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Rules for creating culturally appropriate materials
When creating written materials for a multicultural population, translation from English to the target language is not enough. There are many other factors that must be taken into account to make sure the target audience understands the information. Health literacy is more than just being able to read the information, it is being able to act on it, says Sandra Cornett, PhD, RN, director of The Ohio State University AHEC Health Literacy Program in Columbus. "Culturally and linguistically appropriate materials must include not only the words people understand but also the logic they use and a connection to their experience," she explains.
Even exact translations may not make sense to the target audience. People’s background and culture often provide a different frame of reference than the one American’s are accustomed to, and this creates barriers to understanding. For example, Latinos often are put off by facts, says Cornett. They like to have information given in the context of family or community participation rather than having everything presented as an individual effort.
Cornett offers the following tips to help patient education managers make sure that teaching materials are culturally appropriate:
• Get target audience involved. One way to learn how other cultures prefer their message framed is to get them involved in the developmental process from the start. "Find out what the intended audience wants and how they perceive the issue, then write the material from their perspective," says Cornett. In this way, the material is more likely to be consistent with the reader’s beliefs about health, the cause of illness, methods of curing, and death. The recommended treatments and diets will be something they are more likely to follow as well. For example, a person from another culture may not think that his or her illness is a result of germs but rather a mind/body disconnection.
• Don’t assume that the medical process is understood. People from other cultures may not know what to expect in a medical encounter within the American health care system. Therefore, this information may need to be included. For example, people from other cultures may need to be told that the physician will take a medical history by asking them several questions. If they don’t understand this, they may think the physician is not skilled. Or patients may need to be told that the physician may give them a prescription for medication and what to do with the piece of paper. In their culture, they may not get medications from pharmacies.
Presentation of information
• Consider appropriateness of the presentation. The organization and sequence of information can be different with other cultures. Pamphlets for people born in the United States often begin with an overview or the big picture followed by specific steps. People in other cultures may want to learn gradually and not have so much information included in the introduction. In addition, a symbol that is common in the United States may not be understood by other cultures. For example, not everyone eats with a knife and fork. While cartoons and cartoonlike figures may be appropriate in pamphlets designed for an American patient population, humor may be seen as offensive to people of other cultures. In some cultures, health care is seen as serious. Therefore, humor would not be used to provide information on a health issue.
• Use graphics to support message. Pictures and visual cues help supplement the message and graphics reinforce key concepts. However, the images must match the intended audience in terms of ethnicity, dress, age, gender, income level, and activities in which they engage.
• Field test materials. When writing for other cultures, it is important to field test the material to make sure that it is in keeping with cultural norms and not offensive in any way. There are many different dialects, and a Spanish word that might be appropriate for people from Puerto Rico might be offensive to patients from Mexico. Also, there may not be a word for the English equivalent of a certain condition or body part. Therefore, a description will replace it. For example, there is no Vietnamese word for cervix. It’s important to know that the content is understood.
• Provide information in multiple ways. Print is not the only or necessarily the best way to communicate health information with people from other cultures. Audiotapes, pictorial materials, stories, props, or role-playing may be good ways to disseminate information, especially with people who are not literate in their own language. Written materials might be more effective if they are formatted in ways that are culturally appropriate. For example, Latinos like novellas with the material presented from the perspective of what the family is experiencing and written like a story.
For more information about writing culturally appropriate materials, contact:
• Sandra Cornett, PhD, RN, Director, OSU/AHEC Health Literacy Program, Office of Health Sciences, The Ohio State University, 218 Meiling Hall, 370 W. Ninth Ave., Columbus, OH 43210-1238, Telephone: (614) 292-0716. E-mail: firstname.lastname@example.org.