The Definitive Guide to Healthcare Translation

Transcription

1 The Definitive Guide to Healthcare Translation As a result of ongoing healthcare reform, millions of newly insured individuals need access to healthcare information in their native language. In fact, nearly 55 million people about one in five U.S. residents speak a language other than English at home. For these people, bridging the language gap is essential to their accessing healthcare and managing their health. Let s see what this may mean to your organization. 1

2 THE DEFINITIVE GUIDE TO HEALTHCARE TRANSLATION INTRODUCTION You have obligations to help make this work. Let s look more closely at what this means. If you re a healthcare provider, you not only have language access responsibilities under federal and state law, but you also bear a social obligation to ensure that all your patients and members enjoy equal access to services. If you represent a healthcare plan, you have goals of maximizing enrollment as well as managing all the demands of compliance. Though not without challenges, these are achievable goals that can deliver significant rewards, both for you and for the limited English proficient (LEP) communities you serve. The Office of Minority Health s Guide to Implementing Language Access Services in Healthcare Organizations identifies four elements of an effective language access effort. These include: Assessing the language needs of your patients and members Assessing your organizational capabilities Planning and implementing language access services Evaluating the quality of your language access services

3 THE DEFINITIVE GUIDE TO HEALTHCARE TRANSLATION INTRODUCTION In this document, we share key takeaways and best practices from the localization and translation industry. Consider how these impact your company. Exploring this will help take the uncertainty out of addressing language access challenges for both written and webbased communications. (We will not address oral interpretation or staff training programs, which tend to be provided and managed locally.) We include key planning recommendations, advice on budgeting for translation and localization, and highlight tools and technology that can help you along the way. This culminates in helping you make a wise decision in choosing a translation service. Our goal is to give you some useful ideas you can use tomorrow for reaching your communication goals whatever they might be.

4 SIZING UP YOUR SITUATION What linguistic challenges do you face when communicating with your patients, communities, and members? Assess where you are, then define your program s scope and objectives. By answering the following questions, you can help ensure that you re heading down the right path. You ll also be collecting information that your language services provider (LSP) will need. Be comprehensive in your assessment. 1. What kinds of materials are to be translated? What types of information need to be made available to all residents in your service area? The Office for Civil Rights (OCR) requires that vital documents written in English be translated into common non-english languages. The Centers for Medicare and Medicaid Services (CMS) also have strict translation and interpretation policies. For example, the CMS requires Medicare Advantage plans and Medicare Part D plans to make marketing and plan materials available in any language that is the primary of more than 10% of the population in specific market areas. These materials must be posted on the plans websites. Did you know? According to the Journal of General Internal Medicine, patients with inadequate health literacy are more than twice as likely to be hospitalized as those with adequate literacy (32% vs. 15%). Additionally, low health literacy results in an estimated 3% to 6% rise in healthcare expenses, with plans such as Medicare and Medicaid financing the majority of it. Just because your LEP audience speaks some English, don t assume they speak enough to comprehend key messages and instructions. According to one study (I.S.P. Nation and Daryl Nation, Teaching and Learning Vocabulary), even university-educated English learners know only about 25% of the vocabulary of their native-english speaking peers.

5 SIZING UP YOUR SITUATION Vital documents include any affecting legal rights or obligations, including applications, enrollment and consent forms, letters regarding eligibility or changes in benefits, or anything requiring a response. 2. Who is your target audience? Everyone? Or specific groups, such as men, women, the elderly, or those with specific health conditions? 3. Have you documented your communication objectives? Share these objectives with everyone involved to keep all parties focused on the desired outcome. 5. How does your audience prefer to be reached? Do they use online, mobile, and social media? Knowing your audiences preferred mode of communication can go a long way in not only getting your content to them, but making your messages more meaningful. 4. Have you determined the literacy level of your communications? Nearly 78 million people in the U.S. are unable to understand and apply critical healthcare information due to an inability to comprehend English. Use readability tools such as the Fry Readability Formula for English texts or the Huerta Readability Formula (HRE) for Spanish materials to analyze the literacy levels of your company s communications.

6 BE AWARE OF GOVERNMENT MANDATES Over time, there will certainly be more, not less, regulation. We ve listed a few of the landmark pieces here. Title VI of the 1964 Civil Rights Act: No person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or activity receiving Federal financial assistance. Executive Order (Aug. 2000): Requires all federal agencies to develop and implement programs to ensure that LEP users of their services have equal access to them. U.S. Dept. of Health & Human Services Office for Civil Rights (OCR) LEP Guidance (Aug. 2003): Building off of prior mandates, it requires that organizations take reasonable steps to provide meaningful access to their LEP members. The number, percent and frequency of LEP persons must be taken into account by organizations, as well as the importance of the service and available resources for said populations. State-level legislation: All 50 states have at least two laws related to language services, with California having the most statutory and regulatory Language Access Services (LAS) requirements of all. The Patient Protection and Affordable Care Act (PPACA): The PPACA now referred to as the ACA contains an Anti-Discrimination Provision ( 1557) that pertains directly to ensuring access to healthcare for all individuals, including LEP populations. The ACA requires group health plans and health insurance issuers to provide relevant notices in a culturally and linguistically appropriate manner.

7 HEALTH LITERACY AND LEP MANDATES The Institute of Medicine (IOM) estimates that health literacy is an issue for 90 million people in the U.S. at all education levels. Let's look at that more closely. Did You Know? According to The National Assessment of Adult Literacy, only 12% of U.S. adults have the health literacy proficiency to perform complex health tasks such as using a table to calculate an employee s share of health insurance costs. Learn more! Download The Growing Challenges of Health Literacy.. Even those who speak English as a second language can have low comprehension of new vocabulary or subject matter especially difficult medical terminology. Whether it s through your website, vital member documents or patient education materials, having a firm grasp of health literacy trends is a key piece of communicating well with LEP audiences.

8 THE DEFINITIVE GUIDE TO HEALTHCARE TRANSLATION HEALTH LITERACY AND LEP MANDATES Use readability tools to analyze and ensure proper literacy levels Use these highly rated readability tools to analyze the grade level of your English language content: The Fry Readability Formula Flesch-Kincaid Grade Level, which is now integrated into Microsoft Word. Some best practices for creating readable health materials in any language: Write clearly and in an active voice. Use familiar vocabulary and simple terminology. Use short sentences. We recommend writing and translating materials at a 4th to 6th grade readability level. If you think creating low-literacy level text is as simple as rewording complex medical terminology, think again. This very guide is at 12th grade literacy level, and it doesn t include any medical jargon! Use graphics, videos or pictures that show rather than tell. Keep materials at a fourth- to sixth-grade level.

9 HEALTH MATERIALS SHOULD BE CULTURALLY RELEVANT For immigrant or refugee populations, the U.S. healthcare system can be confusing and intimidating. Developing cultural literacy helps you resolve those difficulties. The U.S. Department of Health & Human Services Office of Minority Health defines cultural and linguistic competency as the ability of healthcare organizations and providers to understand and respond effectively to the cultural and linguistic needs brought by the patient or member to a healthcare encounter. Consider incorporating transcreation into your content development to help ensure that your brand attributes and key messages relate to the target culture. What is transcreation? A review by a skilled, native-speaking copywriter to revise key messages and sensitive areas of the content. He or she takes more creative license than a translator to reach your audience both emotionally and intellectually. Let s look at an example. Translated Spanish Sentence: Nuestra organización está presente para ayudar a los adultos mayores que están en nuestras vidas para que puedan vivir la vida con la salud y con independencia felicidad. (Our organization is here to help today s seniors live healthfully and with independence.) Transcreated Spanish Sentence: Nuestra organización está presente para ayudar a los adultos mayores que están en nuestras vidas para que puedan vivir la vida con la salud y felicidad. (Our organization is here to help the seniors in our families live healthfully and happily.) The linguist understood the importance of family and intergenerational ties to the Hispanic community, and incorporated these elements into the content. It is now more culturally resonant to the target audience.

10 CULTURAL CONSIDERATION CHECKLIST These seven steps help you determine how many language and cultural groups your audience has, and the appropriate literacy level for each. 1. Identify the required language for each document on your list of patient and member communications. 2. List all the countries and/or cultural groups within those language groups. For example, if a required language is Portuguese, note where the speakers are from (for example, the Cape Verde Islands, Brazil, etc.). 3. Next, tally the population for each cultural group. If you have a population threshold for mandatory translations, this is the place to make note of it. 4. Identify the percentage each cultural group accounts for in your total population. 5. We recommend writing and translating materials at a 5th to 6th grade readability level. 6. Finally, list the age level you ll be targeting for each communications vehicle or initiative. For example: child, teenager, senior citizen or multi-generational. 7. Alert all vendors involved in printing or producing the materials that multilingual versions are forthcoming.

11 HEALTHCARE TRANSLATION: WE CAN HELP MAKE TRANSLATION PART OF THE PLANNING PROCESS Translation should be part of every discussion about building or refreshing your healthcare content. This will not only save you time and money, but will also help you ensure more accurate translation. Don t you want your LEP populations to feel as at home browsing your site as your English-speaking audience does? These tips will help you when translating and localizing web-based content. Save yourself time by creating English web pages with enough room for language expansion, especially on buttons or links. Test that your language settings and fonts support the language characters you are using. Have the final content reviewed by a native linguist for spacing, line break, character accents and other small details a non-native eye may never know to watch for. Too often this kind of localization is done by hand, one piece at a time, for market after market. It can be a slow, expensive process that is prone to error. It is far better to plan for localization upfront. Success requires a solid web strategy, sound content management and organization planning, as well as effective integration between your web design team, your IT team, and your LSP. Next, we ll look at how to establish an efficient localization process. Use a linguist with a background in website translation who is aware of code and spacing constraints.

12 ENSURE QUALITY WITH A PROVEN METHODOLOGY It takes a lot of hard work to create a compelling customer-focused communications program. You want to ensure that the translated version carries the same impact. As we ve said before, quality assurance involves much more than just getting the language right. The best way to ensure quality is to build it into your entire translation and localization process right from the beginning. Key methodologies include: Using professionally created and maintained style guides and glossaries. You can reduce the review/revision process by as much as 50%. Using ample white space in designs to accommodate different languages. Foreign language text can expand by as much as 35%. This process been proven to deliver successful translation and localization projects accurately, on time, and on budget

13 FIND A GOOD PARTNER Your choice of a professional Language Services Provider (LSP) is critical to the success of your translation projects. What criteria do you use to find the one that s right for you? Use an LSP to guarantee operational efficiencies, quality assurance levels, and professionalism when you re managing high volumes of translation. While costs are typically higher than when you work with a freelancer, advantages include flexibility to handle peak volumes, team and translator consistency, back-up resources, best practices, leading technical solutions, professional project management, and insurance for errors and liability. Make sure you obtain the ownership rights to your translation memory in advance and receive updated copies quarterly or annually. Did you know? Unlike oral interpreters, translators of written material do not have a governing body for accreditation. There is the American Translators Association, which offers unproctored tests from English into one of 15 languages, but there is not an organization that specializes in the languages or terminology unique to the U.S. healthcare system. One U.S. state s healthcare department accidentally translated the famous slogan Got Milk? into Spanish as Tienes Leche, which actually means Are you lactating?

14 FIND A GOOD PARTNER Additional tips for working with a translation service. Verify that your LSP will be using native speakers. Only native speakers have the linguistic intuition to make your communications sound right to your target audience. They must be equally fluent in English and have some experience working within the U.S. healthcare system Ensure translation expertise in healthcare. The more specialized and experienced your LSP s translation team, the higher the translation quality. In the case of healthcare, familiarity with healthcare terminology, translating at lower readability levels, translation technology, and regulatory compliance such as HIPAA are important assets. Get references. Just as when hiring an employee, check with trusted colleagues regarding the LSP s reputation. A good LSP will be happy to provide references. Online translation management. Does your LSP allow you to manage your professional translation services online through a client portal? This does not mean you won t have personalized service or a project manager. Instead, a portal can increase project management efficiencies by saving time in ordering and managing your translations. Many portals today have instant quoting, project tracking, budget management and customizable options for your organization. Evaluate tools and technology. A good LSP often owns proprietary tools that streamline workflow and aid in the recycling of previously translated text to lower costs and maintain consistency. These tools offset slightly higher perword costs and deliver better translation quality over the long run. If your LSP meets these criteria, chances are good you will enjoy not just a high level of service, but also a high level of confidence throughout the process.

15 CASE STUDY #1: SUTTER HEALTH Sutter Health is a not-for-profit health system in Northern California that serves patients and their families in more than 100 Northern California cities and towns. The Challenge They require translations for a large variety of documents from all departments, from marketing to consent forms to newsletters. They also support many languages. It varies by region and affiliate, but for example their hospital in San Francisco uses over 66 languages and their clinic in Palo Alto uses over 45. As a result, they provide anywhere between languages across their organization with the top requests being Cantonese/Mandarin, Spanish, Vietnamese, Russian, Korean, Japanese and Tagalog. The Solution The not-for-profit turned to VIA for help in centralizing its content translation process to improve content consistency and increase efficiency. They recognized that centralizing healthcare translation requires the specialized knowledge of healthcare translators, as well as alternate translation memory guidelines, style guides and review policies. Given the many locations, languages and cultures involved, they were interested in the depth of VIA s resources and knowledge. Making sure that across the board, the service and quality is at the highest standard and at the best, most competitive price was our priority. - Maria Moreno, Sutter Health The Result After centralizing with VIA, Sutter Health was able to experience faster, more predictable turnaround of its multilingual projects. In addition, the company realized cost savings through the use of centralized linguistic assets such as translation memories and the use of technology tools like the VIA Translation Portal.

16 CASE STUDY #2: SENIOR WHOLE HEALTH Senior Whole Health is a health plan provider serving low-income seniors in Massachusetts and New York. They are among the top 5 percent of insurance plans in the country addressing the special needs of elderly and low-income members. We have ethnic communities in our area that speak languages such as Haitian Creole, Vietnamese, Cambodian and Russian. says Gabriel Martinez, Director of Corporate Marketing and Branding. We ve committed to addressing these groups in their own language and in a way that is culturally sensitive and at the suitable literacy level. The Challenge How to communicate their brand in an appropriate way to this range of audiences in a broad array of languages. The Solution VIA worked with Senior Whole Health to adapt their brand and message to a multicultural audience by transcreating the theme and message into a form which evoked the same feeling across different ethnic groups. VIA transcreated a variety of materials including member communications, summary of benefits, evidence of coverage and pre-enrollment information to reach eight specific languages: Haitian Creole, Vietnamese, Cambodian, Spanish, Portuguese, Russian and Chinese. VIA brings an incredible amount of knowledge to the table. They understand what we are trying to convey and how it should be said in our different target languages. -- Gabriel Martinez, Director of Corporate Marketing and Branding, Senior Whole Health The Results Martinez explained, Our mission is to provide seniors with a health care plan that s simple to join, provides the security of around-the-clock health care, and allows them to live independently. Not only does VIA truly understand what we are trying to accomplish, they also bring the expertise that ensures we are not losing the true essence of our message from culture to culture.

17 LINKS TO MORE RESOURCES A Few Words About VIA For more than a decade, VIA has delivered translation and localization counsel and services to a wide range of industries. We help our clients reach across the barriers of language and culture to connect with their audiences. Our multilingual solutions are tailored to our clients goals and needs, incorporating legal translation, as well as marketing and elearning localization. We work with more than 125 languages including a variety of lesser known refugee languages and to date we ve translated more than 10 million words annually in Spanish alone. We also bring experience in all media, including websites, mobile, social networks and desktop publishing. We know how to strategically leverage technology to help you centralize translation and achieve significant savings. We re proud of our success in the healthcare field, and have partnered with more than 400 healthcare organizations across the U.S., including health plans (both government funded and for-profit) and hospitals of various sizes. With more than 5,000 healthcare translators, we help our clients ensure equal healthcare access for limited English proficient (LEP) patients and members. Learn more! Maximize Your Healthcare Translation Budget The Growing Challenges of Health Literacy 3 Tools for Communicating with Culturally Diverse Communities Tips for Creating Readable Health Materials in any Language Quality Methodology Data Sheet By leveraging the best talent and some very smart technology, VIA has earned a reputation for quality, professionalism, and reliability, including a 99% on-time delivery record. We take our role as an industry leader seriously. We also believe that part of our commitment to LEP communities means giving back. VIA contributes two percent of healthcare profits in the form of donations and grants to organizations supporting those same LEP communities.

18 GETTING STARTED Contact Us We hope the best practices we ve outlined in this guide will help you when you think about your own program how you d like it to run, and about ways to make that happen. We know you re going to have questions, and nothing can take the place of a real conversation. So we invite you to give us a call. Maybe you want some ideas about your particular translation and localization issues. Maybe you re thinking about starting, improving or expanding a language access program. In any case, we have healthcare experts who d be happy to speak with you at any time. Contact us at or visit us online at. Images courtesy of freepik.com