Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and your host of Health Literacy Out Loud. In these podcasts, you get to listen in on my conversations with some really remarkable people­–hearing what health literacy is, why it matters and ways every one of us can help improve health understanding.

Today, I’m talking with Lise Anne Boissonneault, who is a translator and language instructor and has worked in healthcare for over 25 years in Northern Ontario, Canada.

She has translated countless health-related documents from English to French for the general public and managed a busy translation service. Lise Anne has also taught French to healthcare professionals and undergraduates.

We met when I was leading health literacy workshops in a part of Canada that is French-English bilingual. I learned so much about translations from Lise Anne that I invited her to be a guest on Health Literacy Out Loud.

Welcome and bonjour.

Lise Anne Boissonneault: Bonjour, Helen.

Helen Osborne: Thank you so much for joining us on Health Literacy Out Loud. I get a lot of questions and want to know more about the role of translations in health information. I hear that term “translations” and sometimes I mix it up with “interpretation.” What’s the difference?

Lise Anne Boissonneault: The difference is that translation is really the process of translating words or text from one language into another, so it’s the written process, whereas interpretation is really focused on the oral process similar to court interpreters or interpreting at the patient’s bedside. It’s really the oral communication.

Helen Osborne: Thanks. I’m clear on that part.

A lot of people ask questions like “Do you have to do this word by word? How can you get it right? How can you put it in context of someone’s life?” Can you just tell us what happens in that translation process? When you look at a health document, where would you start?

Lise Anne Boissonneault: There are different ways of translating. There is certainly the word-for-word process that is appropriate in some circumstances. It really depends on what you’re trying to translate. Some messages render themselves well to that process.

Helen Osborne: Is that word-for-word what is called a literal translation?

Lise Anne Boissonneault: It is. Thank you for that. An example of where that would work is “What time is it?” That exact sentence or question can be literally translated into French.

There is no context really, or context issues. It’s just moving the words around and it’s actually the same grammar structure so that kind of translation works, but a literal translation doesn’t always work.

Helen Osborne: Tell us about that other kind of translation because that’s the one I’m really curious about. Some people say that it’s not always word for word.

Lise Anne Boissonneault: That would be a cultural reference, for example. The expression “birds of a feather flock together” does not translate well into French. You cannot literally translate word for word, so it would be something totally different.

It’s really about adapting to the culture and adapting to the context. Even within a culture, there are many different cultures within a given language.

Culture is really dependent on the environment, locality and geography. Some expressions that might translate well in France, for example, don’t translate well in Canada.

Helen Osborne: That’s interesting. I know in the U.S. that a lot of people speak Spanish. You have people from Mexico, Spain and South America. People come from all over the world.

I, as a non-Spanish speaker, think Spanish is Spanish, but I’ve been hearing that it’s not. Is it the same thing with French?

Lise Anne Boissonneault: It’s the same thing with French. It’s interesting because Canadian French can differ from region to region.

With the French that’s spoken and not necessarily written, although there can be nuances in the written too, it’s important to understand what the local dialect is. That has to be reflected in the translation, so that’s probably one of the biggest challenges with having something translated.

Helen Osborne: You’ve raised so many points. I just want to hear a bit more about them..

You said that you have to consider culture, context, environment and geography, and then you have to decide, I guess, if it’s going to be literal or more contextual information.

When you are given a project to translate, where do you start? That sounds like a lot of variables.

Lise Anne Boissonneault: I start by getting to know the community. If it’s my own community, it’s not a problem. I’m familiar with the dialect in the target audience, so that comes easy for me.

If it’s another community, such as translating for a healthcare organization halfway across the country, then I really need to ask some questions of my clients and really get to know their community.

If there is some vernacular that they think I should be using, I’d like them to send me a list of those terms.

I’d like them also to inform me of what the literacy levels are in their parts of the country. It’s probably like this elsewhere also, but in Canada, we don’t always have access to education in our first language.

We may speak French or Spanish at home, or whatever our first language is, but it doesn’t necessarily mean that we can study at all levels in that language.

Helen Osborne: I know that you’ve shared that French is your first language, so even though you are bilingual, it doesn’t mean that you’re equally strong or someone may not be as equally strong in both French and English. Is that right?

Lise Anne Boissonneault: In the grammar aspect. For example, you did mention that in Canada we are a bilingual country, and now fortunately we have education in both languages. It’s readily available to people whose mother tongue is French and also to people who want to learn French as a second language.

For our grandparents, for example, depending on where they lived, they did not always have access to education in their first language.

For them to have come to a hospital and be given a translated text in their mother tongue, they might not necessarily understand the written translation because it may not be at a level that is appropriate to their education level. It might be at a higher level.

A translator, in my opinion, has to be aware of what the literacy levels are of their target audience because we may have to adapt.

Helen Osborne: It sounds like you have to gather a lot of information about your audience.

You’re not a clinical person. What do you need to know about the health part of what you’re translating?

Let’s say you’re working on discharge instructions for someone who just had hip replacement surgery or something like that. You need to know about who this is going to go to. I guess, if it’s a hip replacement, you might be able to reasonably tell that maybe it is older folks or you know what region you’re going to.

You need to know that about your audience and their literacy in their mother tongue that you’re translating into or in English, whichever language you’re going into.

What do you need to know about the content of that document?

Lise Anne Boissonneault: That’s a good question. Like any field, a medical translator needs to know elements of medical terminology. They need to have a basic understanding of medical terms to be able to adequately translate the document.

To be able to put it into plain language using universal precautions that will reach the largest audience possible is equally as difficult.

For example, having worked as a translator in the health sector for 25 years, I acquired some basic knowledge about medical terminology, which was really useful in understanding the documents that I was translating.

Also, I took some medical terminology courses. I think it’s interesting because medical terminology courses really focus on the roots of the word and the Latin aspect of it.

What I found was lacking in that kind of training is really that I was not introduced to the vernacular.

Helen Osborne: Can you explain what vernacular is?

Lise Anne Boissonneault: For example, high blood pressure would be the vernacular. Hypertension would be the medical term.

I think that’s what’s lacking in the training. I think we really have to gain a greater understanding of what people will actually understand so that they can really make informed decisions with that information.

Helen Osborne: It sounds like you almost have to learn three languages. You need French, English and Medical Speak.

Lise Anne Boissonneault: Exactly.

Helen Osborne: I know that you go to school for this. You know a lot. There’s a whole body of information you have about the medical terminology and putting into context that process, but we’re all a team, so when somebody gives you a document and says, “Lise Anne, please translate this,” what would you like to know from the person who’s giving you that information?

Do you want that person to say, “I want this word for word,” or, “I want you to use the everyday terms”? How much guidance do you want before you go about translating that document?

Lise Anne Boissonneault: That’s a great question. It’s really important to have a dialogue with your client starting with a great understanding of the information.

If it’s general, such as a brochure, a questionnaire, a consent form or something like that, those are basically easier to translate, but you still want a good idea of what the context is and who the audience is.

If it’s something more technical, you really have to have a great grasp of that information to be able to translate it correctly.

Again, it’s going back to not only translating it as it should be translated so that you make sure you give the patient or the client the right information, but it’s also tweaking it so that it’s understood clearly in plain language.

Helen Osborne: That’s a question I get a lot. Should we give it to the translator in plain language or should we ask the translator to turn it into plain language?

Lise Anne Boissonneault: It should, because we’re basically just translating what we’re given.

Helen Osborne: You want it in plain language?

Lise Anne Boissonneault: We do want it in plain language. A translator’s job is to translate the message, but also at the appropriate level. If a client gives us something that is highly technical, we have to assume that the client wants it rendered in technical terms also.

It’s important for the work to be done behind the scenes before it even gets to the translator.

Helen Osborne: Thank you for that.

It sounds like, if I understand this process, that once you’re given a project to work on then you need to know about your audience, their literacy, their language and where they are as perhaps understanding this. You would ideally like this to be as clearly and plainly written as possible.

You want to know from your client how much wiggle room you can have. Can you adjust this a little bit as needed or do you have to do this word by word? Then it sounds like you go do your translation, which is wonderful.

How do we all know that it comes back the way we want it? How do you make sure of that part? Is that your job or is that somebody else’s job?

Lise Anne Boissonneault: That’s not our job because we are contracted to deliver a product. What happens with that product is up to the client.

You bring up a great point, because not only am I a translator, but I also live in the French community along with my parents and relatives. I know many people who are Francophone and I know what the challenges are with getting a translation that maybe is not at the appropriate level.

Even if it’s not the translator’s responsibility to validate the understanding of the document, I think it’s the client’s responsibility to do that, which is the health service provider.

I think it’s really important to present a draft to native-language speakers in the second language, or the target audience, to really ask them to validate that they clearly understand the document and that they will be able to use the information in the document.

Helen Osborne: One recommendation I had heard was something somebody referred to as a back translation. Somebody else who is bilingual, not that translator, translated back into the first language.

If I give you something in English, I ask you to put it into French. Then I go to somebody else who is French and ask them to put it back into English to make sure that the message is the way that I as a content expert want.

Is that a good way to do it?

Lise Anne Boissonneault: I think back translation is certainly a tool to use. It is putting it back into context for the originator of the document, if it’s back translated into English, to show the author of the document, “This is how the translation renders into English. Is this what you meant to say?” Comparing it with the original document is a good tool to use.

I wouldn’t recommend using translation software to do back translations.

Helen Osborne: Do you mean what’s on the computer?

Lise Anne Boissonneault: Yes. I don’t recommend using translation software to translate either because there is a multitude of problems. It’s not capturing the context or the nuances.

We’re not talking about just a little word here and there. We’re talking about translating sentences and paragraphs and entire documents. It’s really not an efficient tool.

It’s good to validate that the message was appropriately rendered into the target audience.

Helen Osborne: You can do that with people perhaps.

Lise Anne Boissonneault: Yes.

Helen Osborne: You’ve really taken us from the beginning to going through that process of doing it and then making sure your message is understood. Lise Anne, that’s the core of health literacy. It’s doing your best, being thoughtful of your audience and the context and making sure the message is understood.

I want to thank you so much for teaching us that much more about translations and how we can be respectful of all of our audiences, no matter what languages they speak. Thank you so much for being a guest on Health Literacy Out Loud.

Lise Anne Boissonneault: Thank you, Helen. It was my pleasure. Thank you for inviting me.

Helen Osborne: Wow. As we just heard from Lise Anne Boissonneault, it is so important to consider context, culture and our audience when translating important health messages.

Communicating health information in whatever ways we do is not always easy. For help clearly communicating your health message, please visit my health literacy consulting website www.HealthLiteracy.com. While you are there, feel free to sign up for the monthly e-newsletter, What’s New in Health Literacy Consulting.

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Until next time, I’m Helen Osborne.