HLOL Podcast Transcripts

Health Literacy

Applying Plain Language Principles to Translated Health Materials (HLOL #242)

Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, President of Health Literacy Consulting, founder of Health Literacy Month and author of the book Health Literacy from A to Z. I also produce and host this podcast series, Health Literacy Out Loud.

Today’s guest is Katie Leath, who is Director of the Center for Health Literacy at the University of Arkansas for Medical Sciences, otherwise known as UAMS.

Katie is a passionate health communicator who brings years of experience in making health information easy to read, understand and use.

She leads a team of health literacy experts, who create and edit health-related materials for patients and consumers.

Katie brings to all this work her training in marketing, public health and applied communications studies.

Katie, welcome to Health Literacy Out Loud.

Katie Leath: Hi, Helen. It’s so great to be here.

Helen Osborne: This is a joy. I’m going to share how I learned about your work. I’ve known about your Center for Health Literacy for quite a while and have tremendous regard for it. I am on the mailing list for your newsletter.

A few months ago, I got one of your newsletters from UAMS. The feature story was titled “Training Translators to Use Plain Language.” That really intrigued me.

I certainly know about translators. I know about plain language. I know about training. But I certainly don’t know about training translators to use plain language. That’s why I connected with you. I want to learn, and I want our listeners to know all about this topic.

Translators and plain language, what’s the problem?

Katie Leath: Helen, I think the problem is that even when we have a document that we’ve used all of our plain language best practices and it is readable, understandable and actionable, sometimes that doesn’t always translate into the new language version.

Often, unfortunately, we’ve heard from a lot of experts that are translation experts that the translated versions end up being even harder than the source material.

Helen Osborne: You created this material? What languages are you talking about here?

Katie Leath: Our expertise is really in Spanish translation, but I think that the content from this training program would apply very well to any language. We’ve had people who translate many other languages attend the training, even though our expertise is really in the Spanish language.

Helen Osborne: I want to know about two parts. The part that goes from your plain language version in English to it being translated into another language. The other part is how you teach people and train people how to do this.

As that song from “The Sound of Music” goes, let’s start at the very beginning. Let’s start with defining actually what you mean by translation. I know people sometimes think, and I sometimes think, of interpretation. What’s the difference?

Katie Leath: Interpretation is different. That has to deal with oral or spoken language, and translation deals more with written content. We’re talking about taking a piece of written health information and translating it into the new language.

Helen Osborne: Tell us about the process. Your group might draft the material about some health condition, treatment, procedure or something, right? That’s what you do. You have that medical content there. Do you then do your very best job to put that into plain language?

Katie Leath: Absolutely. We have a small but mighty team of writers who works in English to make sure that documents are readable, understandable and actionable using all those plain language best practices that we all know so well.

Then we also have a team of trained Spanish translators, who are also trained in plain language and use all of those plain language best practices to maintain the quality of the plain language standards incorporated in English to make a plain language Spanish version.

Helen Osborne: If you want to be able to distribute the same information, let’s say, in English and Spanish, do you start with the English and then use your in-house translators to put that into Spanish, or do you do the English version and your Spanish-trained translators just do their own version?

Katie Leath: I think it’s a little bit of both. We definitely start with the English, and again, we use all of our plain language best practices to make sure it’s in tiptop shape. Then we hand it over to our translators and they translate it, but they also adapt it.

If you’re talking about a diet for someone who has diabetes, what might be relevant in an English material might not quite fit with the diet of someone who speaks Spanish.

They’re thinking about not only keeping it at a readable level that is understandable, but also that it’s actionable and that it applies to the cultural differences that there might be.

Helen Osborne: I’m trying to think about this from my perspective, as I do some plain language writing. I’m thinking about our listeners, too.

Our listeners may not have that wonderful resource you have of translators in their second language right there. Let’s make it a simpler version, here.

You have that accurate content and you’ve done your plain language best. Then you might pass it off to a translator who may or may not be trained in plain language. Would that be what would apply for most people in doing their communication work?

Katie Leath: Yes, I think so. I think that this might not be as well-disseminated as maybe we would like for it to be. Not every translator has had the opportunity to get these skills to be trained in plain language.

We’ve trained quite a few of our own staff that are translators and then people outside of UAMS. They’ve noted how eye-opening it is. They say, “Oh my goodness.”

They didn’t know what they didn’t know, of course, but they wanted to go back. They said, “I wish I knew all of this great stuff so I could make those things that I’ve translated or worked on before, better.” They realized how much better their new plain language skills made them at translating.

Helen Osborne: You intrigued me. What did they wish they knew that they didn’t, those people who don’t have that plain language translation? I think that would apply to a lot of people everywhere doing this kind of work. What don’t people know about taking the source information and putting it in another language?

Katie Leath: I don’t think that any of it is too surprising. The training focuses on many of those well-established plain language best practices that we use in English writing. One of the ones that I hear often is word choice.

I think that plain language is so much about word choice and there are just so many different components of it. Just like in English, we can say “healthcare provider” or we can say “doctor or nurse.” There are so many different words you can choose.

Spanish and other languages are the same way. There are many different words. You might say doctor in the English version, but there are many different ways you could translate that into Spanish.

It’s thinking about what is shorter so we’re hitting that readability metric. But we both know that readability is not the only thing we’re trying to get at. We’re trying to get at what people use, what they understand, and what’s more common to them.

It’s thinking about how people just talk in their everyday language in Spanish or whatever the language is that you’re translating. What are those common words that they say? It’s using those when you’re translating when you have a choice of what to say.

Helen Osborne: When you ask somebody else, now a translator, to take your material, and I’m going to refer to that as a source material, do you want a word-for-word translation? Or are you giving them a lot of permission about, “Just get to the gist of this and keep it as simple as possible”? What instructions do you give them?

Katie Leath: I think that the most important thing is to maintain the integrity of the message. That is true whatever the English says is what we’re giving to Spanish-speaking people.

I’ll be honest, I speak English and I speak enough Spanish to get myself in trouble. I say that because I’m not a skilled translator, but I’ve worked with a lot of translators over the years. I think there is some room for creativity there, if you will, in your translated work.

You’re really trying to maintain the accuracy of the message, but also explaining it in a way that resonates with the audience you know.

That’s another really important component of, as you know, plain language. It’s making sure that you’re thinking about your audience when you’re writing things and translating things.

Helen Osborne: Thank you for those examples.

I often think of this when I teach about it, too. I talk about the art and science of plain language. The science, I’m using that word not in its purest version. It’s really those things that you’re supposed to do, those best practices. But the art is the artfulness of putting it in context of your readers’ lives. You gave some great examples of that.

Again, assuming you don’t have an in-house translator of that language, you went through this and then somebody else translates your material. You’re not fluent in that language, whatever that language is. How do you know if it meets content standards, if it’s still accurate, usable and readable, and if it’s in plain language? How would you even go about measuring that?

Katie Leath: I think I have a few answers to that. I think one thing that we can do to check our work is we can use readability formulas. We use those in our English language, but there are also some readability formulas that are validated for Spanish as well.

The ones that we use are SOL, which is an equivalent of SMOG and the Fernandez-Huerta, which is the equivalent of Flesch-Kincaid. We chose those because we use some of those same formulas in English.

I don’t know about other formulas validated for other languages, but I’m sure there are. We have quite a big Marshallese population in our state that our health system serves. I do know that there are not any readability formulas, at least not that I know of and we’ve looked, for Marshallese. But I’m sure there are some others out there for other languages.

I think, too, having more than one person work on translations is important. I think another plain language best practice is to get feedback from peers, too. We have multiple editors that look at our written content, and we do the same thing in Spanish. We have more than one translator look at it and provide feedback on it.

Helen Osborne: You talk about readability. I know in the work that I do, readability, word choice, sentence length and word length are only part of it. It’s putting in that actionability, so that’s only part of it.

Do you test it also with some of your intended readers?

Katie Leath: Absolutely. When we can, we certainly want to get it in front of intended readers. We do convene focus groups of Spanish speakers.

I think what’s unique about our focus groups is that we recruit people and put materials in front of people who have failed a validated health literacy screener.

Helen Osborne: Oh, who have failed?

Katie Leath: Yes, so we know that they’re the people who are probably more likely to struggle with information.

We engage them in these sessions in a way to make them feel comfortable and make them know that they’re not there to be judged. They’re there to judge the content of the material. We really get some amazing feedback from them.

We do this in English and Spanish. No matter what group we’re convening, the feedback that we get influences our writing moving forward. You’re always learning something, too, that influences not only the project you’re working on, but how you’re going to do the next project you’re working on.

Helen Osborne: I love that story of people who didn’t pass those health literacy tests. That’s great. Thank you for that whole process, that translation process you’re doing.

I wanted to ask now about the training process, the training process for translators. What’s included in that? Also, please mention your training program. For those who want to learn on their own how to do this, what tips and recommendations do you have for community organizations, clinics, wherever we are around the world?

Katie Leath: We host an Applied Plain Language Training for translators. It is a six-hour intensive, interactive training. It’s split over two days, three hours each session, normally split by a week or two in between. We have interactions planned, breakout sessions planned and, of course, lecture time in there.

Helen Osborne: In person or virtual?

Katie Leath: We can do both. Typically, right now, we do them virtually, but we’ve done them in person before, and actually have a couple of in-person sessions planned later in a few months. We can do them both.

During those sessions, we talk about readability formulas and word choice. We dig in, really, to a lot of those plain language best practices that you probably teach in your plain language trainings.

I think that some things that are a little bit different is we talk about how to be an advocate for plain language. Often translators might get things and, of course, they’re probably not the owner of the document and probably need to get permission to make updates to it. We talk about how to do that, how to approach that.

That’s one place that readability comes in. You could do a readability assessment of the English and it kind of gives you some proof.

People love numbers, unfortunately. We both know that readability is not the end all, be all, but numbers resonate with them. When they see that high-grade-level readability, they might say, “Ew. Yes, we do need to change that.”

Helen Osborne: I think it gives you just a little bit of credibility right there, that starting spot. It’s not where we end. It’s where we start.

You talked about the readability tools. What else do you teach or do you recommend others teach when they go through this?

Katie Leath: We’re in a hospital setting, so a lot of our content is talking about treating diseases. Medications are involved in that. But often you go and get something at the pharmacy and those little labels aren’t necessarily translated.

Some of them are, I’ve seen. Some more common medicines are, like Benadryl and Tylenol. They’ll have some translations on there, but a lot of them aren’t.

One thing that we talk about in our translations is that we provide a translated medicine name so they know what it is and they have some context. We also provide the English name in parentheses so they can do a little comparison.

They have a reference material and they can look and see, “I’m looking for Benadryl, and this is how it’s spelled in English.” They might know the word in Spanish, but they need to be able to find it in English. It makes it more actionable for them.

Helen Osborne: Of course. Thank you for that. What other tips do you have for people to do if they’re doing this on their own and going through the process as best as they can?

Katie Leath: I think providing relevant resources to your readers is really important. Several years ago, and this was before Covid, we were working on some fact sheet about getting a pneumococcal pneumonia shot for older adults. It was a quality improvement project. We did both an English version and a translated Spanish version.

In the English version, it pointed to a lot of resources. Unfortunately those resources, we did not own them. They weren’t ours, and they weren’t translated in Spanish.

They just weren’t available in Spanish, and so in the Spanish version of the fact sheets, since those resources weren’t available in Spanish, we took them out.

We learned through our field-testing session that those Spanish speakers wanted to see those anyway, because sometimes they have their own resources to get those read to them.

They even noted that if, for some reason, they had seen the English version and noticed that it looked different to them, that would kind of erode their trust in their Spanish version, like, “Why does this version that they gave me look different than this English version?”

Now that doesn’t happen all of the time that they have access to both, especially in our setting. But I think that’s important to note, to make sure that you are providing similar equivalent material to folks.

The way that we do that, going back to the materials that were only available in English, is we note that to people in the Spanish version. We will say something like, “This is only available in English.” That way, they don’t go to a resource that’s a dead end to them and we’re not leading them down a hole.

Helen Osborne: Katie, thank you for these great tips. For those who are interested in your training program, how would they find out more information about that?

Katie Leath: They could contact us. Our email address is healthliteracy@uams.edu. They can ask to be put on the list for when our next event is. If you have a group of people you would like to get this training, we can put together a training for a bigger group.

Helen Osborne: Thank you. Maybe they’ll sign up for your newsletter, which is how I learned about this. Thank you for that.

You shared a lot of great information. There’s always more to learn. But I’m curious as to the why. Putting this together, why is this so important, training translators to put health information into plain language? Get to the essence of this.

Katie Leath: I think the important part is that we want our translations to be just as good as the English version, because that equitably enables our Spanish speakers, or whatever the language is, with the right written information that they can read, understand and act on.

When we have that, then we get to those great outcomes that we all agree about: the optimal communication, patient satisfaction, better outcomes, patient safety and all that stuff that we all care about.

Helen Osborne: For everyone. Katie, thank you for all you are doing and for sharing it with us on Health Literacy Out Loud.

Katie Leath: Absolutely. It was a joy.

Helen Osborne: As we just heard from Katie Leath, it’s important to communicate health messages to everyone in ways they can understand. Yes, that means using plain language. It also means using plain language in whatever the recipient’s language is and including translators in that process. But communicating clearly like this is not always easy.

For help communicating your health message, take a look at my book, Health Literacy from A to Z. Feel free to also explore my website, www.HealthLiteracy.com, or contact me directly at helen@healthliteracy.com.

New Health Literacy Out Loud interviews come out the first of every month. Get them all for free by subscribing at www.HealthLiteracyOutLoud.com, or wherever you get your podcasts.

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Until next time, I’m Helen Osborne.

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