After three years and many hours of work dedicated to improving communication between heath care providers and their limited English proficient patients the Hablamos Juntos National Program Office is ready to begin presentation of the results and lessons learned from the efforts put forward through this Robert Wood Johnson Foundation initiative. This information includes the highlights of our "Quality Health Care for Limited English Populations: Hablamos Juntos Lessons Learned" meeting held in Washington, D.C.

The products of the Hablamos Juntos program, including the initial goals and objectives and how these shifted over the course of the planning and implementation, have been captured in several reports now posted on the Hablamos Juntos website. These reports address the role of language services in health care; the work of The Foundation regarding language access and disparities, and how this initiative has helped to uncover new solutions. We also address the policy implications of lessons learned and promising future work including a resource guide soon to be released through the Hablamos Juntos Resource Portal.To access the Hablamos Juntos Resource Portal click here.

To access meeting materials click here...

Affordable Language Services: Implications for Health Care Organizations

Understanding and processing medical and treatment information can be challenging for many patients, but for those patients who do not speak English as their primary language or who have difficulty reading, writing or understanding English, it can be nearly impossible. Limited English proficiency (LEP) patients have a higher risk of misdiagnosis and adverse medication reactions, and have greater difficulty getting the care they need and understanding diagnoses and treatment advice. Sometimes inadequate communication during health care encounters can even result in death.

This brief highlights the effects of language barriers on patient safety and quality of health care, and the challenges organizations must overcome in order to effectively address language barriers. Drawing on the experiences of the 10 Hablamos Juntos demonstration sites, this brief also highlights the lessons that participating providers, health plans and other organizations learned, and suggests next steps that need to be taken in order to ensure that the Nation's LEP patients receive safe, high quality health care.

To access the brief click here...

Developing Better Non-English Materials: Understanding the Limits of Translation

Understanding written information is essential in order for patients to successfully negotiate the system. However, many "vital" health materials include words and concepts-including medical jargon and terms unique to the American health system-that challenge even those patients who speak English as their primary language. Language, culture and health literacy all affect the extent to which text is understood by patients. These features, together with health care terminology and the nature of language, make translation highly challenging. Thus, the production of non-English materials (those written in languages other than English) is typically a struggle for health care organizations, even in the face of federal laws that require health care organizations to translate "vital" documents.

This brief highlights lessons learned by the ten Hablamos Juntos demonstration sites about the barriers faced by health care organizations in producing useful translated text, and in evaluating those products for quality. Overall, it was found that health care organizations have broad misconceptions about the translation process, and lack effective methods to evaluate translated text. Misguided standards-such as using "back-to-English" translation to check quality-may actually contribute to poor translation. Based on Hablamos Juntos' analysis of errors, back-translation may actually introduce errors in translation because it rewards text that purposefully imitates the structure of English. These difficulties make it challenging for organizations to produce useful non-English text. Health care organizations can improve performance in this area by developing systems to identify and produce non-English text, and by building capacity to make decisions about non-English text. In addition, specialized training programs are needed for translators who work primarily with health translations. Many translators also need to improve basic writing proficiency in their native languages.

To access the brief click here...

Symbols Signage Issue Brief
PHASE I: Development of Universal Symbols for Healthcare Environments

Universally recognized graphic symbols, such as those used to delineate parking spaces and other facilities for individuals who are physically handicapped, can be an effective tool for communicating important information to individuals with Limited English Proficiency (LEP). The aim of this project was to design a set of graphic symbols that would be easily understood and ultimately, be universally recognized for use in health care environments to aid LEP visitors. This brief describes the steps taken and includes the resulting symbols.

A complete Technical Paper detailing the testing methods, test scores and recommendations for future symbol design is also available on our website. The health care symbols are public domain upon release, and free to anyone who wishes to use them, thanks to the Robert Wood Johnson Foundation. To learn more about the Signs that Work signage project click here.

To access the brief click here...

We are proud to announce Mundo Hispano^© is now available on our website. A challenge of Spanish translations is ensuring comprehension across speakers from different nations since some terminology is not consistent across Spanish speaking nations. The challenge is made more difficult when Spanish equivalents are needed for terms unique to the American health care system. Mundo Hispano^© is a new user interface to the Google search engine to show how common Spanish phrases and words are used across 21 Spanish-speaking countries.

Mundo Hispano^© allows users to input up to four Spanish words or phrases to search whether these terms are used in websites in 21 Spanish speaking countries, including the United States. The program reports the frequency with which that word or phrase shows up by country and links to the top ten websites found in each country. Patterns emerge, showing the frequency with which terms are used by country.

Designed by Asier Alcázar, Research Assistant at Hablamos Juntos, the program utilizes the Google API service to support multiple, simultaneous queries. Users can search for multiple words across multiple countries, and the results are displayed in a country-by-query table with frequency counts. The program also makes the top ten sites for each query available to allow the user to visit the websites counted to determine if the search is credible. Alcázar, is a doctorate student in the Hispanic Linguistics program at University of Southern California, and also working on a master degree in Computational Linguistics.

The More Than Words team is also working on these other tools.

1. Forms Project. This initiative aims to develop templates for commonly translated forms. The current focus is on consent forms and advanced directives.
2. Translation Brief: an analytical tool to help health care organizations determine whether English materials should be translated, developed from scratch or to use other methods such as audio or video.

Look for more updates on this work in the months to come.

To access Mundo Hispano^© click here...

Hablamos Juntos (Spanish for "We Speak Together") is a unique project designed to forge connections between health care providers and the rapidly growing Latino health market. As a national program of the Robert Wood Johnson Foundation, Hablamos Juntos is investing $10 million in ten demonstration sites around the country. These sites, ranging from health plans and large hospital systems to small nonprofit community organizations, will work to improve communication between health care providers and patients and eliminate language barriers that can lead to medical errors and compromise the quality of care.

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