Australia has recently published a new translation standard to ensure high-quality health information and to boost health literacy rates for the nation’s most disadvantaged populations. Writing for the Australian Health Review‘s September edition, health researchers and educators Jaklina Michael, Tracy Aylen, and Rajna Ogrin documented the disparities in health care outcomes between native-speaking Australians and those who either speak English as a second language or who speak a language other than English.
Behind their report is the story of how a community-driven effort — one that focused less on literalness and accuracy and more on meaning and cultural relevance — has already changed the nation’s translation standards for the better.
In part one of this blog, we describe the background and problems that led to the need for a translation standard. In part two, we will detail the process by which the community developed the standard and the process by which all new healthcare translations are expected to be done.
Healthcare officials and researchers have long recognized the need for community involvement in their quest to improve healthcare delivery to disadvantaged populations. For example, in 2000, a community nursing organization in Victoria undertook a review of health information available for their Macedonian- and Italian-speaking clients. Their staff, clients, and caregivers reported that information was generally “outdated, hard to find, aimed at too high a literacy level, did not cover enough areas or topics, and was hard to read due to print quality and size” and that translations were specifically “highly variable,” “literal,” and lacking all evidence of community consultation and quality checks.
Some six years later, an article published in Australia’s Translation Watch Quarterly by researcher Dr. Ali Darwish asserted that three components were vital to translation quality assurance in Australia: information integrity (content), linguistic integrity (grammar and structure), and translation integrity (meaning).
This was followed in 2009 by the Department of Health’s publication of a “cultural responsiveness framework” that, in addressing language barriers specifically, stated that there should be “evidence of appropriate translations, signage, commonly used consumer/patient forms, education and audiovisual materials in languages other than English for predominant language groups utilising the service.”
As researchers Michael, Aylen, and Ogrin had to acknowledge, however, the nation’s most current healthcare data persistently revealed that the ideals of these efforts were not being realized in the day-to-day experiences of the healthcare consumers who needed them most.
Poor Health Literacy
The World Health Organization (WHO) defines health literacy as “the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health” (Track 2: Health literacy and health behaviour, WHO). According to data published in 2009 by the Australian Bureau of Statistics, more than fifty percent of the nation’s population do not meet this level of health literacy at all.
Low health literacy rates are disproportionately higher among elderly residents, low-income populations, and those who have lower levels of education as a whole. Unsurprisingly people from what Australia labels as “culturally and linguistically diverse” or CALD backgrounds — some 1.23 million Australians originally from more than 200 countries who speak a language other than English — are also disproportionately represented.
Linked to this, unfortunately, are poorer health care outcomes for these populations, as proven by the health literacy and healthcare outcome gaps between those with CALD backgrounds and Australian-born residents. Worse, translated healthcare documents were recognized as a contributing part of these poor outcomes rather than a solution.
The Translation Problem
The research team outlined a number of translation issues that had collectively become a problem for its consumers
- The source text was bad. Although popular guidelines stated that well-written health information should be relevant for its consumers, the guidelines did not provide for a diverse consumer base. Source text written in high-level English spoke to a narrow slice of the population, one that was highly educated and health care literate.
- The translations were too literal. The above matter was then complicated in a translation mandate that called on translators to adhere to literalness and accuracy rather than to translation for meaning and comprehension. No surprise then that high-health-literacy materials did not lend themselves well to translation for low-health-literacy audiences.This meant that complex source material became complex target material, merely transporting “unfamiliar health vocabulary and concepts” that its audiences could not comprehend, relate to, or apply to meet their healthcare needs.
- There were no standards. While guidelines and frameworks abounded, an Australian-wide standard — “an agreed attribute or process designed to ensure that a product, service, or method will perform consistently as a designated level” — did not exist for the translation of healthcare materials.
And, as the researchers noted, it was about time that the nation developed them:
“Given the complexity of health information, the need to ensure applicability and relevance to the target population, and the high rates of low health literacy, minimum standards for developing translated resources are needed.”
Stay with us for next week’s report on how the Australian team developed its new ten-point healthcare translation standard and the challenges of its implementation.