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Applied ResearchExecutive Order 13166 and Its Impact on Translation and Localizationserve their local populations. However, complicatingthe issue, each country or region and even eachorganization seems to have its own idea of whatconstitutes a best practice for localizing informationfor patient groups in its service area. For example, theEuropean Union specifies which documents must belocalized and translated with a set of guidelines, whilethe United States leaves the decision and guidelines upto individual organizations. However, a few commonstrategies have emerged in the discussion.Strategy 1: Make the textual style ofthe information match that of the culture’sexpectations. Research the culture using GeertHofstede’s (2001) and Edward T. Hall’s (1976) culturaldimensions, as well as the preferred style of writing forthe target culture. Information on the ways in whichcultures differ is available and, as the work of Tebeaux(1999) and others suggests, highly applicable to practicalwriting strategies for global contexts.Strategy 2: Research the preferences forgraphics and color in medical documents for thetarget culture and use the preferred style. In somecountries—such as China, Mexico, and the UnitedStates—specific information is available regardingthe preferred format of graphics in various contexts.However, on-the-ground research is needed for manycountries. Focus groups and subject matter expertscan help.Strategy 3: Use widely recognized symbols.When information must be localized for a varietyof cultures and language groups, as in signs, usewidely recognized symbols such as those developedby Hablamos Juntos and the Department ofTransportation (Hablamos Juntos, 2005; Sampson, 2006,pp. 94–98). These free symbols appeal to a wide varietyof language groups.Strategy 4: Use focus groups. Many organizationsagree that focus groups are the best, most cost-efficientway to localize health care information for a particularpatient population. The nature and scope of the focusgroup will vary depending on how widely distributedthe information will be and how many target culturesthe writer is hoping to reach. Many organizations, suchas the Community Health Education Center of theMassachusetts Department of Public Health, conductsmall, locally based focus groups for information fromthe hospital or clinic, while larger organizations, suchas CDC, conduct focus groups across the country toensure that they are capturing a wide array of opinionsfor information that will be published nationally(DHHS, 2001, p. 14; Ogilvy, 2005). Focus groups canprovide valuable information about preferences fortext and graphics when the information is not availablethrough research.Strategy 5: Consider the content, not just thestyle and format. Recognize that the localizationof textual health care information is a sensitiveundertaking, with much at stake for both the patientand the hospitals and clinics involved. Localizinginformation goes beyond a simple consideration oflanguage, style, and graphics; the information mustmatch the culture’s expectations for topics that can becovered and its perceptions about health and health carein general (Callister & Birkhead, 2002; Forslund, 1996;Kreps & Kunimoto, 1994).It is imperative to ensure that medical informationis not just translated correctly but is also culturallyappropriate. The consequences for not connecting withan LEP population are profound—from expensive andtime-consuming lawsuits for the hospital or clinic topatient injury and even death. With time and research,technical communicators, through their efforts toimprove the quality of translation and localizationefforts, are poised to have a positive impact on thehealth and welfare of millions of LEP patients in healthcare settings.ReferencesAmerican Medical Association (AMA). (2006). Officeguide to communicating with limited English proficientpatients. Chicago, IL: AMA.Baker, M. (1992). In other words: A coursebook on translation.New York, NY: Routledge.Barnum, C., & Li, H. (2006). Chinese and Americantechnical communication: A cross-culturalcomparison of differences. Technical Communication,53, 143–165.262 Technical Communication l Volume 57, Number 3, August 2010