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On June 28, 2023, Louise To from the Office of Engagement and Training and Javier Chavez from the MedlinePlus team co-hosted NLM Office Hours: MedlinePlus. The webinar includes a brief presentation on the processes behind providing Spanish language content followed by Q&A.

Links

• About MedlinePlus

• Information for Trainers and Librarians

• Información para bibliotecarios, educadores y promotores de salud

• Tutorial de MedlinePlus para bibliotecarios y educadores en salud

• NLM Support Center

• HEMAT (English)

• HEMAT (Spanish)

Transcript

LOUISE: So today for NLM Office Hours, we have Javier Chavez from the MedlinePlus team. Javier will talk about the processes behind providing Spanish language content before answering your questions. Assisting me in managing today's session is Molly Knapp from the Network of the National Library of Medicines Training Office and Michael Tahmasian from the Office of Engagement and Training, within my office.

So you have three ways to communicate during today's session. You may use the chat feature. Molly will be watching for your questions in chat and relaying them verbally to our guests. For Spanish language questions, we also have Felipe Lagos and Paulina Aguilar here to translate. You may raise your hand if you'd like to unmute and ask questions verbally, but we're mainly going to be answering questions at the end. Following the presentation. I will be looking for those hands in the participants list. And you may also use the feedback icons to give nonverbal feedback throughout the session. Also note that we have a bilingual closed caption with us today, as well as an ASL interpreter. You can find the closed captioning button in your menu options. Now, without further ado, let me pass this on to Javier to tell us about MedlinePlus.

JAVIER: Good afternoon. Thank you very much for the opportunity to present today. I am joined by some colleagues, Mr. Andrew Plummer, who is our senior person at MedlinePlus who I will happily punt any questions regarding background or history that predates me. I also have the pleasure of being assisted by Felipe Lagos and Paulina Aguilar as you mentioned. These folks are part of my team of specialists that manage and produce the content in Español.

So let's begin with the quick overview. Slide please. Little bit of history. MedlinePlus was developed by the National Library of Medicine with a primary goal to provide reliable, up-to-date health information to the general public. It predates all the way back to 1998. Slide.

Little more background on MedlinePlus Español actually was launched in 2002 with the purpose to tackle and to pursue those information those Spanish speaking consumers and bilingual communities that were looking for health information in Español. And MedlinePlus Español offers a wide range of health topics, articles and consumer resources in Spanish and one of the things that we take pride in is that the information is custom tailored to the cultural needs of our Spanish speaking consumers. Slide.

So MedlinePlus today it is available in English and Spanish. You know obviously not all the information is available but most of the information is, I will get a little bit into how and what we translate. In addition there is information available in multiple languages in in one of our portals and obviously we provide information to additional links to government agencies, non government organizations, PubMed, clinical trials and such. Slide please.

A little more about our products today we do have licensed content which includes the ADAM Medical Encyclopedia, supplements, drug information and electronic health records. Slide.

OK, so let's talk a little bit about the bilingual consumer from the perspective of MedlinePlus, you know we do have 38.5 million US residents that who identify Spanish as the most common language spoken at home. This is in addition to or combined with the 62 million plus people who identify as Hispanic or Latino in the United States and our country is adopting more and more a bilingual cultural and embracing a sense of a multi language approach across public health. There have been many examples of this over the last couple of years, that the last and most important one being COVID. Slide please.

So why translate to Spanish? This is a common question. You know, primarily we want to align with the NLM strategic plan, specifically Goal #2, you know speaks about reaching more people in more ways to enhance dissemination and engagement pathways. One of the things that that we focus on is creating these pathways with our consumers with information that is relevant when the information is needed at the time that the information is needed. And I think that our program takes pride in in being able to be a part of the solution to help, you know, reduce those health disparities, supporting those underserved communities that bear disproportionate burden of disease. Slide please.

So about our health topics, just a quick overview. So topics, subtopics, and topic summaries are developed by a team of Spanish health content specialists. We translate the content from the Medlin Plus English pages into Spanish. We're talking almost over 13,000 links of information compared to the 22,000 links in English, but the process itself involves cross reference of authoritative sources to ensure that the information is accurate and trustworthy. We strive to make sure that the information is accurate to our consumers. Our consumers are very keen on pointing out when information is not clear or is not adequate or not correct and the team is always respectful and sensitive to cultural nuances. This is, you know, one of the highlights of our program of being able to understand our consumers and provide information in a way that they can understand it, in a way that is-- that they can perceive it, in a way that they that they can appreciate it, again being respectful of those sensitive, you know, and sensitive to those cultural nuances, you know of our Latino populations. We really work and we strive the most at that meeting point between translation and transcreation. And I'll address a little bit more about this in a few. Slide please.

So the intersection, you know, while translation focuses on the individual meaning of words, you know, it finds interpretation that's closest to the original term. The transcreation actually gives us a little more freedom. We are able to focus on the complete message. We're able to maintain the style, maintain the tone, maintain the context. But we consider a lot more the different aspects that sometimes don't get captured in just translating product such as emotions, cultural and socioeconomic factors. You know, bilingual populations and Spanish speaking populations look for information in different ways and many times if the if the really the emotion or the cultural, the cultural sensitivity you know through the lens that they use to look for information. If it's not clear the information is no longer trustworthy. So how that intended message is perceived by the target audience is everything to us. Slide please.

So a little bit about the editing process. Anytime there is an update on any one of these topics or summaries, this requires a translation. A little blue arrow indicates the process. So as an example, I listed this topic that was very relevant recently. The summary for marijuana as a product, as a health topic was revised by NIDA who is the IC in charge of this topic. What they did was they added a term you know an also-known-as term of "cannabis" to the definition, or to the summary. That prompted the English site to produce this update and to include this information, which then prompts the Spanish team to review the content translate it, transcreate it, and then you know basically create the mirror image of Español. Thank you for the clarification on NIDA, and you know in that process if additional information is required, if the summary becomes edited or extended, it's not as easy as simply adding some more information in English and then translating. We have to identify that culturally relevant language that is used across different regions of the United States. So this for this particular product or topic carries many different words associated with it, but these words are originated from different regions of the United States and this happens constantly with our updates. As we're looking at content that is constantly being translated from English to Spanish, we are always on the lookout for that specific language that we have to tackle or in some cases avoid, so that we can then take that regionalist language and incorporate it into our summaries in Español. And obviously the regionalist language, you know that that comes from the United States really just stems from the different consumers that come from different parts of the Spanish speaking world. Next slide please.

OK, so this is what the sample edits look like on our website. The health topic is listed here. There is an edit on that first arrow. You see the highlight where there's an edit under the names also called. I want to point out that all of our sites are-- You'll see the Español toggle on the top right. This is important because the bilingual consumer can then navigate easily between English and Spanish. As well as the Spanish speaking consumers on the next graphic you'll see the summary. And then I also wanted to highlight the fact that the National Institute of Health, the NIH Institute is primarily responsible for this topic or for this topic change is always listed on our site. So we identified the resource of the source, we identified the resources and then we also want to make sure that our consumers know they can look at this information in Español. Slide please.

So this is what the same page looks like in Spanish. The other names becomes otros nombres. We include the information that the IC has provided. The English title is always at the top right again so that we can navigate back and forth between both languages and then the information on the institute is on the on the next graphic highlighted as well. Slide please.

So I'll share a couple of cultural challenges that you know we've learned throughout our time working with different ICs and different programs across NIH. We hear plenty of challenges with sometimes folks trying to explain ethnic classification in Spanish or to Spanish speaking consumers, cultural barriers, values and beliefs. This is the big one. This is not something that comes lightly, it's not something that any AI system can help translate for you. Those cultural barriers, values and beliefs, these are things that you have to really understand and you have to understand by speaking, communicating and knowing your consumers. Spanish is a, you know, a language that is made-up of so many dialects, which includes those localism and those regional, those regional terminologies that I spoke about earlier. And with this also brings, you know, some healthcare misconceptions, because not every provider is able to really adequately respond with the proper information or the proper dialect of a translation of a health condition or disease. Most Latinos have a path of acculturation that differs from one from the other. Most of all the Spanish speaking countries in the world. As people immigrate into the United States, they bring with them their own sets of culture. Research qualification criteria and informed consent is something that we learned through our colleagues at the Clinical Center where in the past they explained that consumers that do not adequately understand what qualification criteria is, how to how to better understand that criteria or even understanding what informed consent is provides them with challenges as they create openings for research protocols. Slide please.

So a little bit about using MedlinePlus and MedlinePlus en Español. So this is our site. I want to highlight here obviously besides the Spanish toggle that there is information available for trainers and librarians and if you click on that, on the next slide, you'll have some information it it all, some resources, additional resources that are broken down, they extend that way and a couple of hours that I wanted to highlight here is the health information assessment to understand and to label something easy to read. The Health Education Materials Assessment Tool is there is a link on our site here on the English and they will be-- I will show you the Spanish version of this site and it is absolutely available in both languages, and hit the next slide please.

And you'll see these same links with the HEMAT, the tool itself being located slightly in a different location, but it is available to English and Spanish speakers. It is a tool that we are using at NNLM specifically for determining whether something is considered easy to read. It helps us to understand and engage whether or not the consumer is going to have challenges potentially with the information that we're sharing. It is a wonderful tool. It has been fielded and showcased recently. I encourage everyone to take a look at it and perhaps be able to put it to use. Slide please.

OK, so this is a quick snapshot of the assessment tool. Just a-- It consists of basic questions that give you, it gives you a yes or no, some notes, with the basic score to allow you to to produce your own criteria as to whether or not something is considered, you know, easy to read. And again as we move into a world of easy to read information with health literacy directives, you know, providing us with with some of this guidance. It's important that you know that our information is understandable by our consumers in all languages. Slide please.

And we've come to the questions and answer portion. Back to you.

LOUISE: Thanks, Javier. So now it's time to open the floor for questions. As Javier mentioned, joining us is also Andrew Plumer, who's also from the MedlinePlus team and also Felipe and Paulina. Again, you may answer your questions in the chat or raise your hand and then we will unmute you. Molly, I'm going to hand it over to you now for questions.

MOLLY: Thanks, Louise. First, I'd like to share a question that was sent in advance from Marissa Testerman at the University of Texas at El Paso. And Marissa would like to know, Why is there not a Spanish language version of the page on peppermint oil?

ANDREW: I'll take that when Molly. Ohh. Hello everyone. I'm Andrew Plumer. I'm a Technical Information Specialist and Contract Officer Representative at the National Library of Medicine. And well, thank you for the question. Actually it's as Javier said earlier, it's through the input from our users that were able to identify gaps within the vast, vast, vast collection that is MedlinePlus. And yes, while we did have an English version, we did not have a Spanish version, but we were very fortunate that one of our content vendors as Javier showed in the earlier slide does have one and we are in the process now of acquiring that for MedlinePlus. So thank you very much.

JAVIER: If I may add to that, Molly. So this is a great example. Thank you to our consumer that brought in the question by the way. But this is a great example of how there are, there are topics, there are health conditions, there are terms that are readily available to translate. And then there are some that are a little challenging. In the case of peppermint oil, mint, spearmint and I've learned recently of the different varieties of such plants that you can purchase or grow. There are many translations and sometimes there is only one translation. This happens in both languages, where one word in English will have multiple translations in Spanish and then in some cases we have multiple variations in Spanish which translate to just one or two words in English. So in the process of translation, the process of identifying that information, we really have to get creative sometimes and being able to not just identify where those gaps are but ensuring that we that we encompass all those different terms that that have to do with that product or with that topic that we're discussing. This is not something you know that we take lightly because in many cases most sites will simply say that information is not available whereas we will you know strive to go out there and find that information for those consumers. And in this case as Andrew mentioned, we are able, we will be able to update this site. So come back to that real soon.

MOLLY: Thanks Javier and Andrew. Ohh, excellent, Marissa says. Thank you for the explanation. Now we have a question that just came in to chat to the hosts and panelists, so I will read it out loud. Will more brochures and fact sheets become available for Spanish speakers in the future? This would be very helpful for libraries.

JAVIER: Good question. Andrew, would you like to start with that and I'm thinking fact sheets and brochures, mainly of some of the few products that we have on our site. Or am I misunderstanding?

ANDREW: Well, it depends on the content actually. If you're looking for physical format, I'm probably going to gear to the side of no on that. We do offer a print version. You know you can print out the versions you need, but as far as the NLM becoming a distribution point for large print things, that's something we have, you know, phased out over the years. So you are more than, I mean everything on our site except for some of the licensed content is copyright free. The licensed content of course you can use for obviously educational purposes only. So if you have any questions about which things specifically you want to look at, please contact our customer service and let us know which ones. And if you're a little bit, you feel a little bit leery about say printing out something from the medical encyclopedia, but this let us know when we can, you know discuss with our renders and say you know and usually we can solve the problem. But yeah, as far as us becoming that point of having content ready to be you know just to distribute. No. And as far as the Spanish version, obviously with MedlinePlus health topics you can toggle back and forth two of them to see which content in Spanish best serves your need because we don't have a specifically a one to one match in Spanish content. Javier could probably explain that better. It's just a matter of certain organizations don't have the bandwidth to be able to do, you know, to do full Spanish translations, and there are differences.

JAVIER: With that said you know we have-- our team has supported the development of you know pamphlets and fact sheets you know across different ICs. Unfortunately that's not a MedlinePlus product specifically. So that's probably why you won't find it on our site. But I do encourage folks to look across NLM. And one of the things that I learned about NLM as I came on board was of many different programs and offices you know that include information via fact sheets and brochures. Again, it's not within our program, but there are, there are certainly a lot of products available. And then just to go over the-- to explain a little bit about the bandwidth issue. Yeah, there's a reason why there's a lot more sites in English than in Spanish. And that's because the information on most of these health topics is mostly abundant in English and not as much in Spanish. That's why you see the disparity between 13,000 links or so in Español to 22,000 links in English. Well, you know, as information becomes a little less available. We really have to be a little more meticulous about what kind of content we want to be able to to provide our consumers. So we have to work extra hard to make sure that the resources that we do provide even though they are limited are valuable and are trustworthy. In this case it it's definitely more about quality versus quantity.

MOLLY: Thanks Javier. Yeah, you talked you talked about transcreation and that's it's definitely you want to have the quality health information not just the direct translation and I'd also like to point out Louise, in chat, added a link to the NLM customer service Andrew was talking about contact the help desk. And you can do that via that link which is support.nlm.nih.gov.

And now we have another question. This is from Aliyah in chat, and she says I don't speak Spanish, but I teach MedlinePlus to Spanish speakers with a translator. It's not very effective because the conversations are rich and long. They go off topic a lot. Can you offer any tips or best practices for a situation like this where you're an English speaker teaching MedlinePlus and Español with the assistance of a translator?

JAVIER: Yeah, that's a wonderful question. First, I'd say you should join our team meetings because we do this a lot. Unfortunately, it may not necessarily be the MedlinePlus site that's veering off the side conversations. This is one of those cultural nuances we talked about in many cases as we translate something into Spanish because the grammar is somewhat more complex in Spanish and unfortunately will always require more words, more explanations, and because you're actually teaching something that's you know I'm going to say clinical in nature to some extent you're probably going to-- that translator is probably going on overtime trying to not just translate the, I guess, the information that's being shared, but probably putting in a lot more information between what is there in English and what they're sharing in Spanish. This is going to be a challenge across the board for many educators.

And as a previous educator, the best advice I can give you is make less use of the translator at times. Perhaps have some activities or exercises where you have the amazing capability of toggling between English and Spanish. You might use it, you might want to use it, and then, you know, share some terminology. Start with terminology, with your, with your audience, with your students. Have them identify the terms in Spanish without you pointing to it. So perhaps read a paragraph or read a sentence and specifically highlight certain keywords having to look for the information on the you know via the toggle in Español after doing some of that basic vocabulary. Bring back the translator to share the points that you're trying to, you know, get across. And that way the translator won't be busy trying to explain some of those key terms that they're probably stuck in. If that doesn't work, certainly come join one of our morning meetings. We'll be happy to help you navigate that bilingual, you know, setting.

MOLLY: Thank you. Thank you so much Javier. Those are some good tips especially toggling between the MedlinePlus in Español and English and identifying key terms before bringing back in the translator. We like to say the KISS method, keep it simple silly and that yes especially when it comes to multi-languages. OK.

We have a question from Isabel in chat and she says that years ago, or Isabel says years ago she saw a discrepancy between the English and Spanish version of cholera and there was missing text in Spanish. I contacted someone about it-- Ohh, Andrew's answering it-- contacted someone, received a response and it was corrected and it turns out Yep it was NLM customer service. So thanks for that comment Isabel. Just reiterating the support.nlm.nih.gov is a great resource and you will talk to an actual person.

JAVIER: May I just add, I'm sorry, just add for Isabel, you know, we are very grateful for the fact that you've found this discrepancy because most of our edits after it's something is posted and published. Most of our edits come from our team consumers as I mentioned earlier, who always have a fine eye for little things like an extra letter here or there or you know some missing terminology because it is still you know a human you know operated you know centered database would say there. You know we are prone to potentially errors like this. But you know thanks to this setting the tone basically the more people that we have looking at this you know the better our product you know is refined.

MOLLY: It makes me think too. It might be an interesting learning activity to try to spot-- And then you can contact the help desk and there you go build it. José Luis asks, Any opportunities where we can learn when new opportunities to work in MedlinePlus Español come become available? Searching for job opportunities.

JAVIER: Good question. Jose, the good advice I can give you is definitely look at the information on USAjobs which is how I ended up here. I came from the FDA you know in an environment where we were translating a lot of information rapidly but it's two different entities. With that said there are a lot more growing opportunities for bilingual health programs or even bilingual health communications folks who are able to navigate between both languages. Certainly keep an eye on that and look for those opportunities. I would also say additionally just be involved with the different groups and communities across HHS and a lot of times you will see you see our colleagues sharing information about potential opportunities.

MOLLY: Yeah, and Louise shared the link to USAjobs in Chat for folks that are interested in that. One more question from chat. Aliya would like to know when are the morning team meetings? And I'm curious too, are those open to the public or are those for the institutes and centers at in at NIH, those ICs that we were talking about?

JAVIER: I'm so sorry, I didn't mean to mislead you. So the morning team meetings are for the Spanish team at MedlinePlus. We meet Monday through Friday everyday at 9:00AM. It can go between 30 minutes to an hour and 30 minutes long meetings. We usually just go over all of the social media inquiries that come in, you know from the previous day. Thank you for the question because it gives me a chance to talk a little bit about the nuts and bolts. So these questions come in from our consumers who either found something, have a follow up question or sometimes inadvertently link to us in looking for a medical product or some kind or they want to know more about NLM and about MedlinePlus.

So these meetings, we really just discuss the day's work, the ongoing projects that we have, the different translations that we're working on, topic summaries, medical summaries, if any product is out in in the news or if there is a health condition that is in the news, we try to stay on top of it looking for this information in advance of our colleagues at the CDC for example have a great resource in Spanish for you know for consumers, but it's not a resource that's available real time. So we have to at times look for that information before some of the reliable sources have it so that we can have some templates ready. With that said we have accommodated in the past meeting specifically with IC representatives usually very specific programs or offices that are looking to plan something perhaps like a campaign via social media or a fact sheet. As I mentioned earlier the History of Medicine division for example, as they produce bilingual exhibits we have, we have been more than happy to participate in just providing that extra set of eyes as a reviewing entity. And that's mainly because we do this every day. So the English to Spanish toggle, you know in our in our minds works very efficiently. But for anyone on the call, anyone across NIH or beyond, we'd be happy to talk to you about, you know, this process, about our program, about how we manage the information, how about how we prioritize information from English to Spanish. I'd be happy to just-- reach to me via e-mail and we can get something going for you.

MOLLY: Thanks, Javier. We have another question. And this is about the users of MedlinePlus en Español. Geographically, who are the main users of MedlinePlus en Español, are there regional considerations around the US? Do you get users from different parts? Could you speak a little more about that?

JAVIER: So there are regional considerations across the country. Medline Plus en Español around the US is really established by those regional pockets of populations of these consumers. The demographics across the US are built in a way where for example the consumers in the Northeast have at times much different interests and concerns and the consumers in the Southwest or on the West Coast or in the middle of the country.

To give you a real life example, if there is information happening about floods and safety and food safety and crop safety, crop safety is something that affects a certain regions of the United States and not others. And so you know in in a situation like that we would get a lot more people from the Southwest, from the areas of the country where those pockets of consumers are bilingual or Spanish speaking who are in fact affected by you know like a weather event where there is a potential threat you know to that product. And you know most consumers on the East Coast, on the Northeast in particularly they are faster at you know with information as in you know it's the East Coast. They get information sooner. A lot of times things topics that are trending we will see those trending you know from East to West and in that case especially if it's a condition or a disease or health issue that just made the news if for example sometimes a celebrity you know, put something out there and people look for it. It's trending. Once it's trending on social media, if it's a health condition, it's only a matter of time before people start asking us or if we take the lead and start posting about information, proper information about that condition or topic. That's a good question. Thank you.

MOLLY: Thank you. Alright, and please keep those questions coming in chat, would love to hear them. And you're also welcome to post a question in Spanish. We have two translators, sitting, awaiting, with their services. And while you're thinking about that, I have another question. Are there differences between the Spanish and English language site related to the organizations that publish materials in Spanish versus English?

JAVIER: It's a good question. Mainly the difference between the difference is between the different types of topics that people are looking for along with the social media platform of their choice. So, for example, most Spanish speaking consumers rely heavily on Facebook and Instagram, less on Twitter. In the past we used to try to coach more of those consumers by post posting more information on Twitter for example. But it's really a matter of personal choice. We we've noticed from the from the beginning when our Instagram account went live, how the populations that flocked into the Spanish account was about a much higher rate from the beginning. This is us also based on the number of consumers that follow us you know on these platforms. And you know, our interaction with them, it does provide us with some randomized feedback. You know we have a lot of public asking some basic questions. We have health professionals, academics, private practices. At some point everyone has reached out to MedlinePlus en Español and then we also have as we mentioned earlier the NLM consumer customer service feedback, you know, portal where consumers sometimes reach out directly and ask for information.

MOLLY: I have a follow up question. We've talked a lot about the wonderful support desk at NLM. Do they accept questions en Español, in Spanish?

JAVIER: So I have received questions en Español in the past. They're-- whoever is behind the portal is very quick to send it down to us. What we normally do is translate the question, provide the answer and then provide the answer in English as well and then send it back to the portal help desk.

MOLLY: That's wonderful information to know we are nearing the end of our time together today. Javier, this has just been so great. I'm going to have to pass this back to Louise to wrap things up, but I would like to just point out that we've shared the social accounts Instagram, Facebook, and Twitter if you're interested in checking those out. And Louise.

LOUISE: Thank you, Molly, and thank you to Javier and Andrew for lending your expertise. Thank you to Michael, Felipe and Paulina for your support during this time. And thank you to our audience for your great questions and contributing to a very informative session.