Below are a few steps we recommend to get the most out of your time, money and translation projects:

• Use Translation Memory. Translation memory software is a databank that captures previously translated text so you will be able to recycle translation from one document to the next.
• Use a Glossary, Term List and Style Guide. Language is subjective and there are many ways to translate the same sentence. Many translation dollars can be saved by defining style and dialect preferences upfront.
• Centralize Translation Ordering. By building and maintaining a centralized repository of health education content, you can streamline the translation process and establish consistent terminology use and corporate style across all geographies.

Want to know more? Sign up for a free virtual workshop  and we will give you the latest tips, tools and tried and true best practices to help you reap the maximum benefits from your healthcare translations.

Environmental Services employs several hundred people and is one of the departments that have multiple patient interactions each day. This department is one of the most diverse at OHSU, with over 65% of employees identifying their first language to be something other than English. After observing the various native and non-native housekeepers to evaluate their language skills, OHSU found that many were struggling to follow the AIDET (Acknowledge, Introduce, Duration, Explain, Thank) protocol.  As a result, they developed a training initiative in partnership with the Department of Applied Linguistics of Portland State University then worked with VIA to translate the documents at the appropriate literacy level into the top nine language groups spoken by the staff.

The translated handouts were used in conjunction with the English versions during 23 training sessions and they helped the non-native English speakers to fully comprehend the materials. Following the training, these handouts were laminated and distributed to each housekeeper in English and the language of their choice.

Participants provided feedback that the initiative increased their confidence and competency with the tasks they are asked to perform. In particular, they said that practicing the AIDET script in their own language along with English would make it easier for them to do their job well. As a result, they were able to provide better service and help OHSU to deliver health equity to its all patients regardless of their cultural or linguistic background. This was reflected one month after the training initiative when the November 2012 HCAHPS overall raw scores improved.  Read the full case study to learn more.

Karen

The key to avoiding these issues is establishing a centralized translation process. While this may not be the solution for every organization, it may be the right step for larger organizations that are challenged with some of the following:

• Supporting large volumes in one or more languages
• Various types of healthcare content
• Standardized healthcare preferences and terms
• Private health information content
• Meeting compliance regulations
• Desire to improve quality management, reduce costs and minimize mistakes

If any of the above applies to your organization, it may be time to consider the idea of centralization. Centralizing enables fast, predictable turnaround of multilingual projects and delivers cost savings through the use of linguistic assets such as translation memories and technology tools. Centralization also saves time by allowing for a single record of all active and live documents that have been translated. It takes a bit of effort to get there, but it’s definitely worth your while. To read more about centralizing, and how it worked for a large California health System, click here.

Leslie

According to the www.ThinkCulturalHealth.hhs.gov website:

Health inequities in our nation are well documented, and the provision of culturally and linguistically appropriate services (CLAS) is one strategy to help eliminate health inequities. By tailoring services to an individual’s culture and language preference, health professionals can help bring about positive health outcomes for diverse populations.

We couldn’t agree more. At VIA we believe that bridging the language gap is key to ensuring culturally diverse communities enjoy equal access to healthcare. That said, we realize that reaching out to an ever-expanding range of cultures in your community and finding solutions to best meet the growing needs for your limited English proficiency (LEP) populations is challenging and complex. But, we’re here to help. From websites to patient education, VIA tailors each communication to the targeted culture.

As dedicated healthcare specialists, we serve over 400 healthcare clients globally. We’ve built translation capabilities in over 125 languages and a hand-selected network of over 1,000 professional healthcare-specific linguists.

In addition, to help you with this particular aspect of health equity, we have also created a guide with tips about how to keep current with language access mandates while still providing culturally and linguistically meaningful healthcare communications to your members and community.

Cultural competency, along with providing patient materials which can be fully understood in their native language at the appropriate literacy level, can greatly improve not only health literacy and patient engagement, but overall cost to individuals and our healthcare system at large. In “The HealthCare Blog” Judith Hibbard and Jessica Green share ample evidence that the behaviors people engage in and the health care choices they make have a very clear effect on both health and costs, both positively and negatively. Their study reported in the February issue of Health Affairs, highlights this role that patients play in determining health-related outcomes:

We found that patients who were more knowledgeable, skilled and confident about managing their day-to-day health and health care (also known as ‘patient activation,’ measured by the Patient Activation Measure) had health care costs that were 8 percent lower in the base year and 21 percent lower in the next year compared to patients who lacked this type of confidence and skill. These savings held true even after adjusting for patient differences, such as demographic factors and the severity of illnesses.

For more information check out our webinar: Culturally Competent Healthcare: Strategies and Tools for Making a Difference.

Karen

Writing the Content – Goal: Make it easy to understand

• Use familiar and simple vocabulary.
• If you must use a difficult word, explain it to readers immediately after using it or provide a simpler alternative in parentheses.
• Avoid acronyms, abbreviations and jargon.
• Avoid bureaucratic language and legalese which is generally written at a high reading level and in an authoritarian tone.
• Write clearly in an active voice.
• Write one-topic paragraphs.
• Write in short sentences and use bullet points and numbers when possible.
• Test content for literacy/readability level with “Flesch-Kincaid Reading Level” aiming for 8^th grade literacy level or lower.

Formatting the Content – Goal: Make it easy to read

• Use clear headings.
• Q&A formats work well.
• Use simple or familiar fonts and keep the number of different fonts down. (I recommend no more than two different fonts in same document.)
• Keep font size at 11 points or higher.
• A generous amount of “white space” offers the reader visual relief and improves the readability of a document.
• Take advantage of the power of pictures and graphics.

Want to know more? Check out our webinar titled “The Benefits of Health Literacy: Supporting Limited English Proficient Communities.”

The need for awareness and adherence to health literacy principles has become a public health concern estimated to cost the U.S. economy between $100 and $238 billion annually. Health literacy is a broad issue for 90 million people in the US that affects their ability to stay healthy. Only 12 percent of adults in the US today have proficient health literacy skills according to the National Assessments of Adult Literacy (NAAL). This means that nine out of 10 adults may lack the skills they need to manage their care and improve their health. Furthermore, 14 percent of adults have below basic health literacy and are more likely to report their health as poor, as well as lack health insurance.

Education, language, culture, access to resources, and age are all factors that impact a person’s health literacy. Ensuring that health education messages are understood, comprehended and adhered to starts with creating content at an eighth grade or lower literacy level, speaking in first person and using short sentences. It’s also important to incorporate pictures, bullet points and simple easy to understand graphics. Lastly, incorporating cultural nuances for LEP populations will increase readers’ understanding of the material.

Find out more about how you can ensure literacy with your healthcare communications in our brief titled “Growing Challenges of Health Literacy.”

Image courtesy of Pew Research Center

Not a month goes by without one of my new customers asking me to prepare an estimate for them in Chinese. Which always leads to my question, “Do you want Simplified or Traditional Chinese?” and instantaneously my question begs another question from the requester, “What’s the difference?”

Well there is a difference and it took me a couple of years and a little cheat sheet next to my phone to eventually save it to memory. Simplified Chinese, simply put and no pun intended, is the written language of Mainland China.  Traditional Chinese is the written language of Hong Kong and Taiwan.

You see that was easy! Well not really because in healthcare how do you know what your audience wants? The hospitals and health plans I work with predominantly request Traditional but I’m beginning to see more Simplified with certain systems and geographies in the West and the Hawaiian Islands.  So why do both? What’s the difference?

When it comes to Chinese it is important to understand that there is a distinction between the spoken and written forms of the language. There are dozens of dialects in China but the most widely spoken ones are Mandarin and Cantonese. We’ve discussed the two Chinese writing systems, Traditional and Simplified. Neither script is directly linked to a particular dialect. A Mandarin speaker for example may write in the Traditional or Simplified script.  Interestingly enough, it is not uncommon for people who cannot communicate verbally in Chinese to be able to understand each other through writing.

Chinese is one of the oldest written languages, dating back thousands of years. A number of reforms have been implemented to standardize it. The most important one took place in 1956 when the government introduced the Simplified Chinese script in an effort to promote literacy throughout the country. As its name implies in this new script the characters were simplified by reducing the number of strokes. Generally speaking it is much easier for someone who reads Traditional Chinese to read Simplified Chinese than other way around.

So now we know the history but what is best for your audience?  The easiest decision is selecting both but that can be costly, especially if you have a tight budget and numerous materials to translate. If in doubt, select Traditional.  If you know that your audience may be less educated, select Simplified.

Bill Kennedy

Healthcare Account Executive-West

While the official name of the national language is now called Filipino, many people still refer to it as Tagalog. Originally a regional language, Tagalog became the basis of the Philippine national language and is now spoken widely in the entire Philippines by the Ilocanos, Cebuanos, Ilongos, Cordillerans and other indigenous tribes who each have their own native language.

Tagalog/Filipino is formally taught in schools and serves as a medium of instruction alongside English. It is also used in national print and broadcast media, so children learn it both inside and outside the classroom setting. However, Tagalog/Filipino is seldom used in written communications and official documents. English is used extensively in the fields of medicine (doctors write prescriptions, medical reports and diagnosis in English), engineering, law (legal documents and courts proceedings are in English and courts use translators to Tagalog or Ilocano when necessary), banking and finance, and most other professions.

Ilocano is a regional “Austronesian” language spoken in the northern part of Luzon and is sometimes referred to as Ilokano, Iloco or Iluko. Some people refer to Ilocano as a dialect. Carl Rubino explains the difference:

You will undoubtedly run into many Filipinos in your travels who will insist that Ilocano is not a language, but a dialect. This is because Filipinos, like the Chinese, use the terms language and dialect politically rather than linguistically. In the Philippines, the word language is usually reserved for tongues that are given a certain political and legal status. Tagalog, the native language of the people around the Manila area of southern Luzon Island, was declared the basis for the national Language (wikang pambansa) in 1937. All other languages of the archipelago were therefore never duly recognized officially and have been called dialects ever since.

Ilocano is not as adaptive to linguistic evolution as Filipino/Tagalog and is not formally taught in schools, but is still used by millions of people in the Philippines and abroad. It is perpetuated by its oral use in mass media, political campaigns and church services in the Ilocandia region. Ilocano writers of prose and poetry also help preserve grammar rules.

In many cases, because of the wide use of English, terms with no local equivalents in Tagalog or Ilocano are sometimes better left in English since these are understood by the majority of Filipinos and to try to translate them for translation’s sake would render the terms ambiguous, such as credit card, debit or bank account. Thus, it is very common to hear English terms interspersed in conversations in Ilocano and Tagalog.

This year’s theme “Quality Health Care for Culturally Diverse Populations: Achieving Equity in an Era of Innovation and Health System Transformation” was explored in depth. Workshops focused on patient engagement, training and staff development, utilization of quality improvement tools, qualitative data analysis, improving access and care though collaboration and partnerships, the role of eHealth and technology, religious diversity, and recognizing our biases – conscious and unconscious. All topics had the over-arching goal of improving health literacy, access, satisfaction and outcomes for our culturally diverse communities.

The conference was rounded out with sessions addressing our dynamic era of  transformation: advocacy, policy; initiatives from the HHS Office for Civil Rights, and opportunities for advancing equity afforded by the Affordable Care Act. There are too many topics to highlight here – I suggest you check out the DiversityRx web site for more information and to join the conversation.

Karen