Going Beyond Translation - Transcreating Health Education Materials for Limited English Proficient Audiences

Theoretical Background and research questions/hypothesis:  Over 62 million Americans (21.5% of the total U.S. population) speak a language other than English at home. Populations with limited English proficiency (LEP) represent almost 10% of our nation. This audience is in great need of plain language and culturally appropriate health education materials. Simply translating English materials is not sufficient. The development of materials for LEP audiences in their native language is preferred; however, resource scarcity often precludes such development. To address this limitation, the concept of transcreation can be applied. Transcreation is the process of translating existing materials into another language and then adapting them for linguistic and cultural appropriateness. CDC undertook this two-year project to develop a replicable transcreation process to improve health education materials for LEP audiences.

Methods:  A literature review, environmental scan of existing health education materials, and nine key informant interviews were conducted to determine the health communication preferences and education needs of LEP Spanish and Mixtec-speaking populations. Based on findings, a variety of currently circulated materials about tuberculosis, influenza, and unsafe queso fresco (fresh cheese) were selected. Knowledge gained about communication and cultural preferences from the formative research combined with the principles of plain language and health literacy were used to transcreate new materials from existing ones. Select materials were tested with members of the target audience during eight focus groups held in San Diego and Oregon, then revised and finalized based on participant feedback.

Results:  To assess the level of improvement of new print materials, CDC’s Clear Communication Index (Index), a research-based tool designed to assess communication materials using a numerical score on a scale of 0 to 100, was used to compare transcreated materials with the originals. The Index score of the transcreated materials was higher for all assessed materials, and in the case of one poster, the score increased from 31.25% to 100%, further validating the transcreation process. Participants not only understood the messages, they were extremely receptive to the cultural considerations applied in each material, such as the use of bright colors, photographs depicting members of the target audience, and messages addressing concerns of information privacy and cost of health services.

Conclusions:  Health education materials can be transcreated to be culturally and linguistically appropriate for LEP audiences. Transcreation can measurably increase the quality of a material by using the Clear Communication Index.

Implications for research and/or practice:  Recommendations for plain language and health literacy, considered standard practice for English language materials, should also be standard practice for creating or transcreating materials in other languages. Following these principles and also addressing cultural preferences of the target population proved to be a feasible and successful way to develop well-received materials. Organizations should consider using transcreation over translation as a preferred method for producing non-English materials.