Chapter 5 - Translate and adapt: Cultural adaptation

Culture Counts: A Guide to Best Practices for Developing Health Promotion Initiatives in Mental Health and Substance Use with Ethnocultural Communities

In chapter 5 - Translate and adapt:

• Introduction
• Cultural adaptation
• Translation
• Cultural validation
• Summary

On this page:

• Determine the level of cultural adaptation needed
• Include community role models
• Make sure graphics work for, not against, your message
• Use plain language

When adapting a health promotion initiative for ethnocultural communities, translation may be of foremost concern. But even where a different language is not used, it is important to take cultural differences into account. Cultural adaptation is the process of ensuring your message, whether translated into another language or not, is presented using cultural references and role models that your intended audience will identify with.

Canadians should understand the value of cultural adaptation, since many advertisers, marketers and others often treat the Canadian and American markets as the same. Think how you respond when you see ads created for the American market and used in Canada. For example, American advertisers may try to appeal to potential customers’ patriotism, using the American flag and symbols such as the eagle. Such symbols will not create the intended response in most Canadians and may distract or even offend some. In any case, the ad will not be as effective as one produced specially for Canadians.

Creating or adapting a health promotion initiative with an ethnocultural community for that community will always produce a more useful and effective initiative than using one created for some other group.

“For the LRDGs, we found that the message that one should drink less to protect one’s health did not have much effect. ‘You’ve got to die sometime’ is the attitude. Instead, concern about the effects of one’s drinking on one’s children seemed to get people’s attention. So in the Polish version of the brochure, to the advice 'Talk to your kids about alcohol,' we added 'and be a role model for them.'” Elizabeth Gajewski, Polycultural Immigrant and Community Services

“Cultural adaptation” is the process of adjusting health messages to the intended audience by incorporating their cultural heritage, language and ethnicity. Sometimes it means finding the right word. On other occasions, it is about finding cultural equivalents so that information is accurate but is also relevant and understandable to a different cultural audience.

“We included more types of beverages in the Portuguese version of the LRDG brochure, such as homemade wine. We found some focus group members had different ideas about the identification of an alcoholic drink. For example, they might say, ‘Oh, I never drink alcohol.’ Then you ask, ‘You never add a little something to your morning coffee?’ And they say, ‘Sometimes—but that doesn't count as an alcoholic drink. It’s coffee!’ ” —Maria J. Benevides, MSW, RSW, Portuguese Mental Health and Addiction Service

To learn more about adapting existing materials:

• Centre for Culture Ethnicity & Health, “How To: Reviewing Existing Translated Materials – Checklist” (PDF) (Victoria, Australia)

Examples:

• Multicultural Mental Health Australia, “One NESB size does not fit all! What makes a health promotion campaign ‘culturally appropriate’” (Australia)
• National Institute on Aging: “Cultural Adaptation of ‘Exercise: A Guide from the National Institute on Aging.’” (USA)
• Ontario Public Health Association: “Cultural Adaptations to Canada's Food Guide to Healthy Eating.” (Canada)

This poster produced by the Alliance for South Asian AIDS Prevention (ASAAP) shows how the impact of a health message is increased when cultural references and images reflect its intended audience. (Photo courtesy of ASAAP)

Determine the level of cultural adaptation needed

How much adaptation of existing material is needed to make it effective with the intended audience? To find out, start by having the material reviewed by members of the intended audience and key informants. Do they feel the information is relevant and culturally appropriate? For example, in the Culture Counts project, members of the Somali community felt the existing brochure and message of the LRDG was not culturally appropriate for them. As alcohol is strictly forbidden by their religion and cultural beliefs, an approach that starts with the acknowledgement that people do drink would not work.

If the reviewers feel the message is culturally appropriate, they should be asked to look at how the content of the original material, both text and the graphics, should be adapted to be culturally appropriate and clearly convey the health promotion message. You and your community partners can go over the recommendations and see if they can be acted on without altering the accuracy of the information.

Include community role models

Role models from the community who are willing to speak up and write about their own experiences with mental health or substance use problems can help break down barriers and stigma. The role model could be a well-known person or simply a typical member of the intended audience. The role model can talk to community groups, be part of larger presentations, or have his or her story included in media products.

Example:

"Like Minds, Like Mine" - Whakaitia te Whakawhiu ite Tangata" Factsheet. (New Zealand)
This fact sheet about mental illness and stigma for the Maori community in New Zealand includes stories in their own words of community members who are living with mental illness.

Make sure graphics work for, not against, your message

Images, colours, and other graphic elements can add a lot but need to be carefully chosen. For example, the cover of the LRDG brochure shows a wine glass, a tumbler with ice and a beer bottle. Many in the focus groups commented that the tumbler looked much larger than the other two items. Also, a few groups commented that it was not their custom to put ice in their drinks. So when the brochure was adapted, this graphic was changed to a smaller tumbler with no ice in it.

Here are some things to keep in mind when using pictures and other graphic elements:

• Use images that reflect members of the community.
• Use colours and other graphic elements with special cultural meaning to enhance the power of a message.
• Poorly chosen graphic elements can detract from a message. For example, in North America, the colour pink tends to imply femininity and softness, while in some Asian cultures pink has a sexual connotation. In some cultures white is a sign of purity, while in others it is a sign of mourning.
• Thoroughly test images and text on intended audiences to ensure they are effective and culturally appropriate.

Use plain language

“Plain language” means making your text easy to use for as wide a range of people as possible. Whether you are using English or another language for the health promotion product, here are some ways to make it easier to read and understand:

• Use simple, everyday language
• Use shorter sentences (25 words or less) and paragraphs
• Do not use jargon
• Avoid using idioms, slang and humour; if you do use them, be sure to test them on your intended audience.
• Avoid using more than one term for the same thing.  For example, instead of "In some cultures, white implies purity, while in others it indicates mourning,'" "In some cultures white is a sign of purity, while in others it is a sign of mourning."

It is a good idea to use plain language approaches whenever you are producing health promotion texts. It makes them easier for anyone to use and can also make translation go more smoothly.

To learn more about plain language:

• Plain Language Association International
• Human Resources and Social Development Canada: “Plain Language Links”
• Toronto East End Literacy Project: Clear Language and Design Reading Effectiveness Interactive Tool (Canada)
• Harry McLaughlin: “Online SMOG (Simple Measure of Gobbledygook) Measurement tool.” (USA)

Think about how the final product will be used

The physical format of a printed piece can also determine how or if it will be sued.  For example, young people may not pick up a brochure, but may take home an attractive poster to put up in their room.  Women may not pick up a booklet if it is too large to fit in a purse.

"We thought about doing a poster instead of the brochure, but we were concerned that posters would not get put up or that if they did they would be discarded when they got a bit torn." -Maria J. Benevides, MSW, RSW, Portuguese Mental Health and Addiction Service

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