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, researchers and educators Jaklina Michael, Tracy Aylen, and Rajna Ogrin documented the disparities in health care outcomes between native-speaking Australians and people from what Australia labels as "culturally and linguistically diverse" (CALD) backgrounds.
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 described the background and problems that led to the need for a translation standard. Today, in part two, we detail the process by which the community developed the standard and the process by which all new healthcare translations are expected to be done.
The Community-Driven Process
Australia's new translation standard was led by a community nursing organization with high involvement and collaboration from CALD- and public health organizations and members recruited from their ranks. Great effort was undertaken to ensure that the composition of the group represented the diversity of the nation's healthcare consumers, with age, income, ethnicity, and language all taken into account.
Their first goal was information gathering and review. In interpreter- and facilitator-led focus groups they were tasked with, one, evaluating English source materials and their translated versions, and with, two, listing those factors that made the information a barrier to their access to healthcare services. The evaluation turned up issues such as presentation style (including the lack of audio-visual alternatives), the lack of equivalent terminology, and language level among others.
Their second goal was then to identify those themes that would need to exist in any standard for healthcare translation. These raised themes such as "duty of care" and the needs for "community acceptance and consumer-directed" processes, as well as "practical requirements" like document titling.
Fundamental, however, was the sense that the rightful place for healthcare consumers was at all points along the translation process, from the crafting of the source materials to its consumption.
The Translation Standard
This community-led process resulted in a ten-point Translation Standard that they identified as necessary to the production of high-quality and literacy-appropriate translated products. Verbatim, the standard calls on implementers to:
Develop the English text and/or test the translation with members of the target language-other-than-English (LOTE-) speaking community.
Undertake a cultural and linguistic assessment of the English text in preparation for its translation.
Undertake a subject matter expert assessment of the English text as appropriate.
Organize for the English text to be translated by an accredited translator.
Undertake a cultural and linguistic assessment of the translation.
Organize for the translation to be proofread by an accredited translator.
Include the title of the text in English on the translation.
Include the name of the target language in English, on both the English text and the translation.
Distribute the translation in bilingual format-English and LOTE.
Date, monitor, evaluate and update the English text and the translation as part of an ongoing review program.
How It Will Be Done
The new Translation Standard gives healthcare providers a specific mandate to use the translation process to serve the needs of Australia's diverse healthcare consumers. And while the standard builds on the previously published guidelines of the Department of Human Services, its multi-stage process keeps health literacy at the fore.
First and most importantly, the standard calls for the greater involvement of CALD healthcare consumers, especially its bilingual members, to provide insight on whether the English source documents can meet their cultural and linguistic needs.
Second, health professionals provide quality assurance checks before the source documents are sent on for translation.
Third, accredited translators translate the documents. While previously, merely certification by Australia's National Accreditation Authority for Translators and Interpreters was enough, the Translation Standard calls for the translators to be equipped with translation instructions that point to the target audience's cultural and linguistic needs.
Fourth, the translated documents are given an additional quality review by a service provider working with CALD populations to ensure that they actually follow the culturally relevant instructions provided to the translator.
Finally, a second accredited translator is tasked with proof reading for final publication.
A Simple Success Story or a Greater Challenge?
The research paper's authors claim that there are already positive reports on the ground, from service providers and consumers alike, that this undertaking has achieved its goals. The community organization that led the effort has already produced 800 healthcare resources using this standard and in some 35 different languages. And efforts are already underway to recommend this standard for Australia's other health and safety service guides and for other fields serving the nation's CALD populations.
Noting that a similar effort has been undertaken in the United Kingdom, the authors acknowledge that more research must be undertaken to properly evaluate whether the healthcare data of such efforts for underrepresented groups reflects the positive anecdotal evidence. On the end goal, let's return to the WHO for what's at stake:
Health Literacy means more than being able to read pamphlets and successfully make appointments. [...] Health education is achieved therefore, through methods that go beyond information diffusion and entail interaction, participation and critical analysis. Such health education leads to health literacy, leading to personal and social benefit, such as by enabling effective community action, and by contributing to the development of social capital.
We'll be excited to hear what comes next.