Foreign-language material reinforces teaching and improves outcomes

To meet the needs of culturally diverse patients, turn to the written word

Providing written materials for a multicultural population is a high priority for many health care institutions. If an educational piece is important for teaching English-speaking patients, then it equally is important that non-English-speaking patients receive the piece as well, says Etta Short, MS, a health educator at the University of Washington Medical Center in Seattle. "We want to serve the non-English-speaking patient in the same and equal way," she explains.

Similar to English-speaking patients, non-English-speaking patients rarely remember all the verbal instructions they are given. Therefore, it is good to reinforce the lesson with a written handout, reports Diane Moyer, BSN, MS, RN, program manager for consumer health education at The Ohio State University Medical Center in Columbus. "Often we don’t provide materials for our non-English-speaking patients because we don’t have them available," she says. This leads to problems. For example, sometimes non-English-speaking patients fail to prepare for diagnostic tests properly because they can’t remember what the interpreter told them at their last visit.

"In such cases, the test has to be rescheduled. It is difficult to have good utilization of resources when we can’t communicate well," says Moyer.

However, there are many barriers to providing written materials to patients from other cultures, and the greatest of these is the expense. Moyer has $5,000 in her budget slated for the translation of patient education materials. The cost of translation for patient information materials such as consent forms, patient rights, and parking directions is covered by funds in the customer service budget. Yet at $40 a page for translation, not many educational documents are printed annually.

To help stretch her budget, Moyer has partnered with the patient education managers at the other two large health care systems in Columbus. They plan to pool their money for the translation of general patient education materials that are of common use to all three systems, and together they also applied for grants to help cover the cost of translation.

When they first met, they discovered that they all had the same translated inventory, such as baby care and pregnancy information. They all had selected these topics because they are considered high-need and high-risk. "We found that none of us has the budget to translate a lot of the other types of educational materials such as those for chronic disease or tests and procedures," says Moyer. Yet these topics are not system-specific. Generally, heart failure is heart failure whether the patient is at a health care system in Ohio or elsewhere, she adds.

The three patient education managers plan to make the generic materials they have translated available on their intranets so that they are accessible to all clinicians within their systems. However, they also will be available to the community at large so that clinicians outside the three health care systems who serve the Central Ohio multicultural populations will also have access to the materials.

"The material will be available in dual languages so that English-speaking clinicians who don’t know these foreign languages will be able to know what they are handing out," says Moyer.

To make sure the materials meet the needs of the target populations, the patient education managers will assemble a few community focus groups consisting of members of each target cultural population. In this way, they can get an idea of the issues the various cultures have with health care and incorporate the information into the pieces. "Also, we will find out if there are some particular items that we need to incorporate related to rituals, beliefs, or practices," says Moyer.

In addition to pooling resources for translation to make better use of funds, the partners hope to contain costs by conducting an extensive search to determine what is available in the public domain. "We want to see what is currently available that we could link to or import somehow into our inventory to make available to our clinicians," says Moyer.

They also hope to partner with other health care systems that are willing to share documents. Frequently, staff at other health care institutions will contact Moyer to ask if they can translate one of the patient education items that is posted on The Ohio State University Medical Center’s web site. If the other institution will allow Moyer to use the translated copy and include it in the inventory on the medical center’s site, she gives permission.

Without enough funds to translate all educational materials from English to the foreign languages most frequently spoken by patients seen at the health care facility, patient education managers must determine where to spend their money. They must figure out which publications would be the most cost-effective to translate, says Moyer.

At the University of Washington Medical Center, staff in patient and family education services created guidelines for the selection and translation of written materials into the foreign languages spoken by its diverse patient population. These languages include Amharic, Chinese, Korean, Farsi, Russian, Somali, Spanish, Tagalog, Tigrigna, and Vietnamese.

With the aid of the guidelines, the medical center is able to translate between 12 and 18 English-version documents in up to five languages, adding between 30 and 50 documents to its collection each year, says Short. "We have a certain amount of funds we can use for translation each year, so we want to be able to serve our patients the best we can with the funds we have to do the translations."

The best way to determine which teaching materials to translate is to go to the departments and ask, she says. Therefore, each April, patient and family education services sends out a request for proposed translations.

During the solicitation period each clinical services area identifies five frequently used patient education documents authored by the medical center that need to be translated into one or more languages. To help make the determination, staff can use data from interpreter services but generally they know which ethnic groups they see, says Short.

Departments are requested to prioritize the documents selected for translation and to identify the estimated number of patients per month that could be given the material. They have one month to submit their requests for translation. Once the requests are on file, Short checks the patient and family education database to determine if the material has been translated or is in the process of being translated before submitting it to a multidisciplinary task force for review. The task force ranks each publication according to set criteria. With the aid of the criteria the review process takes about two hours. Generally, everything that receives a 3.5 rating and above is submitted for translation. However, before the list is finalized, Short has a translation vendor that has been approved by the medical center provide a cost estimate to ensure that the project remains within budget.

The list of approved translations is completed by June, and a letter is sent to each department contact with the titles of documents and the languages that have been approved or rejected. If a document is not accepted for translation, the reasons it did not meet the criteria is included in the letter. (Short is willing to share the complete guidelines for the selection and translation of materials with anyone who asks. See sources at the end of this article.) Once the materials are translated and available as patient handouts, it is important to get the word out so they will be well used by clinicians to educate patients.

A newsletter that goes out every quarter at the University of Washington Medical Center lists all patient education materials that were printed or published for that quarter, both English and translated information. Also, all translated pieces are in the on-line inventory so clinicians can do a search and then print them out, says Short.

Currently, The Ohio State University Medical Center is upgrading its intranet, and part of the project includes flagging English titles that have versions in other languages. Titles also can be found in language subcategories such as Spanish or Somali. "We are trying to do more cross-referencing so that staff know the translated pieces are there," says Moyer.


For more information on translating educational pieces to meet the needs of a multicultural population, contact:

Diane Moyer, BSN, MS, RN, Program Manager, Consumer Health Education, The Ohio State University Medical Center, 1375 Perry St. Room 524, Columbus, OH 43201. Telephone: (614) 293-3191. E-mail:

Etta Short, MS, Health Educator, Patient and Family Education Services, University of Washington Medical Center, 1959 N.E. Pacific St., Mail Stop 358126, Seattle, WA 98195-6052. Telephone: (206) 598-7448. E-mail: