Imagine that your mother has cancer. You’ve just heard about a promising new experimental treatment and want to enroll it in the study. However, your mother immigrated to the United States as an adult and speaks limited English. When you contact the search team, they tell you that they are not qualified because they only hire English speakers.
Unfortunately, this is a very likely outcome of a scenario like this, because non-native English speakers are often excluded from clinical trials and research studies in the United States.
Despite efforts to increase participation in research, racial and ethnic minorities remain underrepresented in outcomes. A review of 5,008 papers in three pediatric journals from 2012 to 2021 revealed that only 9% of these studies included non-English speaking volunteers.
Language is a major barrier to participation, as even those with some proficiency in English are less likely to participate in studies when recruitment materials are not in their native language. Language barriers also hinder a person’s ability to provide informed consent to participate.
This problem is unlikely to go away. The number of people with limited English proficiency in the United States rose 80% between 1990 and 2013, going from about 14 million to 25.1 million people. As of 2022, this number has risen to 26.5 million people. Excluding people with limited English proficiency is not only unethical, as these groups deserve the same access to experimental and cutting-edge treatments as the English-speaking population, but it also limits the extent to which research findings are applicable to the general population.
One way to remove language barriers is to translate research documents. As a translation researcher, I strive to discover ways to improve the quality of translation to benefit the research community and wider society. However, the translation in research is not clear. Translated materials must not only be accurate, but also serve their intended purpose.
The most widely used method for evaluating translation quality in health research is back translation – translating the translated text into the original language and evaluating how closely it matches the original text. However, this method relies on outdated studies from the 1970s, perpetuating serious misconceptions about how translation works.
Understanding translation
Translation involves more than simply transferring written words from one language to another. For many health researchers, the goal of translation is to convey meaning so that it remains intact in a new language. Along these lines, the translator is supposed to be a conduit for ideal linguistic equivalence. However, current work in the field of translation studies suggests that this perfect correspondence or transfer of meaning is only an illusion.
The translator is not a channel of meaning, but rather a reader of the original text and a writer of the translation. As such, translators have their own position in the world that comes with a set of conscious or unconscious values and knowledge that influence how they read and write. Translation is a process of interpretation no matter how objective the translator aims.
Moreover, languages are not structurally or culturally identical. For example, the English sentence “I arrived late” is structurally consistent with the Spanish sentence “Yo llegué tarde” because the grammatical rules match. But because Spanish expresses subject information through verb endings (“lleg-ué”), “Yo” is usually interpreted as a contrast, meaning that “I” is the person who arrived late and not someone else.
An exact match in a back translation often reflects a translation that is so similar to the original that it often conflicts with the standards of the translated language. For example, the translation of the health status questionnaire “My thinking is clear” into Portuguese is “O meu pensamento é claro”. Despite good back translation results, patients in Brazil reported that it was unclear. Changing it to “Consigo pensar claramente” (“I am able to think clearly”) resulted in communication more effectively and naturally with the target population.
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Translation scholars suggest that the most realistic, descriptive and interpretive approach to translation is one governed by what the commissioner wants to achieve through translation. Under this view, the translator makes his decisions according to the type of text translated and the purpose of the translation.
How translators approach texts and the strategies they use to translate them vary with each document. Some texts require more close adherence to the original words than others. For example, legal or regulatory considerations require that the list of chemical components of a drug be translated more closely to the source structure of a recruitment flyer intended to persuade readers to participate in the study. Translators of research documents need to determine the needs of the specific text in collaboration with researchers and representatives of the community they are studying.
Translation affects research results
Recent studies show that translation can affect the validity and reliability of data. An inappropriate approach may result in translated materials that do not work as intended. For example, a survey may produce incomplete or incorrect data if participants misunderstand or are not clear about the questions.
My team and I investigated how different translation styles affect how readers respond to translated material. We asked bilingual participants to review two versions of a survey measuring perceptions of stress. Each version has been translated into Spanish in a different way.
One translation was produced with a literal approach aiming to be as equivalent to the original as possible, while the other followed a functional approach focused on achieving the specific purpose of the translation. In this case, the goal was to obtain data on how Spanish-speaking populations perceive daily stress.
We asked participants to review both translated versions of the survey, then indicate any unclear sections and which version they preferred. We found that participants preferred functional translation and identified a greater number of problems with equivalence-focused translation. Participants commented that the “equivalent” translation was more difficult to understand, was too direct and seemed to be clearly translated.
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Other studies have shown that access to translated materials is generally less compared to original documents. Researchers have also found that some translation techniques increase the complexity of reading. One study found that a survey used to measure patients’ health progress translated using a functional approach had better readability than its published counterparts that used a more literal approach.
The translation process is complex. Lack of awareness of its complexities can affect not only fair participation in research, but also the validity and reliability of its methodology and results. But with the right approach, translation can increase a study’s reach, diversify its data, and lead to new findings and insights. Communicating with a translation scientist before starting a project can help scientists prevent their data and research from being lost in translation.
In the field of research, language barriers can present a significant challenge when attempting to gather data from participants. When researchers and their subjects do not speak the same language, there is a risk of important information being lost in translation. This issue can lead to misinterpretations, misunderstandings, and ultimately, skewed or incomplete data that may not accurately reflect the experiences and perspectives of the participants. In order to conduct thorough and meaningful research, it is crucial for researchers to address language barriers in a thoughtful and comprehensive manner.