Health literacy and knowledge translation are recurrent terms in medicine. They refer to complex concepts, of which it is important to have a thorough understanding at policy and at operational level in order to reap the greatest benefits, both from research findings in the medical field and from healthcare.
‘Knowledge translation’ describes the set of activities involved in moving research and its results from an academic or scientific context to their practical application in health services and health care systems. As early as in 2005, for instance, based on a previous definition given by the Canadian Institutes of Health Research (CIHR), the World Health Organisation defined ‘knowledge translation’ as ‘the synthesis, exchange, and application of knowledge by relevant stakeholders to accelerate the benefits of global and local innovation in strengthening health systems and improving people’s health’. Currently, the concept of knowledge translation is often summarised in the phrase ‘Evidence-to-Policy’ (E2P).
‘Health literacy’, on the other hand, refers to the set of skills and abilities that one needs in order to obtain and understand health-related information and put them to good use when taking health-related decisions. Concrete examples thereof would be a patient being able to give informed consent to a certain treatment, or to understand how and when to take medication, or even to interact efficiently with his or her general practitioner when the GP needs information in order to establish a diagnosis and prescribe treatment.
While both of these concepts play an important role even in a mono-cultural and monolingual context, whenever there is a language barrier as an additional factor, things become more complex. The first thing a health care provider should do in such cases is to obtain assistance from a professional interpreter, so that communication between the health care provider and the patient can take place in the most efficient way. Incidentally, situations of this kind arise not only with residents of foreign origin, migrants or refugees, but also, for instance, with people travelling in a given country (tourists, business people) who do not speak the local language fluently. Research shows how important it is, in such situations, to resort to the services of a professional interpreter rather than to so-called “informal interpreters”, like the patient’s family members or friends. Studies indicate that the latter tend to be selective in interpreting the health care provider’s questions (e.g. incomplete questions, wrongly formulated questions, sometimes due to a lack of health literacy on their side), are much more likely to make translation mistakes with medical consequences, tend to skip the translation of side effects of medication, and often do not translate sensitive issues. Resorting to a professional interpreter is one of the decisive factors in order to ensure better health care, with efficient communication, a better understanding on the patient’s side, better clinical results and, in the end, higher patient satisfaction. Not to mention the fact that a professional interpreter, contrary to what a relative or a friend acting as an informal interpreter often tends to do, does not meddle in the interaction between health care provider and patient as an interested party. Last, but certainly not least, professional interpreters have a duty of confidentiality and are bound by a code of ethics.
In the multi-cultural and multilingual situations described above, overcoming the language barrier is a first and essential step. However, this is not enough. Even then, the health care provider has to keep “translating knowledge” and adapting communication to the level of health literacy of the patient. In order to check whether the health-related information provided by the health care provider is understandable for a patient, several conversation techniques can be applied, for instance the so-called “teach-back” method, whereby the doctor asks the patient to explain what he or she has just heard.
Sources and further reading:
Sudsawad, P. (2007). Knowledge translation: Introduction to models, strategies, and measures. Austin, TX: Southwest Educational Development Laboratory, National Center for the Dissemination of Disability Research:
https://ktdrr.org/ktlibrary/articles_pubs/ktmodels/
Mirjam P. Fransen, Vanessa C. Harris en Marie-Louise Essink-Bot, Beperkte gezondheidsvaardigheden bij patiënten van
allochtone herkomst, in: Ned Tijdschr Geneeskd. 2013;157:A5581 (in Dutch):
https://www.ntvg.nl/system/files/publications/a5581.pdf
Astrid K. Wahl PhD, Marit H. Andersen PhD, John Ødemark PhD, Anna Reisæther PhD, Kristin H. Urstad PhD, Eivind Engebretsen PhD, The importance of shared meaning-making for sustainable knowledge translation and health literacy, in: Journal of Evaluation in Clinical Practice, 24 April 2022:
https://onlinelibrary.wiley.com/doi/full/10.1111/jep.13690