Most patient surveys are developed for a homogeneous Western target population and fail to take into consideration the diverse cultures, languages and geographies of the actual patient pool. Yet, such surveys remain one of the cornerstones for evaluating patient experience and for patient-provider communication. Some situations and activities in patient questionnaires are not relevant or equivalent across cultures (back pain caused by shoveling snow, walking several blocks, doing housework). In other cases, terms need to be adapted for specific locales (“saubermachen” in Germany, but “putzen” in Switzerland for “cleaning”). These linguistic and cultural gaps are reason for serious concern and translators must learn to use cross-cultural adaptation to guarantee both conceptual and semantic equivalence to ensure the reliability and validity of patient-reported outcomes. We will examine common problems that arise during the translation, back-translation and validation steps and tackle “untranslatable” concepts, idiomatic expressions and metaphors and degrees of linguistic deficiency and abstraction. At the end of this training session, participants will be able: To choose between the meaning and effect of the source translation to adapt to the cultural and linguistic conventions of the target community. To determine the degree of source-target correspondence and the commensurate degree of fidelity of the translation in a medical context. To apply free translation strategies to translate cultural references, idioms, and micro-level translation problems to bridge the linguistic divide.

1. RX FOR IMPROVING
IN A DIVERSE WORLD
Medical Translation
A Closer Look at Patient Surveys

2. 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

3. 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

4. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 4 © BiomedNouvelle
PATIENT SURVEYS:
AN INTRODUCTION

5. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 5 © BiomedNouvelle
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

6. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 6 © BiomedNouvelle
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

7. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 7 © BiomedNouvelle
TOP SURVEY COUNTRIES

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2014 ProZ.com International Conference – Pisa 8 © BiomedNouvelle
TOP LANGUAGES

9. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 9 © BiomedNouvelle
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

10. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 10 © BiomedNouvelle
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)

11. 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.)

12. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 12 © BiomedNouvelle
DEGREES OF ADAPTATION

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2014 ProZ.com International Conference – Pisa 13 © BiomedNouvelle
A SAMPLE PROCESS

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2014 ProZ.com International Conference – Pisa 14 © BiomedNouvelle
TEAM TRANSLATION

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2014 ProZ.com International Conference – Pisa 15 © BiomedNouvelle
BACK-TRANSLATION

16. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 16 © BiomedNouvelle
CHALLENGE I:
MEANING VS. EFFECT

17. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 17 © BiomedNouvelle
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

18. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 18 © BiomedNouvelle
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)

19. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 19 © BiomedNouvelle
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

20. Participant Poll
How many locales do you have for
your language combination(s)?
a) Only 1
b) 2
c) 3
d) 4 or more

21. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 21 © BiomedNouvelle
CULTURALADAPTATION
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.

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

23. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 23 © BiomedNouvelle
CHALLENGE II:
EQUIVALENCE

24. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 24 © BiomedNouvelle
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

25. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 25 © BiomedNouvelle
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)

26. Participant Poll
Are you ever asked to do back-
translations?

27. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 27 © BiomedNouvelle
BACK-TRANSLATION

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2014 ProZ.com International Conference – Pisa 28 © BiomedNouvelle
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)

29. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 29 © BiomedNouvelle
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”

30. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 30 © BiomedNouvelle
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

31. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 31 © BiomedNouvelle
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?

32. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 32 © BiomedNouvelle
CHALLENGE III:
STRATEGIES

33. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 33 © BiomedNouvelle
THE HURDLES
o Lack of consistence in terminology
o Lack of consistency in methodology
o Inconsistent framing for target audience

34. Participant Poll
According to the diagram below, what
type of translator are you?
Risk-taking
Capitulating
Prudent
Perseverant
✗

35. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 35 © BiomedNouvelle
A SPECIFIC CASE

36. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 36 © BiomedNouvelle
STRATEGIES
o Free translation
o Back-translation & Validation
o Cultural adaptation
o Micro-level translation

37. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 37 © BiomedNouvelle
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?

38. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 38 © BiomedNouvelle
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’:.

39. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 39 © BiomedNouvelle
PRACTICUM

40. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 40 © BiomedNouvelle
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

41. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 41 © BiomedNouvelle

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2014 ProZ.com International Conference – Pisa 42 © BiomedNouvelle

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2014 ProZ.com International Conference – Pisa 43 © BiomedNouvelle

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2014 ProZ.com International Conference – Pisa 44 © BiomedNouvelle

45. Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 45 © BiomedNouvelle
QUESTIONS?

46. Grazie
Rx for Improving Medical Translation in a Diverse World
2014 ProZ.com International Conference – Pisa 46 © BiomedNouvelle
Erin M. Lyons
BiomedNouvelle, LLC
elyons@biomednouvelle.com