Patient Safety / Quality

It’s all in the translation

Last month, you had a patient with heart failure who spoke Russian. Today, you’re caring for a diabetes patient who speaks Japanese. Although you could use an interpreter for patient teaching, you know it’s preferable to give the patient translated written information to take home. But the patient-education resources available to you are in English only, except for selected topics in Spanish. What should you do?

National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health Care from the U.S. Department of Health and Human Services state that “health care organizations must make available easily understood patient-related materials…in the languages of commonly encountered groups.” What’s more, starting July 2012, a new requirement from the Joint Commission will be scored that requires hospitals to communicate with patients during care and services to meet oral and written communication needs. Examples of evidence that meets patient’s communication needs include translated and plain-language patient-education materials.

Addressing the need

The Columbus, Ohio region recently has grown more ethnically and culturally diverse. As patient-education specialists in this area, we’ve received frequent requests from clinicians seeking translated patient-education handouts. So we decided to work together to address these needs, knowing the cost of translation is too high and budgets too limited for one organization to handle alone. The result was the website www.HealthInfoTranslations.org, which offers free, easy-to-read, copyrighted patient-education materials in many languages.

Competitors working together

Although our respective health systems have been competitors, administrators supported our initiative because they knew it was the right thing to do. We wanted to give the website a unique look, distinctive from our health systems’ websites. So it was decided that the logos of the three health systems would appear only on the website’s home page, and a statement listing these organizations would appear at the end of each patient-education document to show they were developed by credible sources.

We surveyed clinicians to determine which healthcare topics and languages were needed most, and sought input from community immigrant groups to identify their health-education needs and common health practices and beliefs. We also worked with an advisory group of clinicians and community advocates to set priorities, and received grant funding to start the project. We searched, both online and through catalog reviews of vendor materials, for translated health-education materials that addressed topics on the project needs list. Except for some Spanish items, we found few translated patient-education materials.
We decided our first handouts would be on tests and procedures, particularly those that required special preparation. We compared resources from our respective health-system inventories and found they were similar in many cases. To keep the documents concise and easy to understand, we focused on need-to-know information. Clinicians reviewed the documents to confirm the content was accurate and covered all key information.

Then we identified the top 10 languages in our community, and chose a high-quality translation service with translators experienced in medical translation. We wanted our translations to be accurate and completed in a timely fashion. For quality control, we decided the documents should be back-translated, proofread, and edited by separate individuals before the document was finalized.


Unanticipated challenges

As the project moved along, we faced unanticipated challenges. Translation costs varied with availability of skilled translators and complexity of the healthcare topic. Translators tend to use more formal language, but we requested conversational language to keep the translations easy to understand. Certain languages required language fonts and software upgrades. Also, word meanings varied, and some English terms aren’t common or appropriate in other languages. In addition, integrating culturally appropriate illustrations raised concerns about cost and the number of variations needed.

After addressing these issues, we loaded the first titles onto the website in May 2005. Although website use climbed steadily over the first 18 months, we found it challenging to spread the word through our organizations to community groups and through listservs with patient educators, librarians, and others. We also presented at national and regional conferences to share our resources. In May 2007, a local pediatric hospital joined the project to add topics more specific to pediatric care.

More than 300 titles

Our website now offers more than 300 titles in multiple languages. (See Translations available on the website.) Users can search either by language or topic. Documents have matching page breaks; the English page prints first, followed by the translated page. The clinician and patient see the same information, each in their own language. Audiovisual resources in selected topics and languages are available to view or download.

Where do we go from here?

We’ve started a 4-year review cycle to keep our documents up-to-date. Even in this short time, our community’s language needs have shifted. Although we’ve developed additional patient-education topics, we continue to struggle to secure funding for translations. Doing revisions, new titles, and new languages requires money. To generate income to sustain our inventory, we may need to create a subscription service for accessing website materials.

In May 2008, The National Library of Medicine Medline Plus® launched its “Health Information in Multiple Languages” resource and linked many documents from our site. It even used our translation process as its gold standard in reviewing other resources. The Joint Commission has linked to HealthInfoTranslations.org as a best practice resource, and the Institute for Safe Medication Practices chose our website for its Cheers Award in 2008.

With travel and immigration, the movement of people into health systems across this country will continue to challenge our language resources. But we can make a difference. Clinicians report patients in the Columbus community are pleased to get materials in their own language. Our community partners tell us fewer tests need to be rescheduled because patients better understand how to prepare. No better measures of success exist.

To find out if your organization supports use of the materials on our website, check with your
patient-education specialist. If it does, you can create a link to www.HealthInfoTranslations.org to access all topics and languages available. Finally, encourage your health system to share translated patient-education resources.

Diane C. Moyer is associate director of health system patient education at The Ohio State University Wex­-ner Medical Center in Columbus. Karen Guthrie is manager of community and patient education at Mount Carmel Health in Columbus, Ohio. Barbara J. Wingert, formerly a patient education specialist at OhioHealth in Columbus, Ohio, is an oncology nurse at Sarasota Memorial Hospital in Sarasota, Florida.

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