To create multilingual patient education materials, start with a plain-language English source written for the patients you actually serve, choose languages from local census and patient data, have a qualified human translator produce each version, and test it with patients who speak that language. If you publish the materials online, give each language its own URL and connect them with hreflang so Google shows patients the right one.
For most US healthcare providers this is also a legal requirement. Section 1557 of the Affordable Care Act, under the HHS rule finalized in 2024, requires covered entities to provide free, accurate language assistance, to post a notice of it in at least 15 languages, and to have a qualified human translator review machine translation of critical material.
Who needs materials in another language
The US Census Bureau's Language Use in the United States: 2019 found that 78% of people age 5 and older spoke only English at home, and 67.8 million spoke another language, up from 23.1 million in 1980. Spanish was by far the largest, with about 30.6 million speakers.
Speaking another language at home does not mean a patient needs translated materials. The measure that matters is how well people speak English. The Census Bureau's 2018 to 2022 estimates show 61.0% of Spanish speakers, 48.2% of Chinese speakers and 69.8% of Tagalog speakers spoke English "very well." The rest, roughly 39% of Spanish speakers and more than half of Chinese speakers, are the patients most likely to need materials in their own language.
Your own data matters more than national figures. Before choosing languages, pull:
- The preferred language field from your EHR or intake forms
- Interpreter requests over the last 12 months
- American Community Survey language data for your county, from data.census.gov (table S1601, "Language Spoken at Home")
- Search demand: look for Spanish or Vietnamese versions of your service queries ("dentista cerca de mí", "bác sĩ nha khoa") in your keyword tool
What Section 1557 requires
Section 1557 of the Affordable Care Act bars discrimination, including on the basis of national origin, in health programs that receive federal financial assistance, which covers most providers who accept Medicare or Medicaid. HHS issued its current rule on May 6, 2024. Some parts of the rule have been challenged in court, so check the current status with HHS or your counsel. The language access provisions say:
| Requirement | Section | What it means for patient materials |
|---|---|---|
| Take reasonable steps to provide meaningful access to each person with limited English proficiency | 92.201(a) | Language access is owed to each individual patient, whatever language they speak |
| Language assistance must be free, accurate and timely, and protect privacy | 92.201(b) | No charging for translation; no relying on rough drafts for anything important |
| Use a qualified translator when translation is required | 92.201(c)(2) | Bilingual staff without translation qualifications do not meet the standard |
| Have machine translation reviewed by a qualified human translator when the text is critical to rights, benefits or access, when accuracy is essential, or when it contains complex, non-literal or technical language | 92.201(c)(3) | Discharge instructions, consent forms and medication guidance cannot go out as raw machine output |
| Do not rely on minors or untrained adults to interpret, except in narrow emergencies | 92.201(e) | Family members are not your translation plan |
| Post a notice of free language assistance in English and at least the 15 most common languages of people with limited English proficiency in your state | 92.11(b) | One notice, many languages |
| Put that notice in a conspicuous location on your website, and in specific documents such as consent forms, discharge papers, billing materials and patient handbooks | 92.11(c) | Patient education often sits alongside these documents |
This table summarizes the regulation text. It is not legal advice; your compliance lead should map these duties to your own programs. HHS's Section 1557 page has fact sheets and sample notices.
Fix the English source first
A confusing English handout becomes a confusing handout in six languages. The 2003 National Assessment of Adult Literacy, still the only national measure of health literacy, found 53% of adults had intermediate health literacy, 22% basic and 14% below basic; only 12% were proficient (NCES).
Three free, authoritative resources:
- CDC plain language guidance: put the most important message first, use active voice and familiar words, aim for about 20 words per sentence, and keep paragraphs to one topic and no more than five sentences.
- AHRQ Health Literacy Universal Precautions Toolkit: assumes any patient may have trouble understanding health information and gives practices tools such as teach-back.
- Federal Plain Language Guidelines: the standard federal agencies write to.
Before sending a document for translation, check it against this list:
| Check | Example |
|---|---|
| One main action per document | "How to prepare for your colonoscopy" covers preparation only |
| Most important instruction first | "Stop eating solid food at noon the day before" opens the page |
| Everyday words for medical terms | "Blood thinner" with "anticoagulant" in brackets once |
| Numbers written the way patients use them | "Take 2 pills every morning" over "Take 20 mg q.d." |
| No idioms or culture-specific references | "Don't throw in the towel" translates badly |
| Pictures that show the action | A diagram of the inhaler, labeled |
A step-by-step process for multilingual materials
- Pick documents by risk. Start with what patients must act on correctly: procedure preparation, discharge and medication instructions, consent explanations. General wellness content comes later.
- Pick languages from data. Use your intake data and county census tables, and add any language required for your Section 1557 notice.
- Finalize the English source. Plain language review, clinical review, then lock it. Every later edit means retranslating.
- Build a glossary. List the medical terms, drug names and practice-specific words with approved translations, so every document uses the same term.
- Translate with a qualified translator. Use a professional medical translator or a vendor that uses them. Certification bodies such as the American Translators Association list credentialed translators by language pair.
- Review independently. A second qualified linguist reviews, or a clinician fluent in the language checks clinical accuracy. Some programs add back-translation (translating the version back into English) for high-risk documents.
- Test with patients. Ask 3 to 5 patients who speak the language to read the material and explain the instructions back in their own words (the teach-back method from the AHRQ toolkit). Fix anything they misread.
- Format for each language. Translated text often runs longer than the English; right-to-left languages such as Arabic need mirrored layouts; some scripts need specific fonts. Leave room in the design.
- Publish and track versions. Date every version. When the English changes, flag every translation for update.
Human translation, machine translation and where each fits
| Approach | Good for | Not good for | Section 1557 position |
|---|---|---|---|
| Professional medical translator plus review | Discharge instructions, consent explanations, medication guides | Very fast-changing content | Meets the qualified translator standard |
| Machine translation reviewed by a qualified human translator (post-editing) | Large volumes of patient education, website content | Anything that skips the review step | Allowed; review required for critical, technical or non-literal content |
| Raw machine translation | Internal drafts, understanding an incoming patient message | Anything patients act on | Fails the review requirement for critical content |
| Bilingual staff without translation training | Conversation, scheduling | Written clinical materials | Only qualified bilingual staff may communicate directly with patients |
Machine translation is improving fast, and post-editing can cut cost and turnaround. The rule's line is clear: when accuracy is essential or the content is technical, a qualified human reviews it before patients see it.
Publishing multilingual pages on your website
Patient education that lives on your website reaches patients before their visit and can rank in search. Google's guidance on localized versions sets the rules:
- One URL per language. Put each version on its own page, such as
/es/preparacion-colonoscopia/. Do not swap languages on one URL based on the browser. - hreflang annotations. Tell Google which pages are translations of each other, using HTML link tags, HTTP headers (useful for PDFs) or your XML sitemap. Google treats the three methods as equivalent.
- Links in both directions. Each version must list itself and every other version. If the Spanish page points to the English page but the English page does not point back, Google ignores the tags.
- Correct codes. Use ISO 639-1 language codes (
es,vi,zh) with optional ISO 3166-1 region codes (es-US). Usex-defaultfor a language selector page. - Translated pages are not duplicates. Google says localized versions are only treated as duplicates when the main content is left untranslated.
Add a visible language switcher on every page, translate the title tag and meta description (our healthcare meta descriptions guide applies in every language), and make sure PDFs are tagged for screen readers. Structured data should describe each language version too; see our guide to healthcare schema markup.
Search engines and AI assistants both answer questions in the language they are asked. If a Spanish-speaking parent asks ChatGPT for a pediatrician who speaks Spanish, the answer draws on pages that say so in Spanish. Rank.ai's free AI grade shows which questions your practice is named for today.
Formats beyond the printed handout
- Video with subtitles or native-language voiceover for procedures and devices
- Audio recordings for patients with limited literacy in any language
- Pictogram medication schedules that work across languages
- Text message instructions in the patient's preferred language, sent at the moment they need them (night before a procedure)
Whatever the format, the same review standard applies to the words in it. More on matching formats to patient needs is in our healthcare content marketing guide.
FAQ
Do I have to translate patient education materials into other languages?
If your practice receives federal financial assistance (including Medicare and Medicaid payments), Section 1557 requires reasonable steps to give each patient with limited English proficiency meaningful access, with free, accurate and timely language assistance. That does not mean every document in every language, but critical materials need a path to accurate translation or interpretation. Check the regulation and HHS guidance with your compliance lead.
Can we use Google Translate or ChatGPT to translate patient materials?
You can use machine translation as a first draft. Under the 2024 Section 1557 rule, when the content is critical to a patient's rights or access, when accuracy is essential, or when it is technical or non-literal, a qualified human translator must review it. Never paste patient-identifiable information into a consumer AI tool.
Which languages should we translate into first?
Start with your own patient data: the preferred languages recorded at intake and interpreter requests. Check them against American Community Survey data for your county, and remember that your Section 1557 notice must cover at least the 15 most common languages of people with limited English proficiency in your state.
What reading level should patient education materials be written at?
Readability formulas give a rough check, but CDC's plain language guidance focuses on practical rules: the most important message first, familiar words, about 20 words per sentence and short paragraphs. Test with real patients using teach-back.
What is back-translation and do we need it?
Back-translation means a second translator converts the translated text back into English so you can compare it with the original. It is a quality check for high-risk documents such as consent explanations or research materials. For routine education, an independent review by a second qualified linguist is usually enough.
How do we make translated pages show up in Google?
Put each language on its own URL, connect the versions with hreflang tags that point in both directions, and translate the title, headings and meta description. Google detects page language from the content itself, so translate the full page, body text included.
