A presentation to the Online Legal Information Network, 2003
I've been asked to speak to you about multilingual information on the net — why we should do it and how effective it is.
[Ilona began the presentation by discussing the results of a study on women's information needs conducted by Urbis Keys Young for the NSW Department of Women in December 2001.]
So, in summary, even though this study is almost two years old, I don't think the issues have changed greatly. With the way information provision is advancing (or retreating), if you want to engage non English speaking women you need to be able to provide them with information in their own languages. The question then, is why use the net?
Why Did We Decide to Put Multilingual Health Information on the Web?
For a number of years NSW Health had operated its own Health Translation Service which produced numerous pamphlets in many languages. They did large print runs and sent out their products to hospitals and Community Health Centres, sometimes unsolicited but more often in response to orders. The result was that the system had lots of multilingual information produced over the years and workers had cupboards full of publications. Whilst this was a wonderful resource, the English text in many cases had often been lost so no one knew what was still current and correct. Health workers, therefore were loath to use that material.
At the same time, the cost of print runs was escalating, the need for other languages was increasing, and no one was sure how big a print run should be ordered in any particular language.
With the last change in government, the Health Translation Service was closed in a departmental downsize and our service was funded with the brief to find a new more economical and efficient way of developing multilingual information.
Theory on the Use of Written Material in Providing Information
It is difficult to change behaviour and the provision of educational material does not guarantee change. Written health information is most effective when it is given out by a health professional either to support advice given at the time of a consultation or during an education session.
Our Target
Because of the above, we decided to target health professionals in the hope that they would become the intermediaries in the provision of information in languages other than English. It was also easier for us to reach health professionals through the health system.
How Does it Look?
Let's have a quick look at the site. On our home page we have a catalogue online.
What are the Issues?
Access to computers, etc
Not all health staff are computer literate, not all have access to computers, not all have access to the internet or even the intranet and not all are able to download Adobe Acrobat. For five years we have battled this attitude from workers who say it's just too difficult when they don't have a computer on their desks with internet access.
We have actually come up with what we consider to be a short-term solution. That is a fax-back service. Each item (including each language version) on our website has a discrete publication number. The person who wants the information telephones a 1300 number and, using their touchtone phone, they punch in the publication number and their fax number. From the net, the publication is then sent directly to their fax machine.
Some might say that this is a regressive step when the net is the tool of the future but there is no point ignoring the needs of your client group when they haven't been provided with the most up-to-date technology.
Ensuring the information is up to date
Much of the information contained in the site was inherited from previous systems. Some of the information was designed to be distributed as part of promotional material for specific activities (e.g. Health awareness weeks) with dates and specific telephone numbers and addresses. Other information was written as newspaper articles. With time this information is becoming out of date and much of it needs editing. This is proving to be very time consuming, difficult and costly.
To date the system has about 450 publications on the web in need of checking (3 years after production). This amounts to over 4000 individual items in languages other than English. The checking process involves sending the item back to an expert who specialises in the topic, asking them to check it for current accuracy. You also have to convince them not to edit it or make changes just because they think it might read better. When that is done, we either have to check the references to other services, addresses/telephone numbers or remove all reference to them. Checking is a painstaking task which can only be done by actually contacting the organisations. The reference then has to be located in the body of the text.
None of the material that was scanned in can be changed easily. It must be "whited out" manually and new information cannot easily be inserted. With our new system, the advantages are that a person who reads the language and has an appropriate computer set-up, could make changes to the information directly on their computer.
Selecting material to be put in the system
Multicultural Communication has as part of its role to be the clearing house of multilingual health related material in NSW. The main sources for new information material are:
Of course in other cases we are approached to put the material on the net but, for a range of reasons, it doesn't comply with the NSW Health or our standards.
Monitoring the use of the site
Our ability to gain information about the users of our information has been another challenge. Because we sit on the Department of Health's server it has taken some time for us to be able to get the data we need. What we need to know is how the health system is using us so now we get from the intranet downloads by language, downloads by item and downloads by Area Health Service. So even though we don't know exactly who is using what, we do know which Areas are downloading aged care materials, or early childhood materials and that allows us to target our promotions in Areas where we know particular topics are not being accessed.
Successes
Hits and downloads
The promotion and dissemination of multilingual health information/education material via the web is definitely a success. The overall increase in the number of hits is substantial. The number of hits has grown over two years from 5,000 per month to a top of 202,000 per month. More telling is the number of downloads by the health system because these are actual items being used. These are increasing on a monthly basis and are up to 4,500 per month.
The cost-effectiveness of information dissemination
The cost of producing the information is the same as before because translation is still done by human beings. The savings come from the printing which is now on ordinary paper as opposed to glossy paper, storage and distribution. For NSW Health, too, the production costs have been decentralised because each worker prints out what they need (and pays for it) instead of the Department paying for the printing.
The big bonus is that health staff have somewhere to go to see whether there is an item suitable for them before they spend money on producing something new. They also feel confident (which makes us a bit nervous) that the information is current as opposed to the times when they had cupboards full of brochures and no idea if they were up-to-date or not.
Storage
The storage of the information is practical and easy.
Viewing of material
The system provides a wide range of options for the user to view the material. It is possible to have a variety of materials in one particular language, or the whole range of material about a particular subject.
Reproduction
There is no need to produce multiple copies of the material on paper, as it can be printed as needed. The attractiveness of individual publications is limited to plain paper and mostly black and white printing.
Other materials on our site
We can produce catalogues of all resources or catalogues by language. Also on our site we have:
We are constantly holding consultations with health staff, meeting workers and answering questions that come to us. The most disheartening thing is to hear someone say "we didn't know about your site, it's fantastic". We're delighted that they think it's fantastic but why didn't they know about it?
There is an ongoing turnover of staff in the health system in NSW and inservice education is provided by Area Health Services. For us the biggest challenge is to let everyone know what we have to offer. It never ceases to amaze me that half our hits come from the United States. We want workers to know about us. We want workers to use us. We want workers to automatically turn to us when they need multilingual health information. We have just produced new promotional material which we plan to distribute right throughout the health system.
If you want to have a look at our site the address is:
http://www.mhcs.health.nsw.gov.au
Fax back service: 1300 859 659
