How to choose and work with translators

Accurate translations result from team effort

The translation process of educational materials from English into Spanish or another language will be a successful project if several steps are followed, says Lynn Gordon, MPH, a health education writer in Los Altos, CA.

Everyone has a limited budget. Therefore, a patient education manager must first decide what is appropriate to translate, she says. Factors to consider include how many people within a patient group speak a particular language, whether they are literate in that language, if the subject is appropriate or of interest to the population, and if this audience likes to receive medical information in a written format.

If a translation project is approved, the next step is to find a qualified translator. Get recommendations from colleagues, advises Gordon. Translators can also be found on association web sites. For example, the Northern California Translators Asso-ciation has a list of translators with a description of the projects they have worked on. If a translator has worked for the court system or fashion industry, but has no experience related to health, he or she would not be a good choice, says Gordon.

Also, if the Spanish-speaking patients served by a health care system are from Mexico and the translator is from South America, the translation may not be appropriate. Spanish varies from country to country, explains Gordon.

"That doesn’t mean that the translators aren’t qualified for the job. However, you would want to make sure they have a lot of experience with people of Mexican descent living in the U.S.," says Gordon. The same word in Spanish will mean something completely different. For example, the word for baby that Chileans use is the word that Puerto Ricans use for bust, she explains.

It is important for the translator to be familiar with health education. Many medical translators are more accustomed to doing technical work, and use a level of language that is not appropriate for patients, says Gordon. Also, certification is not a good criterion for selection because there are almost no certification programs in the United States, she adds.

When determining whether to work with an agency vs. an individual translator, be aware that there are pros and cons to both. Consistency can be a problem with an agency. If a project is extensive, several translators may work on the piece and, if they don’t coordinate the work, the terminology within the material may not be consistent.

Also, although a project completed by an agency may be good, there is no guarantee that the same translator will work on future material submitted by a health care institution. "The next time you may have a different translator working on your materials who may not do as good a job, so you don’t always know what you are getting," says Gordon. An agency usually is quicker than an individual, especially on a large project, she says.

Location doesn’t really matter for it is easy to work with translators electronically. Gordon has several out of state clients. "The nice thing about a person being local is they are more likely to be familiar with your local population to the extent that is needed," she says.

Working with translators

Before hiring a translator, ask for references. Also ask to see samples of his or her work so it can be reviewed for spelling, grammar, and writing technique. And be sure to discuss price as well.

"There are three different ways to charge. The translator could charge by the word, the hour, or the piece," says Gordon. If the charge is per word, find out if it is according to the English words or the language in which the material will be translated, she advises. The translated version is usually longer than the English version.

If possible, get an agreement for a price per English word so the cost is clear. Anyone on a budget should get an estimate per piece, says Gordon. "If you are trying to see if you can afford a translation, you can ask for a range of what might be charged," she says.

Once a translator is selected, do a trial project, advises Gordon. Have that project back-translated, or at least have a native speaker review the material.

Word-for-word translation is never appropriate for educational materials. Frequently, the material is difficult to read and doesn’t sound natural because the syntax is different from English. For example, in German, the verb is at the end of the sentence; therefore, if translated word-for-word into English it would be difficult to read and distracting. "A person needs to be a good writer to produce a good readable translation," says Gordon.

No matter how skilled the translator, the project should be a team effort and include the patient education manager. It’s important that translators know that they can call with questions. "As a person who does some translating, I think it is very important and helpful to have your materials prepared properly for translation," says Gordon. If something is well written in the first place, it is easier to translate and it is more likely that the translation will be accurate and of high quality.

Some translators will lower the reading level, including Gordon. However many translators are not able to do this. Therefore, it is wise to make sure the document is at an appropriate reading level for the target population in the English version.

Is it culturally appropriate? 

Consider cultural adaptations as well. For example, when discussing exercise in the English version, skiing might be suggested. But if the brochure is for people from Mexico, another sport might be substituted, such as soccer or dancing, because many Mexicans would not be familiar with skiing, says Gordon.

If the translator is asked to culturally adapt the material, ask to see what was substituted before the final version is completed, advises Gordon. For example, if the pamphlet discusses nutrition, foods appropriate to the particular ethnic group should be substituted.

When there are references in a brochure such as hotlines, books, or classes, let the translator know if they are available in the language of the target population, such as Spanish. "If they are, then you need to get their official names in the language that you are translating into and the correct phone numbers," says Gordon.

When the resource is not available in the reader’s language, mention it, but indicate that it is only in English and find alternatives in the language, or omit the reference, says Gordon.

Encourage the translator to use the most generic terms when translating the piece. There may be several words for one item, but one word might be more mainstream than all the others, says Gordon. If there are one or two alternate words that might be understood by some people exclusively, they can be put in parentheses after the other term, she says.

Titles of publications often have a play on words or slang in them. In this case, work with the translator to come up with a title that would be appropriate in the other language, advises Gordon. Also, let the translator know if there is anything in the brochure or pamphlet that needs to be left in English, such as a funding credit or cataloguing information. Some English words that the reader might find on a product label in the United States might be left in as well.

The translator may need to provide keys in the material so the graphic designer knows which piece corresponds to the English version. "For some jobs, that is important or your graphics people will be confused," says Gordon.

When working with a translator on a piece, it is important to find out if the translation will take up more space. For example, Spanish can take up 25%-30% more space than English. "If you need to fit something into a certain space and you are going into a longer language you may need to figure out what you want to cut before you hand the material over to a translator. In that way you won’t spend money having something translated that won’t be in the final product," says Gordon.

When the accuracy of the information is of vital importance, it is a good idea to have it back-translated before the final copy is submitted for publication, says Gordon. For example, if the material contains critical information, such as post-op instructions, you need to be sure the patient clearly understands the signs that would prompt him or her to call the physician immediately.


For more information about the translation process, contact: Lynn Gordon, MPH, Health Education Writer, Los Altos, CA. Telephone: (650) 941-5672.