One key aspect in the complex landscape of healthcare that often goes unnoticed but holds immense significance is the intersection of health literacy and translation. In a world marked by diversity, ensuring that health information is accessible to all individuals, regardless of language or literacy level, is a fundamental prerequisite for promoting overall well-being. Health literacy and translation work hand in hand to bridge gaps and create a healthcare environment that is truly inclusive. Clear, concise, and culturally sensitive communication ensures that individuals from diverse backgrounds can fully participate in their healthcare journey. This not only improves patient outcomes but also contributes to the overall effectiveness of public health initiatives.
Health literacy— the ability to read, understand and act upon health information — is now known to be vital to good patient care and positive health outcomes. Nearly half of all American adults—90 million people—have difficulty understanding and acting upon health information. Since adults use different kinds of printed and written materials, we can break down literacy in 3 different skill set areas: the understanding and application of words (prose), numbers (numeracy), and forms (documents).
Prose literacy – the ability to search, understand and use continuous texts (e.g. editorials, news stories, brochures, and instructional materials).
Document literacy – the ability to search, comprehend, and use non-continuous text, such as maps, tables, transportation schedules, drug/food labels and job applications.
Quantitative literacy – the ability to identify and perform computations embedded in text, such as balancing a checkbook, figuring out a tip or filling out an order form.
Our work in health literacy and translation is not in translation alone which makes us unique in this industry. For over 15 years, we have provided plain language writing and health literacy design, awareness workshops and readability testing.
Health Literacy and Translation in Healthcare
There are various tools that can be used to assess a patient’s health literacy. When a patient speaks another language though, the tools are limited to a few languages that are available. The most common language to find availability of these tools is in Spanish. In addition to assessing a patient’s literacy level, there are also assessments that should be given to their caregivers who often take on additional roles, such as helping with medical decision making and filling out forms.
Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50). The Short Assessment of Health Literacy for Spanish Adults (SAHLSA-50) is a validated health literacy assessment tool containing 50 items designed to assess a Spanish-speaking adult’s ability to read and understand common medical terms.
Pfizer, a longtime leader in health literacy initiatives, has developed the Newest Vital Sign in English and Spanish. The Newest Vital Sign is based on a nutrition label from an ice cream container. Patients are given the label and then asked 6 questions about it. Patients can and should refer to the label while answering questions. The questions are asked orally, and the responses recorded by a health care provider or researcher on a special score sheet, which contains the correct answers. Based on the number of correct responses, the health care provider or researcher can assess the patient’s health literacy level.
Pfizer provides several examples of how an ice cream nutrition label serves this assessment best with the following examples:
Clinical example: The patient has scheduled some blood tests and is instructed in writing to fast the
night before the tests. The skill needed to follow this instruction is Prose Literacy.
Ice cream label example: The patient needs this skill to read the label and determine if he can eat the ice
cream if he is allergic to peanuts.
Clinical example: A patient is given a prescription for a new medication that needs to be taken at a
certain dosage twice a day. The skill needed to take the medication properly is Numeracy.
Ice cream label example: The patient needs this same skill to calculate how many calories are in a serving of ice cream.
Clinical example: The patient is told to buy a glucose meter and use it 30 minutes before each meal and before going to bed. If the number is higher than 200, he should call the office. The skill needed to
follow this instruction is Document Literacy.
Ice cream label example: The patient needs this skill to identify the amount of saturated fat in a serving of ice cream and how it will affect his daily diet if he doesn’t eat it
Tools and research in other languages showcasing the intersection of health literacy and translation in healthcare
All Aspects of Health Literacy Scale (AAHLS) for Chinese speakers in Traditional and Simplified Chinese. In this study “Assessing Health Literacy Among Chinese Speakers in the U.S. with Limited English Proficiency“, the researchers found that participants achieved higher health literacy scores when they encountered health information/situations in Chinese rather than in English. Participants were unlikely to question their physician’ and nurses’ advice, regardless of language scenarios. This finding is consistent with results from Wang et al. (2012), who found Chinese immigrants were less likely to challenge physicians or express their needs to physicians, compared to U.S. born Chinese and non-Hispanic Whites. This hesitancy may be due to Chinese cultural beliefs, as physicians are highly respected because they represent the authority of medical knowledge (Wang et al., 2008). Enter the vital role of health literacy and translation in healthcare. With our communities becoming increasingly diverse, healthcare providers must be equipped to communicate effectively with individuals who may speak languages other than the predominant one in their region. Translation services play a pivotal role in breaking down language barriers, ensuring that everyone has access to accurate and comprehensible health information.
The European Health Literacy survey tool has been validated in 6 Asian countries.
The Health Literacy Toolshed publishes a list of health literacy measures that are most valuable.
The first results of a clinical trial were just published that show that a health literacy-informed communication can reduce discharge medication errors in hospitalized children. The outcomes showed that it reduced home liquid medication administration errors and enhanced caregiver medication knowledge compared with standard counseling.
In conclusion, recognizing the intertwined nature of health literacy and translation is crucial for fostering a healthcare system that leaves no one behind. As we navigate the intricate web of health information, let us champion initiatives that prioritize clear communication and accessibility, ensuring that everyone can make informed decisions about their health and well-being.