HLTH 8402 Week 8 Language Access Discussion Post Example

Week 8 Discussion: Translation and Communication

A Written Notice in English and Spanish About New Evening Prenatal Hours, and What It Lost on the Way to Families Whose First Language Is Mixtec, a Language Many Speak but Few Read

When the Caldera Valley district moved its prenatal clinic to evening and Sunday hours for the harvest months, it announced the change with a one-page notice. The notice was carefully translated into Spanish, printed on both sides of a sheet, posted at the clinic and given to patients at visits. It explained the new hours, the dates and a phone number to call.

In the first month after the change, clinic arrival records showed a clear increase in evening and Sunday visits by Spanish-speaking patients. Visits by Mixtec-speaking patients, now recorded separately, rose much less, and several Mixtec-speaking women who came on weekday mornings were surprised to find the clinic closed.

My claim is that the notice was translated but not communicated to Mixtec-speaking families, and that the difference is the one Resnicow et al. (1999) drew between surface and deep structure. Surface structure means matching a message's visible characteristics to its audience: language, images, the people who deliver it, the places it appears. Deep structure means reflecting how the audience understands health, how information travels in the community and what the message's content means in their lives.

On the surface, the notice failed first. It was in two languages, neither of them Mixtec. Many Mixtec speakers in the valley speak Spanish as a second language but read little of it, and Mixtec itself is mostly spoken rather than written. A written page, in any language, was the wrong channel.

The deep structure failed too. Information in these communities often moves by word of mouth through family, crew leaders and neighbors, and through trusted people such as the district's Mixtec-speaking promotora. Holmes (2013) described how farmworker communities rely on such networks because institutions so often fail to reach them. A notice handed out at a clinic visit reaches only those already at the clinic, and those who come in the mornings were exactly the ones the change was meant to reach.

The federal CLAS standards ask agencies to offer materials and signs that people can easily understand, in the languages common in the area they serve (U.S. Department of Health and Human Services, 2013). For a mainly oral language, "materials" should mean recorded audio or video messages and spoken announcements, not only print.

What would have worked better? A short recorded message in Mixtec, played on a phone call or shared by voice message among families; the promotora visiting camps to explain the change in person; and crew leaders, with permission, passing the news at the start of shifts.

Question for the board: which language or community in your area does a written notice miss?

Reply to Ahmed

Ahmed, you asked whether the lower Mixtec numbers could reflect fewer pregnancies in that group. That is possible. Comparing with the same months last year, by language, would help separate a communication gap from a population difference.

Reply to Nora

Nora, you suggested pictographic notices. Pictures help with surface structure, but they still depend on families seeing the notice. Pairing them with spoken messages through trusted people would address both.

References

Holmes, S. M. (2013). Fresh fruit, broken bodies: Migrant farmworkers in the United States. University of California Press.

Resnicow, K., Baranowski, T., Ahluwalia, J. S., & Braithwaite, R. L. (1999). Cultural sensitivity in public health: Defined and demystified. Ethnicity & Disease, 9(1), 10-21.

U.S. Department of Health and Human Services. (2013). National standards for culturally and linguistically appropriate services in health and health care. https://thinkculturalhealth.hhs.gov/clas/standards