Speaking your language: why translating health information is so important

This article was authored by Dr Alice Wood, Clinical Director and Clinical Safety Officer of Cognitant, with collaboration and input from the Patient Information Forum.

Language barriers can create significant challenges to people at all stages of their healthcare journey. In the UK, around 8% of the population do not speak English as their first language and as many as one million people cannot speak English well or at all.^{1, 2}  Challenges encountered may include registering with a GP, accessing urgent care, navigating healthcare premises, explaining their concerns, and understanding what doctors and other healthcare professionals (HCPs) say. This can contribute to poorer health outcomes within this population.¹

Tackling the health inequalities and inequities seen among people from different ethnic, cultural and socioeconomic backgrounds is rightly a national and regional priority for the NHS, which can be seen in key health policy documents such as the NHS Long-Term Plan. We believe a sound understanding of your own health and conditions is a crucial determinant of enabling good health. For example, if you do not understand the basic principles of your type 2 diabetes and its treatment, how can you make informed food choices and recognise when to take your medication? Improved health understanding supports individuals to make healthier lifestyle choices, giving them a greater opportunity to lead healthier and happier lives.

However, there is a significant lack of easily accessible, reliable health information in languages other than English. This presents challenges to individual patients, communities and HCPs. It impacts on population health and exacerbates existing health inequalities.

Challenges and needs

Patients:

People with limited English proficiency (LEP) are unable to access key information relevant to their health and may not understand how to access health services, their diagnosis and treatment plan explained by their own clinician.

They often rely on relatives for informal translation support. Although this is valuable, it may put pressure on personal relationships and may raise ethical issues about privacy.

People with limited English proficiency may not respond to vaccine invitations, take part in cancer screening, or understand how to take medication correctly. If healthcare professionals can support these groups to access reliable health information in their first language, particularly if it’s culturally appropriate, then many of these concerns can be addressed, supporting better health equity. 

Clinicians:

Supporting patients with limited English proficiency is a significant challenge for clinicians across the country. How can they help these communities, who are often at higher risk of certain diseases, to understand their health and play an active role in managing conditions?

It is widely recognised that non-adherence and taking medication incorrectly is common in the UK. One study found that, 10 days after starting a new medication for a chronic condition, almost one third of patients were already non-adherent (N=258, England).³ This has significant economic and health repercussions for individual patients, population health and our struggling healthcare economy. What proportion of patients who are non-adherent have never understood the reason for taking the medication or how to take it? And what proportion of those patients have met these challenges because of limited English proficiency? Providing accessible health information not only enables people to understand the importance of adherence; it can help them take appropriate self-care measures and reduce the need to access healthcare services.

If clinicians had resources available to give all their patients, regardless of their literacy in English, truly accessible information about their health, diagnosis and treatment, their health outcomes could be considerably better. This is key for those who speak English too – ensuring health information resources can be understood by those with lower levels of literacy should remain a priority to help tackle health inequalities. Additionally, starting with simple, visual information can make the translation process easier and cheaper down the road. The solution? Ensure that health information across all therapy areas is available in formats suitable for a lower literacy level and in a wide range of languages spoken across the UK, which aligns with our mission.

Our experience

At Cognitant Group, we set out to address this unmet need. For example, we created an interactive, avatar-led animation about chronic kidney disease which we have fully translated into 4 languages other than English, to meet the needs of the local community.

It is not a simple task to create accurate and culturally sensitive translations of health information, but we are incredibly proud of the final result and continue to create high-quality, accessible translated health information for those who need it.

There are a range of challenges associated with translating health information. Creating accurate and culturally sensitive translations consumes time and expertise, and thus increases financial costs, which can be a limitation for certain content suppliers, such as charities. There are also challenges associated with quality control of the final product and a fear of ‘getting it wrong’ for concerns about liability. For our translation process we use resources from the Patient Information Forum (PIF) and the Association of Translation Companies for guidance and use our PIF membership to ask our peers about their experiences with translation.⁴  It is clear that the challenges associated with translating health information to a high standard are so significant that many health information-producing providers do not know how or where to start. The costs and risks are so daunting that most groups avoid translating their resources for fear of making a costly mistake.

At Cognitant Group and PIF, we see high-quality translated health information as essential to reducing health inequalities and inequities across the UK. We have therefore started to explore how we can make the process of translating health information more accessible to groups creating these resources. PIF recently organised a roundtable discussion bringing together key stakeholders from the health information space, including representatives from those who create health information and those who translate medical content. We explored the key challenges to better understand how we can move forward with this important transition. The results of this roundtable will be formally released in due course but the key themes and recommendations synthetised from the session by PIF are below.

Recommendations from PIF for translating health information:

1 – Make a start with translation

Embedding machine translation can make it easier for digital users. It can also help you identify areas of greatest need as you ‘step up’ your translation.

2 – Follow your information production process

Use your standard process. A checklist on page 14 aligns good practice with the PIF TICK criteria.

3 – Choose the most appropriate translation

It is not feasible to translate every piece of information. Take the time to identify the greatest need among your users. This may extend to specific dialects.

4 – Start with health-literacy friendly materials

Information written in plain language is easier to understand and translate. Make use of appropriate images to aid understanding.

5 – Involve users

The wrong tone of voice can be a barrier for users engaging with your information. You can find more guidance on running meaningful engagement in our guide to Co-production: Involving users.

6 – Clinical sign off

There are different ways to check clinical accuracy. The method chosen should relate to the clinical risk presented by the content.

7 -Pilot translated information

Pilot with representative users – both HCPs and patients. Remember literal translations may not always be culturally appropriate.

8 -Use disclaimers

Let users know translations are not always perfect. They should check or ask for further explanation via interpreting services.

The PIF’s guide on translating health information gives content creators the foundations on which to design and implement processes successfully, allowing them to meaningfully address significant health inequalities and inequities among vulnerable communities.

NHS England’s Accessible Information Standard makes particular reference to ensuring that ‘people who have a disability, impairment or sensory loss’ can access and understand the information they need. However, there is no reference to those living in England with limited English proficiency needing the same consideration. With this standard currently under review, we see this as an opportunity for key stakeholders and policy makers to support those creating health information to engage with improving the collective pool of translated resources for the benefit of individuals, clinicians, population health and our healthcare economy.

END

References

1. Office for National Statistics (ONS). 2011 Census: Detailed analysis – English language proficiency in England and Wales, Main language and general health characteristics. Available at: ons.gov.uk/peoplepopulationandcommunity/culturalidentity/language/articles/detailedanalysisenglishlanguageproficiencyinenglandandwales/2013-08-30. Accessed May 2023
2. uk. English language skills. Available at: www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/english-language-skills/latest. Accessed May 2023
3. Barber N et al. Patients’ problems with new medication for chronic conditions. BMJ Qual Safe 2004;13(3):172-75
4. Patient Information Forum. Translating health information. Available at: https://pifonline.org.uk/resources/how-to-guides/translating-health-information/. Accessed May 2023