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1.5 Written Materials in Other Languages
Health care providers use a great deal of written information to
communicate with patients. This material includes prescription and pre-op
instructions, health education brochures, and managed care enrollment
forms, member services materials and health plan cards. Providers generally
understand the futility of giving English language material to LEP patients,
but do so anyway assuming that the patients will find someone else to
translate for them.
Increasingly, health care organizations are attempting to translate
their commonly used written materials into several different languages,
and how that process takes place can have implications for true patient
comprehension.
Translation of written materials is mostly done on an ad hoc basis.
Organizations needing materials translated often use: in-house bilingual
individuals who may have no background in translation; community based
ethnic organizations who do some translation but may similarly lack training
or sufficient command of both languages; commercial translation services;
and translated materials produced by other organizations. The process
of translating material from English to the target language can be excessively
mechanical--more like text re-processing--especially if organizations
simply ship a collection of documents that may be unintelligible in English
to be faithfully translated into another language without adaptation.
The temptation to default to this approach may become greater with the
availability of internet-based translation software. One California hospital
several years ago purchased, as a time-saving measure, a very expensive
computer-based translation "machine" that would theoretically manufacture
standard discharge instructions in Spanish for an emergency room. Staff
could input certain variables into the program to customize it for each
patient. After a time, someone discovered it made so many mistakes that
a bilingual staff person needed to review and correct each document before
it could be released to a patient.
Ideally, written materials in other languages should reflect the
dialectic and cultural nuances of the local target population. Documents
that reflect an awareness of these details and the educational and literacy
level of the target audience demand a more sensitive approach than mere
text translation. There is no point in debating the best possible direct
translation of "patient responsibility in a managed care environment"
for Somali refugees who may only have been to a three-room clinic a few
times in their life. In the best approach, materials should be developed
from scratch in the target language based on discussions with focus
groups, and should incorporate an appreciation of the cultural norms of
the community. This process is especially important when the materials
are to be used to motivate behavior change, as in health education and
disease prevention. They can then be translated into English for review
and reference purposes by the health care provider.
Given the difficulties of customized material development for most
organizations, more could certainly be done to improve the availability
and quality of traditional translations. One is the adoption of standards
for translation. Some agencies and organizations have developed protocols
for how written materials should be translated. The translation task
force committee, for the California MediCal managed care linguistic
and cultural competence standards has developed such protocols for managed
care organizations participating in the program. The University of
Minnesota Translation Laboratory is finalizing extensive translation
protocols for the Minnesota Department of Health, with which they have
a translation contract. A prototype version of these protocols is included
in Appendix 6.
Also needed is the development, adoption, and dissemination of glossaries
and dictionaries in a wide variety of languages. This would facilitate
the work of both translators and interpreters, and standardize vocabulary
used for medical terms, especially in the languages of more recent immigrant
populations that may not have those concepts in their mother tongue. California
State University-Sacramento is just starting up a translation and
interpretation service for public agencies and others, and one of their
goals is the development of such reference materials and making them available
online.
The other task is to facilitate the more efficient sharing of already
translated, commonly used written materials (such as basic disease prevention
and health promotion brochures or pamphlets). Many organizations have
tried or continue to collect and distribute a variety of these materials,
and the Center for Applied Linguistics in Washington, DC sponsored
two published collections of such information. The difficulty with currently
available resources like these is that each effort is typically limited
in focus or scope (ie., just Spanish-language materials, or just materials
on immunization); they are scattered around the country and difficult
to track down; and the process of collecting, storing, copying, and disseminating
written documents is time-consuming and expensive for the sponsoring organization.
In addition, documents that rely on non-Roman script, adaptation and customization
of printed materials can be difficult for the client.
The internet offers an attractive medium for a centralized database/repository
of commonly used documents and glossaries. The costs of developing and
enlarging the collection would not be dependent on storing and reproducing
written documents, and the collection would be readily available for download
and customization by anyone with a computer and appropriate software.
It would also make ongoing review and updating easier--a necessary process
to ensure that materials remain current with scientific and methodological
advances. One such source has been developed by the NSW Department
of Health in Australia, and the site receives heavy traffic from American
users.
Summary Recommendations for 1.5
- Promote original language development of health materials that incorporate
community input and appropriate levels of medical and health care system
terminology.
- Promote adoption of translation protocols (such as those developed
by California and Minnesota state agencies) by community based organizations,
providers, provider organizations, and other agencies that produce or
use translated materials.
- Support participation in translation certificate training programs
for community based interpreters/translators, especially from small
language groups.
- Support consensus development, adoption, and dissemination of glossaries
and dictionaries that attempt to standardize medical terminology, especially
for small language groups.
- Support development of a centralized database of translated materials
that include regular review and updating, ideally on the world wide
web.
Contacts, Resources, References
1.5
Bruce T. Downing, PhD
University of Minnesota, Ling/ILASLL
190 Klaeber Ct., 320 16th Ave. SE
Minneapolis, MN 55455
612-624-6552
bdowning@maroon.tc.umn.ed
Melba Rosa Hinojosa, RN, MA,
Health Plan Adviser
CA Dept of Health Services
Health Coord. Unit
714 P Street, Room 650
Sacramento, CA 95814
916-654-0748
Andy Molina
CSUS Business Services Bureau
7750 College Town Drive, Suite 102
Sacremento, CA 95826-2344
916-278-6633
gonzalezs@csus.edu
Jean Gilbert, PhD, Director
Cultural Competence
Kaiser Permanente
393 E. Walnut, LR-6
Pasadena, CA 91208
626-564-3743
NSW Multicultural Health Communication Service
http://mhcs.health.nsw.gov.au
Ilona Lee, Manager
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