Standard 7: Translated Materials (mandate)
“Health care organizations must make available easily understood patient-related materials and post signage in the languages of the commonly encountered groups and/or groups represented in the service area.”
Why Written Translated Materials Are Important
Written materials can add to the spoken information patients receive from clinicians and other staff, reinforcing key messages that may be forgotten. However, such documents have little value if patients cannot understand the language in which they are written—this puts patients at risk of not adhering to recommended treatments or procedures. Materials should be translated into commonly encountered non-English languages in a way that is consistent with the culture and literacy levels of the target language groups. In addition, oral interpretation or alternative-format information can offer another tool to bridge the access gap faced by LEP individuals who have no written language or are not able to read.
Languages and Materials for Translation
Guidelines from the OCR recommend translation of written materials in situations where there is a population of a size or percentage significant enough to need information in a language other than English. Healthcare organizations should be familiar with other national, state, or local regulations concerning provision of language assistance services and should ensure that relevant staff members—those in member services, member communications, health education, outreach, advertising, and public relations, as well as direct-service providers—receive information about them.
OCR guidance on Title VI provides examples of key documents that should be translation:
- Consent forms
- Letters containing important information about participation in a program
- Notices about the reduction, denial, or termination of services or benefits
Another criterion for selecting materials to be translated includes those that are necessary for patients to access and make educated decisions about their healthcare, such as:
- Administrative and legal documents—materials requiring informed consent, obligation, or acknowledgement of legal or financial rights and responsibilities; waivers of rights; emergency room, release, and discharge forms; documents establishing eligibility for services; explanations of benefit coverage packages; evidence of coverage cards and notices of noncoverage; information on patient services and rights; health plan member handbooks or critical portions thereof; and appointment slips
- Clinical information—prevention and treatment instructions, including how to prevent transmission of a contagious disease; what to do before, during, and after a procedure or treatment; how to take medications; and how to perform routine self-care or self-monitoring
- Patient education, health promotion, and outreach materials—brochures, fact sheets, pamphlets, promotional flyers and posters, health warnings, immunization notices, and other materials that support treatment programs (eg, for chronic disease or reproductive health) and prevention activities (eg, cancer or blood pressure screenings).
Translation Methodologies and Protocols
Translating written materials on a piecemeal basis—eg, using bilingual staff members, community-based ethnic organizations, materials prepared by another organization—poses risks of giving patients inaccurate or inappropriate information. Therefore, whenever possible, providers should develop explicit policies to ensure the quality of translators and their work.
The University of Minnesota Translation Laboratory (www.translab.us) has developed extensive translation protocols for the Minnesota Department of Health, which makes available many of its written materials in a wide array of languages. Other efforts are ongoing to develop glossaries and dictionaries in numerous languages to assist translators and help standardize the vocabulary for medical terms, especially in the languages of recent immigrants who may not have terms in their native languages for Western medical concepts.
Minimum professional standards should include translation by a trained person, back translation or review by target audience groups, and periodic updates. A commonly practiced approach is to begin with an English version written at a grade 4 to 6 literacy level, the translation of which is reviewed for accuracy by healthcare professionals and by community members for understandability and cultural context.
Minimal qualifications for healthcare translators should include:
- Previous experience, education, and training in translation
- Command of both English and the target language
- Familiarity with medical terminology
Criteria for selecting translators should include a review of
- Translation methods and procedures used, from submission of English copy to printing of finished materials
- Recruitment and training of translators
- Procedures for reviewing translated materials
- Knowledgeable staff to work with the translators and to review the quality of the translations