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English source and Spanish translation of patient guides for specialty medication VeletriEffective translation of patient guides starts before a single word has been translated. When source materials are created without the consideration that they may eventually be translated, a potentially straightforward process can become more complicated, more time consuming, and more expensive. We recommend asking the four questions below before you reach the translation phase to help streamline the translation process for you and improve outcomes for the patient populations you’re trying to reach.


1. At what grade level is this content written?

Comparison of a post on X (formerly Twitter) written at a 21st grade level and rewritten at a 7th grade levelBefore you think about translation of patient guides, we recommend testing them for readability in the source language. The American Medical Association (AMA) and the National Institutes of Health (NIH) recommend that publicly available health-related information be written at a 6th – 7th grade reading level. The NIH’s reference guide, Clear & Simple, may help you better understand how you can take health literacy into account when writing and designing your source materials. If you decide that your patient guide should be rewritten at a different grade level, our health literacy division can help with that. English readability tests aren’t typically applicable to other languages, but a good translation will be written at a level that corresponds to the source.


2. Does my layout account for expansive languages?

A text bubble in an English and a Spanish version of the same PowerPoint, where the English text fits and the Spanish translation does notAn important consideration that frequently gets overlooked in translation of patient guides is layout. We’ve received many a source file where the text fits the space of the layout exactly, with not a centimeter to spare. This causes problems for languages like Spanish and German (among many others) which typically expand by about 20 – 25% when translated from English. For example, here’s a translation from English into Spanish that we did recently as part of a benefits enrollment communication:

Want more benefits information?

¿Quieres más información sobre los beneficios?

As you can see, the Spanish is almost half-again as long as the original English text. The layout of the announcement had this text in a speech bubble and the English just fit. Fortunately, the layout had room for the speech bubble to be slightly larger, so we didn’t have to shrink the font size. If your layout doesn’t allow for these types of modifications, it may mean compromising readability by shrinking font sizes. When designing your source layout, we highly recommend accounting for additional space that may be needed to accommodate the translated text.


3. Is my imagery relevant to my message and intended audience?

English source compared to Spanish translation of patient guides to healthy meal planningThis question is probably already on your pre-launch checklist. We encourage you to ask it again in the context of translation of patient guides. Last year, we helped create a Spanish version of Novo Nordisk’s Planning Healthy Meals Navigator. Besides replacing all the English text with Spanish, they also updated several of the images to include foods that might resonate more with Spanish-speaking immigrant populations in the US. This is only one small example. Connecting with the patient populations you aim to reach deserves a global approach. Don’t rely on incomplete perspectives and stereotypes to answer this question. There are several ways you can ensure your imagery is relevant and appropriate, including creating well-developed personas for all members of your intended audience.


4. Will I need back translation of patient guides?

If your patient guide will be submitted to a pharmaceutical regulatory committee, you’ll probably need to submit a back translation along with the original and translated versions. Make sure you build this into your timeframe as well as your budget. Back translation may take longer than the initial translation because it may raise questions about the meaning of or intent behind the original source text or the translation. These questions need to be addressed before the translation is finalized and the back translation is submitted for regulatory approval. Back translation may also cost more than the initial translation because most translators charge per source word. As we mentioned earlier, many languages are expansive compared to English. This means that your translation may very well have more “source” words than the original English. And more source words typically means a higher investment.

An example of a back translation of patient guides submitted for regulatory approval


Failing to consider translation of patient guides when creating the source versions can disrupt timelines, budget, and patient engagement. Answer the four questions we just explored the next time you develop a new resource and reap the benefits of a proactive approach! And if you need help answering these questions, let us know and we’ll walk you through.