rx for improving medical translation in a diverse world: a closer look at patient surveys
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RX FOR IMPROVING
IN A DIVERSE WORLD
Medical Translation
A Closer Look at Patient Surveys
Participant Poll
What is the main type of patient-directed materials you translate?
a) Patient Information Leaflets/Informed Consent Forms b) Marketing Materials
c) Patient Brochures/Guides
d) Medical Interpretation
1 To culturally adapt meaning vs. effect
2 To determine commensurate source-target correspondence
3 To strategically translate to bridge the linguistic divide
Rx for Improving Medical Translation in a Diverse World
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GOALS
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PATIENT SURVEYS: AN INTRODUCTION
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WHAT’S AT STAKE?
A question of language: The probability that someone is going to say their health is “excellent” is a question of language and culture.
Can you work with existing surveys to cover topics and adapt them to look at specific race, ethnic or linguistically diverse populations versus surveys that are expressly designed around these issues?
How would you translate this scale into one of your languages?
Not at all Somewhat Moderately so Very much so
Rx for Improving Medical Translation in a Diverse World
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o Health Status – quality of health, dysfunction, symptoms and impairment
o Quality of Life – evaluation of psychological, physical and social aspects of life affected by treatment over time
o Well-being – evaluation of psychological illness, anxiety, depression and well-being
o Patient Satisfaction – appraisal of experiences, side effects and efficacy
o Symptoms and functioning – focus on range of and specific impairment
TYPES OF SURVEYS
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TOP SURVEY COUNTRIES
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TOP LANGUAGES
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PATIENT OUTCOMES Patient Experiences
Office Staff Personal Doctors Phone Advice Specialists
Intermediate Outcomes
Adherence U8lisa8on Health Plan
Disenrollment
Health Outcomes
Health Status Func8on Status Life Expectancy
Mortality
Patient experiences are linked to important intermediate outcomes, such as adherence to treatment regimens, which in turn influence health outcomes
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TRANSLATION CHALLENGES
o Plain-language translation o Cultural adaptation
o Degree of fidelity
o Idiomatic expressions/metaphors
o Inter-linguistic abstraction
“mal di pancia” vs. “gastrite”, “optimal
care” (jargon) Health insurance, system,
etc. is separate from language and/or locale
Leisure street games, gangs, sport,
clubs, books, weekends, holidays, festivals
“pins and needles”, “to feel under the
weather”, “Splitting headache”, etc.
Kummerspeck (DE) (weight gained from emotional eating)
Participant Poll
Which of the following do you find to be your biggest translation challenge?
a) Idioms, colloquialisms, other turns of phrase b) Complex grammar and run-on sentences
c) Terminology and jargon
d) Adaptation (for marketing, specific audience, etc.)
Rx for Improving Medical Translation in a Diverse World
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DEGREES OF ADAPTATION
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A SAMPLE PROCESS
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TEAM TRANSLATION
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BACK-TRANSLATION
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CHALLENGE I: MEANING VS. EFFECT
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SAY WHAT YOU MEAN… …MEAN WHAT YOU SAY
o Good translation requires a shift from referential meaning (dictionary) to pragmatic meaning (contextual)
o The patient audience requires communicative language
o Surveys are a comparative tool: concepts need to be translated to facilitate comparison across groups
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SPAIN VS. LATIN AMERICA
Mis problemas respiratorios me dificultan hacer cosas tales como, llevar cosas pesadas, caminar a unos 7
kilómetros por hora, trotar, nadar, jugar tenis, escarbar en el jardín o en el campo. (MEXICO)
Mis problemas respiratorios me dificultan hacer cosas tales cómo llevar cosas pesadas, caminar a unos 7 kilómetros por hora, hacer "jogging", nadar, jugar a tenis, cavar en el jardín o
quitar la nieve con una pala. (SPAIN)
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PLAIN LANGUAGE
LATIN ORIGIN PLAIN LANGUAGE ABDOMEN STOMACH
ANGINA CHEST PAIN
CONJUNCTIVITIS PINK EYE
DYSPNOEA SHORTNESS OF BREATH
LEUCOPOENIA LOW WHITE BLOOD COUNT
POLYURIA FREQUENT URINARION
TUMOUR CANCER
o There tends to be a shift in register between physician- and patient-oriented materials in English
o However, romance languages tend to use the Latin cognate, whereas English privileges less formal terminology
Participant Poll
How many locales do you have for your language combination(s)?
a) Only 1 b) 2
c) 3
d) 4 or more
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CULTURAL ADAPTATION In the Persian version of the Fatigue Impact Scale (FIS), only men were asked about financial matters and only married couples were asked about sexual activity.
Participant Poll Can you think of an example of cultural adaptation for patients in one of your languages?
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CHALLENGE II: EQUIVALENCE
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CROSS-CULTURAL EQ.
o Semantic equivalence – equivalence in the meaning of words
o Conceptual equivalence – validity of the concepts in the target language
o Idiomatic equivalence – equivalent idioms/expressions in target language
o Experiential equivalence – situations should fit target language
Rx for Improving Medical Translation in a Diverse World
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EQUIVALENCE? o Ultimately, patient surveys call for the privileging of conceptual
equivalence over semantic equivalence
** Back-translation & Validation **
“Use my arm to rise from a chair”
SOURCE TRANSLATION EXPLANATION CHAIR SESSEL Back-translated as “armchair” CHAIR STUHL Re-translated as
“chair” (generic)
Participant Poll
Are you ever asked to do back-translations?
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BACK-TRANSLATION
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IDIOMATIC EXPRESSIONS
Pure idioms conventional, non-literal multiword expressions that are opaque
(none of the components has a literal meaning)
“to spill the beans”
“hang tight”
“d’une seule haleine” (FR)
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IDIOMS IN SURVEYS o Ideally, idioms should be weeded out from the source language
patient surveys before translation.
YET! Time and time again, they make their way into patient surveys!
“out of the blue”
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THE PHQ EXAMPLE o In the case of patient surveys, if present, idioms should be
translated with non-idioms in the target (to stop any further confusion) – putting an end to the vicious cycle
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DEGREE OF FIDELITY o Does the concept of “walking several blocks” exist in your
language/culture?
ü Or, would a unit of measure (1 kilometre) be clearer?
o Would “to do laundry with a washer and dryer” make sense in your linguistic/cultural context?
ü Or, does a “dryer” conceptually exist, but is not widely used?
o What does “spend time with your family” mean in your language or culture? ü Does this automatically imply nuclear vs. extended family?
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CHALLENGE III: STRATEGIES
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THE HURDLES o Lack of consistence in terminology o Lack of consistency in methodology
o Inconsistent framing for target audience
Participant Poll
According to the diagram below, what type of translator are you?
Risk-taking
Capitulating
Prudent
Perseverant ✗
Rx for Improving Medical Translation in a Diverse World
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A SPECIFIC CASE
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STRATEGIES o Free translation o Back-translation & Validation
o Cultural adaptation
o Micro-level translation
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WHO IS YOUR TARGET? o What is the average literacy of the target population? o What is the locale of the target population?
o What is the patient environment? References?
Rx for Improving Medical Translation in a Diverse World
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VENUTI AND TRANSPARENCY o Lawrence Venuti’s modern translation
theory is based on the premise of invisibility.
o A “good translation” is “readable”, “fluent” and “idiomatic”.
o “in other words, that the translation is not in fact a translation, but the ‘original’:.
Rx for Improving Medical Translation in a Diverse World
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PRACTICUM
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EXAMPLE 1: FACIT-Sp-12
o The FACIT-Sp-12 is a Quality of Life (QoL) instrument used to measure Spiritual Quality of Life
o It is to cancer and terminal patients
o The survey is used as a tool during palliative care and end-of-life care
Rx for Improving Medical Translation in a Diverse World
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Rx for Improving Medical Translation in a Diverse World
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Rx for Improving Medical Translation in a Diverse World
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Rx for Improving Medical Translation in a Diverse World
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Rx for Improving Medical Translation in a Diverse World
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QUESTIONS?
Grazie
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Erin M. Lyons
BiomedNouvelle, LLC elyons@biomednouvelle.com
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