Sharing Best Practices for Effective Multilingual Communication in Healthcare
It’s no secret that minorities are getting hit the hardest by Covid-19 in the United States. The Coronavirus may be novel, but the forces that keep medical care unequal are older than the country itself. Needless to say, research also has historical challenges when it comes to representing diverse communities. Accessibility to participants from different populations varies greatly, even when researchers have the best of intentions. The socio-economic hurdles are very real, and get plenty of airtime in the news, but it’s up to the professionals who work in science and medicine to root out the individual causes of those inequalities over time. One of the most powerful such barriers to culturally broad research participation is the language barrier, and it can be a much more intricate obstacle to untangle than many people expect.
One could easily argue that medicine is the most risk-laden field to translate for. Mistakes can do real harm and are documented as having led to bad outcomes on many tragic occasions. A close second however might be research with human participants. This is because, like medicine, many kinds of research require a constant interface between scientifically literate professionals and the public, whose literacy may vary. Other fields, like engineering, may require the translation of complex technical information, but it will almost always be information that goes between professionals who are in-the-know about the same topics. Medical professionals and researchers who work with the public will already know all too well that some crucial concepts are very difficult to convey to laypersons. Good compliance can be a tricky thing to attain for this reason, even when everyone speaks the same language.
This is why not just any translator or interpreter will do. People who encounter language barriers in the work environment often look for quick fixes. The first question is usually “Does anyone who works here speak this language?” Next it’s “Does this patient/subject have a bilingual family member who can help?” Then, if those options don’t yield results, there’s always Google Translate. Whichever method you end up with, problem solved. Right?
Not so much, actually. The two human interpreters described above, the bilingual employee and the family member, are known as heritage speakers. A heritage speaker is generally someone who speaks a minority language in the home, but the majority language at work and school. In most cases they are able to communicate well in their heritage language with friends and family, but their formal education in that language will likely have ended when they arrived in their new home country, if it ever took place at all. This is why bilingual staff are not always a good solution. They speak two languages, but they may only speak science in one of those languages. It takes real investment to learn the language of one’s field of study in multiple languages. It does not happen automatically. The third option mentioned, the well-known online tool, translates incorrectly so often it can be comical when it’s not dangerous. See our other blog entry on using Google Translate in a medical facility to learn about the studies that have shown just how risky it is.
The truth is that medical and scientific language professionals are always the best option. They won’t stumble when they have to interpret dense terminology, and they will know how to avoid the pitfalls that lead to documents that are confusing or even unintelligible in the target language. What’s more they have a workflow that contains both fail-safes that catch errors, and efficiency tools, like termbases, that reduce cost. There’s just no replacing the decades of experience scientific language professionals and businesses have gained as a community.
Now we arrive at the real problem, money. We mentioned how language barriers are often taken for granted and treated as an afterthought. One of the repercussions of this blind spot is that research budgets rarely take language issues into account proactively. Funds can quickly spread thin when grants or donations are being relied upon and every dollar must be accounted for, often before the research has begun. Administrators and executives who oversee funding may not understand the need for a comprehensive interpretation and translation budget, especially when the insufficient solutions described earlier are so readily available. The methodology of the experiment itself might be a concern as well, as it may not account for the impact of the constant presence of an interpreter if the study must take place in a controlled setting, especially if behavior is an important component, and translation will need to take place multiple times as documents are updated.
As the Covid-19 pandemic continues, it’s clear that every scrap of information is potentially useful. What’s more, documenting and observing the behavior of patients is just as critical as studying the effectiveness of new therapies. Behavioral and environmental factors like the accessibility to healthcare and commonly held professions of certain cultural or ethnic groups are likely to be the leading differentiators in outcomes between communities, but on occasion there are illnesses to which certain groups have genetic vulnerabilities. While this possibility is not commonly discussed regarding Covid-19, underrepresentation of certain populations in research would keep any such tendencies hidden longer if they do exist.
In steadier times, when research is taking place at its usual pace, necessary change in best practices may seem like a luxury to be achieved one day in the future, after urgent short-term projects are completed. Incorporating translators and interpreters into the methodology of new studies may fall by the wayside during such times. In the current state of crisis, however, fast and efficient research will certainly save lives, and at the same time well-integrated language solutions will help to curb a problem we already know exists. No time could be more crucial than the present moment to absorb appropriate language solutions into research and medical care as a matter of course. By investing in them up front rather than patching them up after the fact, they can be streamlined and made cost effective by, for example, identifying the most commonly-spoken languages in a given region, and creating strong termbases for the entire organization so that updates to documents are quick, consistent, and cost-effective. The benefit of a proactive approach to language barriers becomes self-evident when communicating with diverse participants feels smooth and unhindered, and when we as a scientific community can feel proud knowing our knowledge gained will be a truer reflection of the world.