Rx for Improving Medical Translation in a Diverse World: a Closer Look at Patient Surveys

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
2014 ProZ.com International Conference – Pisa 3 © BiomedNouvelle
GOALS

PATIENT SURVEYS:
AN INTRODUCTION

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

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

TOP SURVEY COUNTRIES

TOP LANGUAGES

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

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.)

DEGREES OF ADAPTATION

A SAMPLE PROCESS

TEAM TRANSLATION

BACK-TRANSLATION

CHALLENGE I:
MEANING VS. EFFECT

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

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)

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

CULTURALADAPTATION
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?

CHALLENGE II:
EQUIVALENCE

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

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?

BACK-TRANSLATION

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)

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”

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

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?

CHALLENGE III:
STRATEGIES

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
✗

A SPECIFIC CASE

STRATEGIES
o  Free translation
o  Back-translation & Validation
o  Cultural adaptation
o  Micro-level translation

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?

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’:.

PRACTICUM

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

QUESTIONS?

Grazie
Erin M. Lyons
BiomedNouvelle, LLC
elyons@biomednouvelle.com

Rx for Improving Medical Translation in a Diverse World: a Closer Look at Patient Surveys

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