Translation is often a huge hurdle for organizations looking to serve new populations in their community. It requires a lot of time, resources, facilitation and trial and error. It took CATIE over a year to find translators in Simplified Chinese, Punjabi, Urdu and Tagalog who were capable of producing accurate and accessible language to educate people in the four priority communities about hepatitis for CATIE’s Hepatitis C Ethnocultural Education, Outreach and Social Marketing Program. For a full description of this program, please see the case study.

Finding translators

CATIE started this process by connecting to established organizations that work with immigrant populations (such as Access Alliance Health and Multicultural Services and the Ontario Council of Agencies Serving Immigrants in Toronto) and organizations that have a reputation for providing good health information in various languages (such as the Sexuality Education Resource Centre [SERC]). CATIE asked these organizations about their translation and review processes and about the translators they used.

Before hiring translators, CATIE tested them using a document that contained hepatitis C information, medical terms, technical language and information about sex and substance use. This document was essentially a “long draft” containing most of the content CATIE was considering using for the website and print resources. Medical and community reviewers helped to determine the quality of the translation. Feedback from CATIE’s reviewers made it clear whether the document needed to be completely retranslated or if it could be edited with some further discussion and used in the program’s education work. Translators who fared well under these reviews were added to a list of qualified translators for this project.

Translation process

Final versions of all material used in CATIE’s Hepatitis C Ethnocultural Education, Outreach and Social Marketing Program’s campaigns and resources are written in English and then translated into four languages (Simplified Chinese, Punjabi, Urdu and Tagalog) by the vetted translators. Every translation undergoes a medical review to ensure that the language and explanations are accurate. It then undergoes a community review to ensure that the language is accessible; part of this review involves assessing the reading level and checking that non-derogatory terms are used and that the text is gender neutral, where possible. Together these reviews assess the quality of the translation offered by CATIE’s translators.

CATIE found newcomer doctors to act as medical reviewers through its community partners as well as through its networking in the area of settlement. Community reviewers are often frontline service providers who work in settlement services or healthcare, and some of these individuals eventually worked on the project as bilingual facilitators. The original medical and community reviewers were members of CATIE’s initial community advisory councils; the fact that these individuals contributed to the program in multiple ways helped establish community partnerships and shape the direction of the project. An ongoing roster of translators and reviewers is maintained for all the languages in which CATIE currently works.

Stigma and language

Hepatitis C is a stigmatized disease and is often associated with drug use and sex work. The language used for substance use, sexuality and sex acts is frequently derogatory, and it is commonly used in such a way that community members may think hepatitis C is something that only affects certain kinds of people, further perpetuating the stigma associated with hepatitis C and substance use. CATIE made it clear in its work with its translators and advisory councils that it was looking for neutral language about substance use and sex, that health information is important for everyone and that the program’s materials are more likely to have an impact if people aren’t shamed.

The translation process

CATIE uses an 11-step process to translate materials used in the hepatitis C project:

1. Translation – The final English version is sent to an approved translator.
2. First medical review – This is conducted by a newcomer doctor, where possible.
3. First community review – This is conducted by a frontline worker from one of our community partners or by our facilitators.
4. Revision – Comments are returned to the translator, who makes revisions that make sense to them. At this stage, translators often state a case for their initial word choices (this action identifies subjective language areas for discussion).
5. Second medical review – If the translator hasn’t accepted all of the reviewers’ initial edits, the medical reviewer often discusses their word choice with the community reviewer or one of the facilitators and makes a decision on the best word.
6. Second community review - includes discussion/notes with another reviewer or facilitator on word choice where the translator hasn’t accepted edits. As long as the medical reviewer deems the language/explanations accurate, the community reviewer(s) get(s) the final say on what language is most accessible.
7. Second revision – Additional edits are sent to the translator for final translation.
8. The final translation is sent to draft layout or design.
9. The layout is proofread by the medical and community reviewer.
10. The document is sent to the printer or uploaded as a draft to the website.
11. Proofs from the printer or draft website are given to community reviewers for final review of language and formatting.

Ever-evolving language

Language is ever-evolving in this area of work. Discussions around word choice are usually subjective and can sometimes continue indefinitely. Ultimately, CATIE chose to seek community leadership from frontline staff working directly in each community to determine what constitutes accessible and appropriate language. The rapid pace of development and approval of new hepatitis C treatments has required that information be updated annually. Even established translation services may not have strong capacity in all of the languages for the project. It is worth the trial and error to find a good translator who understands the values of the project and the project team’s approach to the work.

Display typefaces (print and online)

Determining the best display typefaces for print and online was a challenge for all languages, and it often took a number of tries to get everything to display properly in each format.

In print, this meant finding typefaces that could be used within Adobe InDesign that were legible. CATIE’s designer also had to use plugins for the program that could manage languages that read right to left.

Working online with Unicode typefaces¹ and the display of non-roman character languages (such as Arabic script, Kanji and other writing systems) required some trial and error to get content to display correctly.

Although CATIE’s primary work in this program has been in four communities, CATIE has also translated key resources into six other languages, in addition to English and French. The typefaces that we use in print and online are as follows:

Hindi: Arial Unicode

Punjabi: Raavi (online), DRChatrik (print)

Urdu: Jameel Noori Nastaleeq (print), Arial Unicode (online)

Tamil: Arial Unicode. The original translation was done in encoding called Bamini that had to be converted through an online Unicode tool for use on our website. Corrections from our reviewers are also encoded in Bamini and need to be converted to Unicode for uploading online.

Bengali: Vrinda.

Tagalog: Any roman character display typeface works.

Vietnamese: Arial Unicode.

Spanish: Any roman character display typeface works.

Simplified Chinese: Arial Unicode

Arabic: Lateef (print), Arial Unicode (online)

Language expansion

Since 2011, the number of languages CATIE includes on its hepatitis C information website has increased to 11 in addition to English. To determine which languages to add, CATIE considers the past work of national hepatitis C immigrant community projects (such as the Canadian Ethnocultural Council’s work), international hepatitis C epidemiology and current immigration trends and subgroups in Ontario, as well as information gathered in meetings with different settlement organizations and in specific regions in Ontario.

Web-based information is currently available in English, French, Arabic, Urdu, Bengali, Punjabi, Hindi, Tamil, Simplified Chinese, Tagalog, Vietnamese and Spanish.

• 1. An international encoding standard for use with different languages and scripts, by which each letter, digit or symbol is assigned a unique numeric value that applies across different platforms and programs.

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