Project's problems tackled one by one

Benefits make overcoming glitches worthwhile

When the patient education coordinators at The Ohio State University Medical Center, OhioHealth, and Mount Carmel in Columbus partnered to create translated educational handouts for patients limited in English proficiency they encountered a few problems.

"Our biggest struggle is getting funding. It is very time consuming. We do a lot of work in that area," says BJ Wingert, MS, RN, patient education specialist at OhioHealth.

A grant from the Columbus Medical Association Foundation helped launch the project and the same foundation provided a second year grant. The Mount Carmel Foundation agreed to provide some funding for translation and the OhioHealth Foundation is considering it as well. Ohio State is covering the salary of the project assistant for one year.

"Ideally we would like to get an endowed fund started to keep the project going for three to five years," says Diane C. Moyer, MS, RN, consumer health education manager at The Ohio State University Medical Center.

Moyer says the group wants to expand the project to include multi-media materials so patients could hear a voice reading the words accompanied by a few pictures as many immigrants that need medical care don't read well in their own language. Procedural things, such as giving injections or wound care, would work well in this format, says Moyer.

"I have personally spent hours and hours doing proposals and grant applications. It is very frustrating that we aren't able to get everything we are asking for but we also realize we have been very fortunate in what we have gotten for this project and we are glad to have it off and running," says Moyer.

In addition to the cost of translating most material into nine languages, changing illustrations so that they are culturally appropriate has added to the cost. The group has had their illustrator create multiple faces so the way the patient looks in the document matches the print language. For example, Hispanics are used when Spanish is the translation or Asians if the document is in Chinese or Japanese.

The decision to work with a translation service that provides several checks for accuracy and a quick turnaround time has caused some relationship problems between immigrant community contacts and the patient education coordinator partnership. Therefore, the partnership is looking for ways to use the skills within these community groups so they receive some of the grant money funding the project. Once the partners are able to create multi-media materials members of the various immigrant communities might be able to do some of the oral interpretation, says Moyer.

Getting focus groups from the various immigrant communities to help tailor the handouts to each patient population is often challenging, says Wingert. Material on the Web site is more culturally appropriate when these community groups provide input. For example, in the Spanish version of the teaching sheet on depression the term is referred to as "feeling sad" for the Hispanic population does not like the word "depression."

Benefits outweigh problems

While the project has had a few glitches the benefits far outweigh any of the difficulties.

"The benefit for Mount Carmel is having many more translated materials available and that is the same benefit for our community and really across the country. Anyone can use these handouts for their purposes at no charge. I think that is a benefit for patient education in general," says Karen Guthrie, MS, RN, patient education specialist at Mount Carmel.

These handouts also provide consistent information for people in the various immigrant communities who are often intimidated by the health care system and therefore like to share what they learn, she says.

This sharing helps get information on preventative health care out into the community, says Wingert. "Knowledge doesn't always change behavior but you have to start there. When people don't understand what they can do to prevent disease or keep healthy they never have a choice to make those decisions to be healthy," she explains.

Guthrie says the feedback from health care professionals working with the immigrant population has been positive and they find the handouts an asset to the care they give.

The project has been personally of benefit to those involved as well.

"Consistently working with two really excellent people outside my system has stimulated my writing and brought it up a level in terms of easy to read. Anyone can write about these topics at a high level, it is getting it at that standard easy to read level that is more difficult," says Guthrie.

Since the three patient education coordinators meet every three weeks they are able to discuss problems they have with their workload in general and bounce ideas off one another. Since all basically work in one-person departments this support has been very helpful, says Wingert.