Are you keeping up with the changing work force?

Language, literacy gaps may affect training

As hospitals hire growing numbers of foreign-born workers, employee health professionals are facing an unprecedented challenge to adapt health and safety training.

The proportion of Hispanic workers in the U.S. work force is expected to increase by more than one-third by 2008, and the number of Asian workers will rise by about 40%, according to the Bureau of Labor Statistics. Overall, about one in 10 Americans was born in a foreign country, according to a recent U.S. Census report.

While some workers, such as Filipino nurses, are well-educated and highly proficient in English, low-wage foreign-born employees may struggle with literacy even in their native language. The bottom line: Employers must make sure employees understand the health and safety training, not just that they receive it, employee health experts stress.

That may include providing written materials in the employees’ native language, using an interpreter during training sessions, and considering cultural and literacy issues, says Sherry Baron, MD, MPH, medical officer and co-team leader of special populations at risk for the National Institute of Occupational Safety and Health (NIOSH) in the Cincinnati division office.

"No matter if the employees’ first language is English or not, you must have training that they can understand," emphasizes Sandra Elias, RN, OHN, occupational health and workers’ compensation consultant at St. Jude Heritage Occupational and Environmental Health Services in Fullerton, CA.

Courtesy masks lack of comprehension

New employees may be so agreeable that they nod politely when asked if they understand the information in a training session, but the consequences of that gentle evasion can be significant.

Piedmont Hospital in Atlanta hired a group of young men from Sudan who had been dubbed "The Lost Boys" because of their traumatic experiences after their villages had been destroyed. The men had high school education, and some even had attended college. While they speak English, "some of them understand better than others," says Joyce Geddie, RN, former manager of the hospital’s employee health clinic. Their native language was an unusual African dialect that was not available from translation services.

As new employees in environmental services, they received the standard orientation as well as specific training in bloodborne pathogens. They acted as if they understood everything, even nodding during the training session, Geddie says.

But when one employee was observed pushing down on the trash with a gloved hand, Geddie realized the training would have to be repeated, this time with feedback focused on determining whether the employees understood.

"You need to be prepared for all the extra [things] you need to do," she says. Piedmont also has a large Hispanic work force and has conducted some training in Spanish. The Material Data Safety Sheets also are in Spanish, she says.

New web sites offer Spanish versions

As hospitals and other employers recognize the importance of training geared toward immigrant workers, more resources are becoming available.

The U.S. Occupational Safety and Health Administration (OSHA) announced efforts to improve safety for Hispanic workers and launched a Spanish-language web site. Employees now can file OSHA complaints in Spanish.

The NIOSH division office in Morgantown, WV, just launched a Spanish-language web site with links to other health and safety information in Spanish. The web site includes about 25 NIOSH documents that have been translated into Spanish, as well as some documents from OSHA. (For more information, see editor’s note, below.)

"It was really in response to a large demand from employers and from our own discussions with people in industry and labor. There was a big need for [material in the] Spanish language," says Marie Haring Sweeney, PhD, chief of the document development branch in the education and information division.

The Centers for Disease Control and Prevention (CDC) in Atlanta has published Vaccine Informa-tion Statements (VISs) for DTaP, hepatitis B, and pneumococcal conjugate vaccines in 12 languages, and has information on hepatitis A, B, and C in Spanish and Turkish. The CDC also has developed a Spanish-language web site.

Meanwhile, employers sometimes hire translators for specific orientation materials. "When I do training — I am not bilingual — I have translated the forms into Spanish," says Elias.

She sometimes works with a translator as she conducts a session. Even if the employees seem to have good English skills, it may be helpful for them to have printed material in their native language, she says.

If you have workers who actually are employed by an outside contractor, such as food services or security personnel, you are not absolved from responsibility to make sure they were properly trained, Elias notes.

"I’d ask for their training documentation and an outline of their training," she says. "I’d also watch and see what they’re doing."

Language isn’t the only barrier that can affect comprehension of training material. Sometimes cultural differences may affect how employees interpret policies.

"Trainers may take for granted information about disease or disease causation, but it may be very different in another culture," Baron says.

In one case, researchers observed that farm workers weren’t washing their hands after working in the fields. After some discussion with workers, they learned that the workers mistakenly believed that they could get arthritis or other conditions from washing with cold water.

Low-wage earners who are recent immigrants also may have lower literacy levels, Baron says. Training methods should take that into account, she says.

"Some training methods that may be more participatory, involving the use of lots of drawings and explanations and activities, probably work well for everybody, but [they work] particularly well for individuals who come from backgrounds where they’re not as attuned to reading documents," Baron points out.

It may seem like a new burden to provide foreign-language materials or training. But keep in mind that foreign workers usually represent a growing segment of the community served by the hospital, she says.

"You’ll be hiring people as part of an ever-increasing size of some ethnic community."

(Editor’s note: The Spanish-version OSHA web site is at, and the NIOSH web site is available at The Spanish version CDC site is at Information on AIDS/HIV is available in Spanish at and