Building inventory of foreign language materials in a cost-effective manner

Select wisely, pool resources, and make sure you are on target

Written materials are common teaching tools used to reinforce verbal instruction . . . in English. Foreign language materials aren't as abundant. One reason for the smaller inventory is the cost of translation.

"We have several thousand documents in our English patient education inventory. No health system can afford to make those resources available in multiple languages," says Diane Moyer, BSN, MS, RN, program director of patient education at The Ohio State University Medical Center in Columbus.

Due to cost, Mount Carmel East is not able to translate its entire inventory either, according to Karen Guthrie, MS, RN, manager of community and patient education at this health care facility located in Columbus, OH. "We have translated many topics that are high-volume topics and especially those related to safety and those that have long-term health impact," says Guthrie.

These topics would include information on high blood pressure, managing risk factors for heart disease, and various nutrition topics, such as limiting sodium.

Due to the cost of translation and the large variety of languages patients speak, most health care facilities struggle to build an appropriate foreign language inventory, says B.J. Wingert, RN, BSN, MS, a patient education specialist at OhioHealth in Columbus. "Health care budgets have only gotten tighter over the last few years," she adds.

However, there are ways to build a foreign language inventory. These three health care professionals have formed a partnership along with a fourth institution, Nationwide Children's Hospital, to translate materials. They meet to select materials, then work to make them generic and more culturally appropriate before having them translated. The teaching materials are posted on a web site — www.healthinfotranslations.org.

"Our community has benefited from the partnership we have to develop a collection of translated documents," says Moyer.

With the partnership, her institution went from an inventory of 20-30 titles in Spanish to having access to the 3,000 titles in 18 languages through HealthInfoTranslations.org. She encourages others to share translated documents across health systems, so clinicians have the tools they need to provide more appropriate education to immigrant patients receiving care.

In addition to the combined effort, each of the institutions has strategies for building an in-house inventory.

Moyer says to keep costs in check, it is important that requests for translation of documents come through channels through which agreement has been reached on the priority needs and how the funds will be allocated. At OSUMC, requests are to be made through customer services or the patient education office. Interpreter services staff know that if a request to translate a document is made to their office, it must be referred to the proper departments.

Another cost-saving strategy is to make sure documents are in a patient-friendly format and style before translation, so the copy is understandable. Also, it is important to be sure that patients speaking a particular language have skills in reading, because print documents aren't helpful to patients who are not literate in their primary language.

Evaluate populations

Make sure the population has some interest in the topic or health condition, and that there is a volume of patients who might use the translated document, advises Wingert.

Conditions and diseases that affected immigrants in their homeland may decrease in the United States, and they may begin to adopt some American lifestyle practices that contribute to other diseases. Health care needs can be a moving target, explains Wingert.

Guthrie says prioritizing topics for translation helps to keep costs under control. She prioritizes according to safety, which covers many topics addressed by National Patient Safety Goals and high-volume/high-use topics such as pregnancy and heart disease.

Items required to meet regulatory requirements need to be translated despite the cost; however, these are generally items related to safety that would be translated regardless of the requirements, such as preventing falls and preventing infections, says Guthrie.

"As new topics are added in English, we evaluate the need for translation into other languages. We also translate items in the current inventory as they become used more frequently," explains Guthrie.

At Mount Carmel, in-house translators are used for the three main languages needed: Spanish, Somali, and Russian. In addition, the vast resources on healthinfotranslations.org are accessed. Guthrie says she has an appropriate inventory of foreign language materials between Mount Carmel materials and the web site.

Purchasing materials from a vendor can be more cost-effective than producing them with either in-house translators or a local translation company, if a vendor can be found that addresses an institution's high-need languages, says Moyer. Most often, commercial vendors are only addressing those topics and languages that target the larger percentage of their client base. "For the most part, items are available in Spanish from more of the commercial suppliers, but the topics in other languages are few outside of high-risk issues," she says.

Language and topic needs can be all over the place, says Moyer. One day she might get a call from a clinician for something about heart failure in Russian, and the next day field a question related to fasting in Arabic for a patient with diabetes. The next week the request might be for a teaching sheet on crutch walking in Italian.

If a clinician requests a topic in a foreign language and only one patient needs the material, Moyer will do an online search with the help of the librarian at the medical center. Also, she contacts patient education coordinators at other institutions to see if they might have a translated document they would let Moyer use. She has web sites bookmarked for certain language topics, such as Medline Plus and Healthy Roads Media.

To create a greater inventory, the four patient education coordinators in Columbus who work together on teaching materials seek funding from foundations and other grants, but this money can be elusive.

The political climate related to immigration has put a wall up for some funders, in addition to the tough economy of the past couple years, explains Moyer.

"It takes a lot of time and energy to write a grant, and then you have no guarantee that you are going to get any funds," she adds.

Those giving grant money have a difficult time understanding why the process of translation is so expensive, and why faculty and students who speak the language can't translate materials instead of medical translators.

Yet proper translation is very important in patient education, says Moyer. Crackers may mean cookies in one language and saltines in another, which could be a problem for the patient who needs to limit sugar or salt intake. Translators also need to be cautious about phrasing.

"Translations are very complex, and each language group brings its set of issues that must be addressed. It is more than just taking the English version and running it through a conversion on the computer, and it is an expensive sell," explains Moyer.

Wingert adds that funding sources want data or research showing how the money/project affected patients. While the group has a lot of anecdotal examples of how clinicians used the materials translated for healthinfotranslations.org, it doesn't have actual data on improved patient outcomes.

Regardless of the difficulties or cost, it is very important to have materials available to patients in the language they are comfortable reading and speaking, says Guthrie.

"Retention of verbal instructions — even with an interpreter — is difficult when we add in the various learning barriers and challenges that are inherent in a health care setting. Therefore, whenever possible, we need to offer our foreign language-speaking patients the same standard of care that we do for our English-speaking patients, providing written health education materials," explains Guthrie.

Sources

For more information about building a foreign language patient education inventory, contact:

• Karen Guthrie, MS, RN, Manager, Community and Patient Education, Mount Carmel East, 5975 East Broad St., Columbus, OH 43213. Telephone: (614) 234-6062. E-mail: kguthrie@mchs.com.

• Diane Moyer, BSN, MS, RN, Program Director, Patient Education, The Ohio State University Medical Center, 660 Ackerman Road, Room 667, P.O. Box 183110, Columbus, OH 43218-3110. Telephone: 614-293-3191. E-mail: Diane.Moyer@osumc.edu.

• BJ Wingert, RN, BSN, MS, Patient Education Specialist, OhioHealth, 550 Thomas Lane, Columbus, OH. Telephone: (614) 566-5613. E-mail: bwingert@ohiohealth.com.