Accessing, using, and understanding the U.S. healthcare system is difficult for almost everyone. But for people who speak limited English or come from other cultures, these tasks might seem impossible. In terms of language, it can take people many years to become fluent. With limited English, people may have sufficient social language to talk about the food or weather. But until they are truly fluent, they might have difficulty discussing abstract “how” and “why” concepts common in health conversations. Culture, too, impacts how people understand and make sense of health information. Regardless of where people were born and brought up, each brings their own experiences, values, customs, and logic to each situation. Yet despite these differences, health providers must communicate in ways that all of their patients can understand.

Here are some how-to tips:

• Work with interpreters and translators. Interpreters work with the spoken word, communicating what one person says in words that another person understands. As possible, work with trained medical interpreters rather than bilingual family, friends, or volunteers. Translators work with the written word, taking information from one language to another. Beyond words, translated materials should be culturally appropriate and include graphics and examples that readers can relate to and accept.
• Ask who makes decisions. In some cultures, patients are not the ones to make health decisions. Find out whether the patient, someone in their family, or a designated decision-maker accepts this responsibility. Include that person when discussing treatment options.
• Speak at a slower pace. When talking with people who speak limited English, focus on essential, need-to-know skills and behaviors rather than nice-to-know background information. Speak at a slower pace, pausing for two or three seconds after asking questions or giving new information.
• When possible, use common words. Examples include using the word “cancer” rather than “oncology,” or “kidney doctor” and not “nephrologist.” Avoid medical jargon and acronyms like “BP” when you can just as simply say “blood pressure.”
• Find additional ways to communicate your health message. This can include simple line drawings showing ideas or actions, stories, and metaphors. Consider “hands-on” practice as well. For example, instead of just telling patients how to take a new liquid medication, use an actual dosing device to demonstrate what to do and then have patients re-demonstrate how they would do it.
• Confirm understanding. When communicating with patients who speak other languages and come from other countries, do not assume that a nod and a smile necessarily mean that your message is understood. To confirm understanding, ask an open-ended question such as, “How will you ___ ?” rather than a yes/no question like, “Do you know how to ___?”  When it appears that the other person does not understand, find other ways to communicate the same message.

Pairing this How-To Tip with select Health Literacy Out Loud (HLOL) podcasts:

• “Consider Culture and Language and Language When Communicating About Health (HLOL #171),” an interview with Wilma Alvarado-Little.
• “Translating Health Information (HLOL #134),” an interview with Lise Anne Boissonneault.
• “Understanding One Another Even When Language and Accents Differ (HLOL #79),” an interview with Barbara Hoekje.

This Health Literacy Consulting How-To Tip is adapted from the “Know Your Audience: Culture and Language” chapter in Helen Osborne’s book, Health Literacy from A to Z: Practical Ways to Communicate Your Health Message, Third Edition