Rx for Improving Medical Translation in a Diverse World: a Closer Look at Patient Surveys

RX FOR IMPROVING

IN A DIVERSE WORLD

Medical Translation

A Closer Look at Patient Surveys

Participant Poll

What is the main type of patient-directed materials you translate?

a)  Patient Information Leaflets/Informed Consent Forms b)  Marketing Materials

c)  Patient Brochures/Guides

d)  Medical Interpretation

1 To culturally adapt meaning vs. effect

2 To determine commensurate source-target correspondence

3 To strategically translate to bridge the linguistic divide

Rx for Improving Medical Translation in a Diverse World

2014 ProZ.com International Conference – Pisa 3 © BiomedNouvelle

GOALS



PATIENT SURVEYS: AN INTRODUCTION



WHAT’S AT STAKE?

A question of language: The probability that someone is going to say their health is “excellent” is a question of language and culture.

Can you work with existing surveys to cover topics and adapt them to look at specific race, ethnic or linguistically diverse populations versus surveys that are expressly designed around these issues?

How would you translate this scale into one of your languages?

Not at all Somewhat Moderately so Very much so



o  Health Status – quality of health, dysfunction, symptoms and impairment

o  Quality of Life – evaluation of psychological, physical and social aspects of life affected by treatment over time

o  Well-being – evaluation of psychological illness, anxiety, depression and well-being

o  Patient Satisfaction – appraisal of experiences, side effects and efficacy

o  Symptoms and functioning – focus on range of and specific impairment

TYPES OF SURVEYS



TOP SURVEY COUNTRIES



TOP LANGUAGES



PATIENT OUTCOMES Patient Experiences

Office Staff Personal Doctors Phone Advice Specialists

Intermediate Outcomes

Adherence U8lisa8on Health Plan

Disenrollment

Health Outcomes

Health Status Func8on Status Life Expectancy

Mortality

Patient experiences are linked to important intermediate outcomes, such as adherence to treatment regimens, which in turn influence health outcomes



TRANSLATION CHALLENGES

o  Plain-language translation o  Cultural adaptation

o  Degree of fidelity

o  Idiomatic expressions/metaphors

o  Inter-linguistic abstraction

“mal di pancia” vs. “gastrite”, “optimal

care” (jargon) Health insurance, system,

etc. is separate from language and/or locale

Leisure street games, gangs, sport,

clubs, books, weekends, holidays, festivals

“pins and needles”, “to feel under the

weather”, “Splitting headache”, etc.

Kummerspeck (DE) (weight gained from emotional eating)

Participant Poll

Which of the following do you find to be your biggest translation challenge?

a)  Idioms, colloquialisms, other turns of phrase b)  Complex grammar and run-on sentences

c)  Terminology and jargon

d)  Adaptation (for marketing, specific audience, etc.)



DEGREES OF ADAPTATION



A SAMPLE PROCESS



TEAM TRANSLATION



BACK-TRANSLATION



CHALLENGE I: MEANING VS. EFFECT



SAY WHAT YOU MEAN… …MEAN WHAT YOU SAY

o  Good translation requires a shift from referential meaning (dictionary) to pragmatic meaning (contextual)

o  The patient audience requires communicative language

o  Surveys are a comparative tool: concepts need to be translated to facilitate comparison across groups



SPAIN VS. LATIN AMERICA

Mis problemas respiratorios me dificultan hacer cosas tales como, llevar cosas pesadas, caminar a unos 7

kilómetros por hora, trotar, nadar, jugar tenis, escarbar en el jardín o en el campo. (MEXICO)

Mis problemas respiratorios me dificultan hacer cosas tales cómo llevar cosas pesadas, caminar a unos 7 kilómetros por hora, hacer "jogging", nadar, jugar a tenis, cavar en el jardín o

quitar la nieve con una pala. (SPAIN)



PLAIN LANGUAGE

LATIN ORIGIN PLAIN LANGUAGE ABDOMEN STOMACH

ANGINA CHEST PAIN

CONJUNCTIVITIS PINK EYE

DYSPNOEA SHORTNESS OF BREATH

LEUCOPOENIA LOW WHITE BLOOD COUNT

POLYURIA FREQUENT URINARION

TUMOUR CANCER

o  There tends to be a shift in register between physician- and patient-oriented materials in English

o  However, romance languages tend to use the Latin cognate, whereas English privileges less formal terminology

Participant Poll

How many locales do you have for your language combination(s)?

a)  Only 1 b)  2

c)  3

d)  4 or more



CULTURAL ADAPTATION In the Persian version of the Fatigue Impact Scale (FIS), only men were asked about financial matters and only married couples were asked about sexual activity.

Participant Poll Can you think of an example of cultural adaptation for patients in one of your languages?



CHALLENGE II: EQUIVALENCE



CROSS-CULTURAL EQ.

o  Semantic equivalence – equivalence in the meaning of words

o  Conceptual equivalence – validity of the concepts in the target language

o  Idiomatic equivalence – equivalent idioms/expressions in target language

o  Experiential equivalence – situations should fit target language



EQUIVALENCE? o  Ultimately, patient surveys call for the privileging of conceptual

equivalence over semantic equivalence

** Back-translation & Validation **

“Use my arm to rise from a chair”

SOURCE TRANSLATION EXPLANATION CHAIR SESSEL Back-translated as “armchair” CHAIR STUHL Re-translated as

“chair” (generic)

Participant Poll

Are you ever asked to do back-translations?



BACK-TRANSLATION



IDIOMATIC EXPRESSIONS

Pure idioms conventional, non-literal multiword expressions that are opaque

(none of the components has a literal meaning)

“to spill the beans”

“hang tight”

“d’une seule haleine” (FR)



IDIOMS IN SURVEYS o  Ideally, idioms should be weeded out from the source language

patient surveys before translation.

YET! Time and time again, they make their way into patient surveys!

“out of the blue”



THE PHQ EXAMPLE o  In the case of patient surveys, if present, idioms should be

translated with non-idioms in the target (to stop any further confusion) – putting an end to the vicious cycle



DEGREE OF FIDELITY o  Does the concept of “walking several blocks” exist in your

language/culture?

ü  Or, would a unit of measure (1 kilometre) be clearer?

o  Would “to do laundry with a washer and dryer” make sense in your linguistic/cultural context?

ü  Or, does a “dryer” conceptually exist, but is not widely used?

o  What does “spend time with your family” mean in your language or culture? ü  Does this automatically imply nuclear vs. extended family?



CHALLENGE III: STRATEGIES



THE HURDLES o  Lack of consistence in terminology o  Lack of consistency in methodology

o  Inconsistent framing for target audience

Participant Poll

According to the diagram below, what type of translator are you?

Risk-taking

Capitulating

Prudent

Perseverant ✗



A SPECIFIC CASE



STRATEGIES o  Free translation o  Back-translation & Validation

o  Cultural adaptation

o  Micro-level translation



WHO IS YOUR TARGET? o  What is the average literacy of the target population? o  What is the locale of the target population?

o  What is the patient environment? References?



VENUTI AND TRANSPARENCY o  Lawrence Venuti’s modern translation

theory is based on the premise of invisibility.

o  A “good translation” is “readable”, “fluent” and “idiomatic”.

o  “in other words, that the translation is not in fact a translation, but the ‘original’:.



PRACTICUM



EXAMPLE 1: FACIT-Sp-12

o  The FACIT-Sp-12 is a Quality of Life (QoL) instrument used to measure Spiritual Quality of Life

o  It is to cancer and terminal patients

o  The survey is used as a tool during palliative care and end-of-life care











QUESTIONS?

Grazie



Erin M. Lyons

BiomedNouvelle, LLC [email protected]

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Rx for Improving Medical Translation in a Diverse World: a Closer Look at Patient Surveys

Health & Medicine