Plain language doesn’t stay plain in translation
Plain Language Summaries (PLSs) are one of Language Scientific’s dedicated practice areas. Along with Linguistic Validation, Multilingual AI Validation, Endpoint Adjudication, and our Clinical Helpline, our PLS practice is at the core of the language services we provide, all with medical-grade accuracy.
Translating Plain Language Summaries is important, because it makes them accessible to readers who aren’t proficient in English, whether you’re running a global clinical trial or communicating with people in the U.S. who have Limited English Proficiency (LEP). But plain language doesn’t automatically stay plain in translation; that’s where Language Scientific’s expertise comes in.
Plain Language Summaries are becoming more common and more critical. A 2021 article in Health Literacy Research and Practice cites “a growing focus on patient-centeredness and on the ethical responsibility to report research findings to the public” as a driving factor.
What is a Plain Language Summary?
Plain Language Summaries (PLS) are documents aimed at a non-specialist audience: often patients, caregivers, or the general public. They summarize complex scientific research in language that someone without a medical or scientific background can understand. Clinicaltrials.gov defines plain language as “communication that the intended audience can understand the first time they read or hear it.”
Plain Language Summaries are important for a number of reasons:
- Patients need to understand clinical trial results and scientific findings. This is particularly true for inclusion/exclusion criteria and the potential outcomes of enrolling in a clinical trial. Plain language helps patients understand what they are agreeing to, and the potential risks and benefits of their participation in a trial.
- Informed consent forms need to be translated at a patient’s level of understanding. For more information about translating informed consent forms, see our article on the topic.
- Plain language gets the message across. In its publication Everyday Words for Public Health Communication, the Centers for Disease Control and Prevention states, “When you do need to reach a broad, public audience without specialized knowledge about a topic, everyday words are the most appropriate language to help the most people understand the information.”
- Clear writing builds trust. The Plain English Foundation reports some impressive statistics. New Zealand decreased the error rate on its citizenship application from 66% to 10% by writing in plain English. Patients took 14 minutes to read a medical brochure; this dropped to 4.5 minutes after a plain English rewrite, and the patients understood the information better.
- Inefficient writing wastes time and money. In her plain language advocacy book Rewrite: How to overcome daily sabotage of your brand and profit, author Lynda Harris makes the case that “words come with a price tag,” and states that the value of communication lies in what the reader hears or understands, not what the author meant. A clinical trial could be derailed by a patient not understanding the word “placebo,” or that they could be administered one. Instead, say “a substance that looks the same but contains no drug.”
Not always plain in translation
If a Plain Language Summary is well-written in the original language, it should be easy to understand. The Journal of Rheumatology’s Plain Language Summaries Guidelines recommend an 8th grade reading level, and various sources recommend 6th to 8th grade.
However, this doesn’t mean that the PLS will be equally readable once it’s translated into other languages. This happens for a few reasons:
- Linguistic variations. Many clinical trials translate into all 24 of the European Union’s official languages, and even far beyond that. Language Scientific works with more than 200 languages, including Romansch (spoken by fewer than 100,000 people in Switzerland), Mixteco Bajo (one of Mexico’s largest indigenous languages), and Telugu (one of India’s 22 scheduled languages). Things like sentence structure, terminology, and conventions for communicating medical concepts vary widely among languages as disparate as these. Even the concept of “pain” (is it physical, emotional, spiritual?) can be difficult to pin down.
- Cultural variations. A 2022 article in Pediatric Nephrology notes that across cultures, even a word like “fine” can be tricky. “In some cultures, senders are used to being open, frank, and honest when giving their opinion. If they say something is “fine,” then it is just fine. Some cultures are very different. One needs to sense much more than words express. People can say one thing but mean another. Saying something is “fine” sometimes means it is not fine, possibly it is the exact opposite.”
- Balancing accuracy and accessibility. This is one of the core challenges of translating PLSs. Translators who work on Plain Language Summaries must understand the task. If a translator looks at the phrase “a substance that looks the same but contains no drug,” and thinks “a placebo,” the PLS’s accessibility will be compromised. But the translation must also be accurate; there’s a difference between a “placebo” and a “fake pill.”
Jargon: adaptation doesn’t always mean a direct translation
Eliminating jargon is a core premise of Plain Language Summaries. The CDC “Everyday Words” document referenced above recommends replacing the term “acute” with “a sickness that lasts a short time and goes away,” or “a sickness that happens suddenly.”
Jargon-free language makes complicated medical concepts easier to understand, while still conveying the correct meaning. Plain language experts often recommend “audience testing”: having a non-scientist read the proposed PLS to make sure they can understand it.
See this blog post for more information on translating clinical trial protocols.
Acronyms are another huge issue in clinical trials. The PI, the CRO, the IRB, HIPAA. They’re hard enough for someone in the field to remember, let alone someone who has never seen them before. The U.S. Food and Drug Administration’s publication In Plain English, Please contains several recommendations:
- Avoid acronyms if possible
- Change them into full words whenever possible; “the organization conducting the clinical trial,” rather than “the CRO”
- Use acronyms when the public is more familiar with them versus the expanded term; most people in the U.S. probably recognize “NASA” more readily than “the National Aeronautics and Space Administration”
Translation introduces another layer of complexity. A translated word may be technically correct, but may violate the principle of accessibility if the reader of the translation can’t understand it. Translation also introduces the possibility of an error creeping into the target document. A self-taught medical translator may see the word “Alzheimer’s disease,” and decide to replace it with “dementia.” This is a seemingly simpler term, but it doesn’t mean the same thing.
Enter: the subject-matter expert. Subject-matter experts are the ideal professionals to adapt medical jargon while maintaining the source document’s meaning, because they understand the concepts behind the words. Take a term like “evidence-based,” that appears often in medical information. A subject-matter expert is the best person to identify a plain language way of expressing this concept, choosing from options such as, “It has been shown to work.” “Studies show that it works.” “Scientific evidence shows that it works.”
Why not just use AI for Plain Language Summaries?
Automated translation has come a long way, but it’s simply too risky for critical medical translations. Here, we give examples of when AI is and is not appropriate for translation work. AI will rarely if ever be the right solution for writing or translating Plain Language Summaries.
AI may be an option if:
- You’re looking for the gist of a non-mission-critical document
- You’re doing first-pass research or sorting through large volumes of data and documents
- You’re translating informal, non-medical communications that do not contain confidential information
AI is not the right option if:
- Your documents contain specialized medical terminology that AI may misinterpret
- A translation requires cultural awareness
- The document needs to be consistent with other documents in a batch
For these reasons, raw AI output falls short when it comes to translating Plain Language Summaries, but it can be useful for other tasks, such as glossary creation and assessing reading level.
The goal: clarity across multiple languages
Plain language isn’t just about simplifying complex medical and scientific concepts. When we translate Plain Language Summaries into multiple languages, we have to look at linguistic features like sentence structure, directness, and cultural assumptions about how the healthcare system works.
A plain language translation succeeds when it is clear and easily understood across multiple languages. “Sounds like the original” isn’t the right goal. Rather, we want to make sure that readers understand the same information regardless of their language.
The following table shows key features of plain language, along with associated translation challenges and best practices
| Plain language principle | Associated translation challenge | Solution: best practice |
| Always use active voice: “The research team will watch you closely,” versus “Monitoring of patients will be done by the research team” | A word-for-word translation may reintroduce the passive voice or awkward phrasing | Use short, natural sentences that clearly show who is doing what |
| Use short, clear sentences: “Don’t take the medication if you feel sick,” versus “If an adverse event occurs, promptly discontinue use of the medication” | Some languages use more words to express the same concept | Break complicated ideas into more than one sentence if needed. Focus on clarity rather than making the translation match the source document. |
| Use culturally familiar language: An instruction to “eat whole wheat bread instead of white bread” may not make sense in a culture where rice or or tortillas are more common | Examples and references may be unfamiliar across cultures | Have native-speaker translators adapt these examples while maintaining the medical or scientific meaning |
| Address the reader in a culturally appropriate tone: an example would be addressing a patient by first name versus Mr./Ms. in English | Direct address and formality vary greatly across cultures and even regional variants (Canadian French versus European French) | Subject-matter experts should identify the form of address that is the most appropriate and accessible for the target audience |
The true test: Can the target audience understand the translated document?
A Plain Language Summary must remain accurate and accessible when it’s translated. That often requires a series of steps, such as:
- Non-specialist review of the original PLS
- Translation by medical linguists and subject-matter experts who understand the nuances of PLS translation
- A readability assessment to ensure that the translated PLS matches the reading level of the original
- Non-specialist review of the translated PLS
- A linguistic review of the proposed translation
PLS translation isn’t just another medical translation project. It’s a key component of health literacy that builds trust in the medical system and expands health equity by giving equal access to medical information.
Language Scientific is committed to medical-grade accuracy in translation, serving pharmaceutical, clinical research, and medical device organizations running global clinical trials. For more than 25 years, our translations have been performed by subject-matter experts with advanced degrees in medicine and science, supported by proprietary language technology, and delivered under the company’s LS Certified™ standard in over 215 languages.
Visit languagescientific.com for more information on our four specialized clinical trial practices: endpoint adjudication, linguistic validation, plain language summaries, and the clinical helpline.
