSS domains. The analysis shows that the adoption of VRI is shaped by interrelated challenges spanning the NASSS domains, including unpredictable demand, technological constraints, contested value propositions, adopter training challenges and organisational, regulatory and workforce factors. The findings suggest that linguistic diversity functions as a complexity multiplier which amplifies and interconnects implementation challenges across domains, while the effectiveness of VRI depends on the sustainability and governance of the interpreter workforce. These findings highlight the need for ecosystem-level coordination that includes the linguistic, organisational, workforce and technological dimensions of interpreting-assisted maternity care.