Adapting content to a local culture
A linguistically correct version can still fail its readers, because health beliefs, images, symbols, register and forms of address do not cross with the words. Adapting content to a local culture means aiming the text at the reader's culture rather than at the words of the source, checking its beliefs, images and symbols, expecting one language to carry several cultures, matching register, forms of address and wording to the reader, fitting the format, healthcare practice and law of the market, and having the adaptation done and tested from inside the community.
Cultural translation
Culture encompasses the social behaviour and norms found in human societies and the knowledge, beliefs, arts, laws, customs, capabilities and habits of the individuals in them, and humans acquire it through enculturation and socialisation; the word comes from the Latin colere, to tend the earth and grow, or to cultivate and nurture. Each language developed in its own human population and continuously evolves with the culture of its speakers, and communication is effective only when it is targeted to the reader's culture, which the writer therefore has to know.
A word-for-word translation cannot communicate effectively in the target language. A translation must consider cultural aspects. Familiarity with a culture's customs and traditions makes it easier to find distinctions, double meanings and embarrassing phrasing, so cultural translation involves a deeper comprehension of both the source and the target language, and it could even be called a more advanced version of translation, because it provides more than word-to-word conversion. Cultural translation also adds a consultancy dimension, and because it goes deeper than translation, the translator is an important actor in a company's expansion abroad. Translators are entrusted with a cultural mission: besides being experts in the target medical area, they are asked to communicate effectively to healthcare providers and the general public. Beyond translating and adapting graphics, currencies, date formats, addresses, telephone numbers, colour choices and punctuation, translators must make the communication in the target language professional, which implies rethinking the structure of the text, and a key aspect of cultural translation in health management is that the final communication must be understood, avoid conflict and align with the targeted needs. In one experienced translator's view, cultural translation is not an option for health communication professionals but the only way.
Direct translation alone is often insufficient, because without proper cultural adaptation even well-intended health messages can lead to misunderstanding, distrust or non-adherence to treatment plans. Healthcare providers who prioritise cultural adaptation in medical translation can improve patient education, support treatment adherence and build trust in medical interventions, and aligning translated materials with local expectations and healthcare realities significantly enhances the effectiveness of health communication. Cultural adaptation involves understanding health perceptions, using appropriate tone and language, adapting medical terminology and incorporating culturally relevant visuals, so that information is not only accurate but also meaningful and actionable for diverse patient populations.
Translation on its own only scratches the surface of catering to a specific audience, and meaningful impact needs localisation, which takes into account the audience's geographic location, lived experience, cultural context and the other factors that influence how they receive and process information, such as their health literacy. There is little point creating content, in the first instance or via translation, full of medical jargon and complex imagery if a significant proportion of its readers are left with a partial understanding at best.
Although "globalisation" is often used as a pejorative term, a medical writer's proficiency in language, coupled with an understanding of regulatory and healthcare systems, therapeutic areas and patient populations, affords the writer a unique position to be a positive force in producing content that is true to science and research ethics while its terminology, context and implications are adapted to be culturally appropriate to each audience.
Health beliefs, images and symbols
Health beliefs, perceptions of illness and attitudes toward medical interventions vary widely across cultures, and they shape how patients interpret symptoms, treatments and preventive care. Messages should be crafted in a sensitive and unbiased way that encourages patient engagement without reinforcing stigma or fear. Certain idiomatic expressions, metaphors and humour used in health education materials need careful adaptation and localisation to stay clear and relevant. Patients are more likely to trust information that visually reflects their community and lifestyle, and including diverse representations in patient education materials helps foster inclusivity. Imagery, colours and symbols should align with cultural expectations: white represents mourning in some Asian cultures, while it symbolises cleanliness in Western contexts.
An owl, the European symbol of wisdom, was the centrepiece graphic of a New Zealand poster promoting childhood vaccination to Māori parents as a wise choice. The programme was a resounding failure, because the native New Zealand owl, the ruru in Māori and the morepork in English, is a symbol of death in Māori culture, so the very clear inference for Māori parents was that childhood vaccination was associated with death. Once the association was understood, the Māori community was consulted to identify more appropriate symbols, and the vaccination programme was reinvigorated when the owl was replaced with images of woven baskets and rainbows, which are symbols of wisdom for Māori. The case is a classic example of the need for medical writers to understand their target audience.
One language, several cultures
A shared language does not establish shared medical usage: medical terminology and common usage can differ between regions that share a language, as Portuguese does between Portugal and Brazil. Some languages have words or whole concepts that do not exist in another, and such differences are seen not only between cultures but also between social groups that claim to speak the same language.
Italian is spoken by about 60 million Italians and by about 720,000 in the Italian-speaking cantons of Switzerland. When a new drug for erectile dysfunction was close to approval in Italy, a company's Italian affiliate asked its Swiss colleagues to review the promotional material they were to use for the product in Switzerland. The Swiss text read "Quando il tuo piccolo amico ti pianta in asso…", literally "when your little friend leaves you alone…", which is perfect Italian but unacceptable and hilarious to any Italian. The Swiss colleagues had translated it from the original German version, and the phrase was probably a good way of communicating the concept of erectile dysfunction to the Swiss Italian-speaking general public.
Although a growing number of healthcare providers worldwide speak English, non-native English speakers often do not recognise the differences between British, American, Australian and Canadian English, each of which has its own cultural background. In the experience of a writer who has worked with people in North and South America, many people living there do not consider the importance of different cultural backgrounds, and some well-known and respected top managers can hardly distinguish one European country from another and barely know that Europeans speak different languages, although the vast majority of North and South Americans know and appreciate the cultures and languages of the Old World. As Europeans have become exposed to New World cultural models, differences between countries have decreased.
Register, forms of address and wording
Scientific style addresses a relatively small group of professionals in clear, precise, impersonal language with stereotyped vocabulary and syntax, and it is not the most attractive style for the general reader. Even when a study is told as a story, the general reader is generally not attracted to it if its technical wording is kept. Improving the reader's health literacy is a long and not always successful option, and when translating a text for the general reader, the translator needs to adapt to that reader's thinking and language level. Some cultures favour a direct, authoritative tone from medical professionals and others a more collaborative, patient-centred approach, and content should be adapted accordingly to build trust and engagement.
Register follows the reader: in English-into-French translation, headache becomes maux de tête for patients and the general public, in a drug leaflet or a patient questionnaire, but céphalées in documents for doctors and researchers, such as a summary of product characteristics or a clinical trial presentation. Other pairs run the same way, such as prise de poids against gain pondéral for weight gain, fonctionnement des reins against fonction rénale for kidney function, serrement dans la poitrine against oppression thoracique for chest tightness and crachats against expectorations for sputum. Some medical terms have direct translations that are technically correct but may not be commonly understood, and adapting them to local use avoids confusion and enhances patient understanding. A technically correct translation may not always be understandable to patients, and medical terms that may not have a widely recognised equivalent in the target language should be given alternative phrasing or explanatory footnotes.
Under the influence of English, German texts use the second-person singular du more often than they used to, giving it the meaning of the English you addressed to an adult, although Sie, the formal pronoun, is the one that should address an adult. French tu is for children and familiar people, and said to an unknown adult it might seem rude, although once people become familiar, especially within the same age group, tu becomes socially accepted, mostly after asking whether the other person agrees. The English you addressed to an adult in a formal context therefore becomes vous in French, and translating it as tu would be inappropriate, because French is not under the influence of English in this case and tu would seem weird to French adult readers. One of the only cases in which tu is advised in a French medical text is a medical trial consent form or informative medical document written for children, so it is very important to know whether a French translation is for adults or children.
It is important to take the evolution of society into account when writing and translating medical texts for patients. Wording for patients must not convey anything pejorative or discriminatory: patients présentant un cancer or patients atteints de cancer sound more neutral than cancéreux for cancer patients. Likewise, the preferred French terms for patients are patients présentant un diabète or une dépression rather than diabétiques or dépressifs, patients âgés rather than vieux patients, and transgenre or trans rather than transsexuel, and the second term of each pair is not to be used. Awareness of gender considerations is also very important: a text on breast cancer screening said that patients having breasts could benefit from screening, a group that took in cisgender women assigned female at birth and transgender women assigned male at birth and taking feminising hormones. Recognising patients' preferences, differences or conditions gives them a sense of inclusion, which is one of the tools for making them feel more involved in their treatment or trial participation.
Format, practice and law in the target market
Translated materials should consider the literacy levels, medical practices and attitudes toward healthcare in the target audience's community, and localise examples, recommendations and treatment references to align with regional norms and accessibility. When translating a patient questionnaire, it is important to be aware of the patient's culture: a questionnaire about hand motor skills may ask about peeling an orange in one country and opening a milk carton in another.
Many patients, even in developed countries, have low health literacy. Plain language principles make materials clear, concise and actionable, and bullet points, numbered steps and infographics should present critical health information in place of long paragraphs. Visual adaptations should also consider literacy levels, so that pictograms, icons and step-by-step illustrations are intuitive and support comprehension. Not all patients have reliable internet access or the ability to navigate digital health portals, and printed versions of translated materials keep them accessible to older patients, rural populations and people without digital literacy. For digital formats, text-to-speech compatibility and mobile-friendly design make them more usable for diverse populations.
Healthcare protocols, treatment guidelines and healthcare systems vary between countries, and translated materials should accurately reflect the medical landscape of the target region. Consent forms, prescription instructions and discharge summaries should comply with both the legal requirements and the patients' expectations in each country, and materials should reflect these norms so that patients feel comfortable engaging with their care.
Adaptation from inside the community
Cross-cultural communication is often difficult, so materials developed by medical communications agencies at a regional level are usually adapted by local medical writers to meet local needs. Most societies, however, are a patchwork of cultures, and the interests of minorities can easily be overlooked in favour of the majority. The most effective way to ensure cultural appropriateness is to involve local healthcare professionals, patient advocates and community representatives, and usability tests and real-world feedback from native speakers and patients can reveal hidden barriers and give insights for continuous improvement. Feedback on translated materials should be gathered from healthcare providers and patient advocacy groups, to identify terms or phrases that may be confusing and refine them. Even the best-translated materials cannot replace culturally competent healthcare providers, and training programmes that teach providers to use these materials effectively and to communicate across cultural boundaries improve overall patient care.
The historical context of clinical research within a community may also need considering: examples such as the Tuskegee syphilis experiment might go some way to explaining the continuing reluctance of certain communities to take part in clinical trials at all. The importance of such context is why one translation provider always recommends that translation and localisation be completed by an expert from within the relevant community, such as a Mexican Spanish native speaker living in the US for content addressed to the Mexican diaspora there, who can advise on tone, cultural context and appropriateness, localise accordingly and avoid specific pitfalls.
International organisations, researchers and companies are increasingly aware of the importance of translation professionals in considering different cultural approaches. A cultural translator must know the cultural background of the source text and must live in the culture of the targeted healthcare professionals.