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Community accessibility of health information and the consequent impact for translation into community languages.

1. Introduction

In a multilingual and multicultural society such as Australia, effective community-wide communication among diverse groups of language speakers with different cultural backgrounds is a constantly challenging issue. One of the areas where it is of significance is in the health and medical fields. In New South Wales, the Multicultural Health Communication Service (MHCS) takes a leading role on meeting the health information needs of Australians from a wide range of language backgrounds. It provides advice and services to state-based health professionals aiming to communicate with non-English-background speakers. A central question for this organisation is the quality of the information that is written in English for subsequent translation into different community languages. Despite the organisation's advocacy of the use of Plain English (personal communication, April 2007), a major concern is the written quality and readership accessibility of health-related texts written in English, which are used as the basis for translations into a number of different languages used in the community. In particular, there is a view that the role of Plain English in the preparation of translated materials appears to be misunderstood and underestimated.

This paper describes a collaborative project undertaken by the authors with professionals from the MHCS and from the translation and interpreting field. The project was designed, first, to analyse and investigate the comprehensibility to the community of health information written in English; second, to examine the impact on translation into other languages and third, to survey the usefulness of health information perceived by the general public who have different linguistic and cultural backgrounds. This paper will address the first issue on the basis of a linguistic analysis with two English texts and the second and third ones discussing quantitative results of a survey conducted with the general public who speak English, Chinese, or Korean as their mother tongue. Very little research has been undertaken to investigate issues of community accessibility of health information and the consequent impact for translation into community languages. Thus, the study was conceived as a pilot project to begin investigation of the issues mentioned above.

2. Research design

This pilot phase was carried out through four steps. First, following extensive linguistic analysis of 30 health related texts currently used within the community, we selected two texts that were agreed by the whole project team to be less accessible English texts. The two texts were Men who Smoke (T1) and Do you Have a Breast Change? (T2) (see Appendix 2). These texts were also selected because they deal with high profile health issues within the community. Second, the two texts were revised for greater accessibility using the considerations of multiple domains of meaning drawing on systemic functional linguistics (see Section 3). Third, the two original texts (V1s) as well as their revised versions (V2s) were translated into Chinese and Korean by two professional translators (see Appendices 3 and 4). The translations were then each checked by another professional translator. Finally, a survey was conducted of approximately l00 readers from English, Chinese and Korean-speaking communities respectively. In the survey, the original and revised versions of the texts were presented to investigate their reactions to the different versions, and specifically, the extent of the accessibility of the information.

3. Text revision

Plain English is often defined by its proponents as the antithesis of "gobbledegook" or "jargon". Eagleson (1990, p. 4) provides the following description:
      In short it is the opposite of gobbledegook and of confusing
   and incomprehensible language. Plain English is clear,
   straightforward expression, using only as many words as are
   necessary. It is language that avoids obscurity, inflated
   vocabulary and convoluted sentence construction. It is not baby
   talk, nor is it simplified version of the English language.

      Writers of plain English let their audience concentrate on the
   message instead of being distracted by complicated language.
   They make sure that the audience understands the message
   easily.


All of this is excellent advice; however, in perusing more closely the nature of the specific advice put forward in policy guidelines, we see a number of problematic areas of interpretation. (1)

First, it may be difficult for health professionals who are usually highly educated to place themselves in the position of readers with very varied levels of literacy in their first and second languages. Thus, advice tends to be targeted at a "generic reader" who may be assumed to have similar levels of literacy. Health information by its very nature often requires the use of technical and specialist language (the "jargon" referred to). Finding alternatives to technical and "long" words, rather than employing them within clearly written linguistic structures, where they are glossed or defined, could result in misleading substitutes and inaccurate information. It may also be difficult for writers to distinguish between what might constitute "clutter" and what might constitute the appropriate level of detail to provide sufficient information. In addition, balancing formality and friendliness of tone is a judgement that must be made by writers who may not have extensive insight into how to manipulate linguistic resources to set an appropriate tone. As a result, overuse of familiarity in presenting information could become alienating. Though overuse of the passive voice might result in dense impenetrable information, of itself it is not necessarily inappropriate. The most specific advice is offered at the sentence and word level in relation to sentence word quantities (writers may also be advised to "use verbs rather than nouns"); however, this advice may fail to take into account the nature of the topic and the level of detail required in sentence construction.

In addition, as linguists working within a theoretical framework of systemic functional linguistics (Halliday, 1994; Halliday and Matthiessen, 2004), we are aware that content may be changed in the process of rewriting. Nevile (1990) shows that text rewritten in Plain English may have changed content and argues that "if one is to rewrite a text in order to increase its readability, a great deal of caution is needed to preserve the content of the original" (Nevile, 1990, p. 36). Accordingly, our analytical approach to written texts is to explore them at four semantic levels: experiential, logical, interpersonal and textual to maintain the content of the original as much as possible. Instead of following a particular set of rules like those suggested for Plain English, in the revised versions of the texts we took into account how experiential meanings (i.e. who did what how and why, etc) are delivered: i) with clear logical relations between clauses that are not too complicated; ii) in an interpersonally appropriate tone; iii) within a coherent textual structure.

The linguistic analysis of the two selected texts showed that problems embedded in the texts could largely be categorised at two levels: the macro-level and the micro-level. The macro-level involved the overall textual structure of the text in terms of the genre or text type. In the Breast Change text for example, the information was provided in the form of question posing. In response to the first question, What causes a breast change?, the information did not actually describe the causes of change, but rather stated that breast changes are not an automatic indicator of breast cancer. The information on hormonal change, however, did suggest what causes breast changes. The information on cysts described not so much causes of breast changes but kinds of breast changes, while information on breast cancer was more related to how breast cancer occurs. Thus, in the original version of the text we found a mismatch between the question forms and the functional information supplied to respond to the question. However, we did not foreground this issue when revising the text. The primary reason is that we were not sure whether this is a textual structure that is typical in medical discourse. When we asked a linguist who was also originally trained in medicine for his opinions about this macro textual issue, he said it did read like typical medical information texts. While we were aware of the need to explore features of medical texts in detail, that analysis was beyond the scope of the pilot project.

At the micro-level we noticed problems primarily in three domains of meaning, experiential (who did what etc.), logical (relations between clauses) and interpersonal (formality, personal attitude etc.). They will be briefly explained with the following example, which is a response labeled Fact in the Men Who Smoke text to the Myth, I'm fit and healthy, smoking won't affect me. The combination of nominalisations and nominal groups that contain an embedded logical relation within them makes the original texts highly complicated to understand. Thus, the complexity of the original texts was firstly addressed in the revised texts experientially. The original text presented below, for instance, uses a number of nominalisations such as reduced oxygen uptake, shortness of breath, reduced endurance and poorer visual judgment. In order to reduce the density of information through the use of nominalisation, the experiential meanings of the nominalised items were unpacked into clauses in the revised text (e.g. when you take in less oxygen).

Example texts

Original

Carbon monoxide in cigarette smoke attaches readily to the substance in the blood responsible for transporting oxygen to the cells (haemoglobin). This means the blood is less able to carry oxygen around the body. Reduced oxygen uptake results in less oxygen being available for working muscles, which in turn reduces endurance. During exercise smokers are more easily exhausted, suffer shortness of breath, have reduced endurance and are slower to react.

Revised

When you smoke, a chemical in cigarette smoke called carbon monoxide attaches itself to your haemoglobin. Haemoglobin is the substance in the blood which carries oxygen to your cells. Therefore smoking means the blood is less able to carry oxygen around the body. When you take in less oxygen, you have less oxygen for your muscles to work and this reduces your fitness and stamina. This is why during exercise smokers are easily exhausted, short of breath and slow to react.

Another consideration taken into account to make sure a message was accessible in the domain of experiential meaning was how much knowledge could be assumed. For example, the original text seems to assume that the target reader already knows terms such as carbon monoxide as it starts with this technical term without an explanation. However, in the revised text, carbon monoxide is not treated as a common-sense term but as a specialised term and therefore the meaning is introduced as a chemical in cigarette smoke called carbon monoxide before the term is mentioned.

In terms of the domain of logical meaning, clauses embedded within nominal groups were elevated to rank clauses in order to deliver the experiential message in a more manageable amount per sentence. In the above example texts, for instance less oxygen [[being available for working muscles]], which is a long nominal group with an embedded clause, was revised into you have less oxygen for your muscles to work. The revised text also addresses an interpersonal issue, as in the original there is a disjuncture in register between the conversational style of the Myth statements and the explanations provided which are written in a very technically medical style. The lexicogrammatical features that typify conversational registers are not carried through. For instance, the myths statements are written in an informal way using the first person pronoun "I" but the responses are written in an abstract, formal and scientific way where there is little use of first or second personal pronouns. In the revised text, the second person pronoun "you" is employed as much as possible to maintain the informal tone set in the Myth statements. One may argue that this subtle interpersonal issue has little to do with Plain English. However, this is certainly an important domain of meaning that needs to be addressed carefully in any text to make sure the purpose of the text is achieved. In the texts selected for the study, it is one of the linguistic features that could deter the target reader from reading the text, which works against the intention of public health information.

This brief illustration intends to show that it requires more than a set of rules to communicate information or messages clearly in written form in the public health domain. Contextual information such as the purpose of the communication (e.g. expounding, enabling or recommending) and the assumed educational level of the public is vital in determining how language should be used to convey multidimensional meanings.

4. Translation

The two original texts (V1s) as well as their revised versions (V2s) were translated into Chinese and Korean by two professional translators. The Chinese translator had over 20 years experience of translating in the Australian context while the Korean translator had more than10 years' experience of translating, but not within Australia. Reflecting on the Skopos theory that translation strategies should vary depending on the purpose of the translation (Reiss and Vermeer, 1984), they were given a translation brief about the translation task. Although they were informed about the project, they were asked to translate each text as they would usually do with a translation brief. They were allowed to use whatever resources they normally use and given four hours to complete the translations. They were then given a week to revise their translations and send them back to the researchers electronically. The translations were checked by another translator and they were revised in consultation with the original translators.

In their post-translation interviews, both translators indicated that they chose to translate as faithfully as possible to the source texts following the same sequence of information and without adding or omitting any information. However, they also chose to make translation shifts (cf. Catfold, 1967) when they were necessary to make their translations easier to read. They tended to make more shifts when they translated the original versions than the revised ones. For instance, both Chinese and Korean translators translated the revised version of the Men Who Smoke passage in Section 3 without making any translation shifts but made a fairly major translation shifts when they translated Reduced oxygen uptake results in less oxygen being available for working muscles, which in turn reduces endurance in the original version as follows:

Chinese

[TEXT NOT REPRODUCIBLE IN ASCII.]

Back translation: Oxygen uptake reduces, so does oxygen needed for muscles, which lead to endurance reduction.

Korean

[TEXT NOT REPRODUCIBLE IN ASCII.]

Back translation: As oxygen uptake reduces, oxygen needed for working muscles becomes insufficient and then the body's endurance reduces.

Both translators translated the nominal groups, Reduced oxygen uptake and less oxygen being available for working muscles, as clauses. The original English text was revised in the same manner to make the information more accessible. This is one of examples that show both professional translators made translation shifts considering the accessibility to the target reader of their translated texts.

5. Survey

With two sets of the texts (original and revised) in each language concerned (English, Chinese and Korean), a survey was conducted of 246 participants in total. The survey consisted of two parts. The first part was a semi-structured interview format. The participants were asked questions on the readability of both texts, Men who Smoke (T1) and Do you Have a Breast Change? (T2). The original (V1) was compared with the revised version (V2) for each text. In the second part, they were asked closed questions about demographics including gender, age, education and length of time living in Australia. They were also asked to express their opinions in general about the accessibility of health information that is distributed in Australia. The participants' demographic information and their preference choices will be discussed in Sections 5.1 and 5.2 respectively and their opinions about the accessibility of health information in Section 5.3.

5.1. Respondent demographics

Of 246 participants, there were 98 respondents whose first language is English; 75 whose first language is Chinese; and 73 whose first language is Korean. Age and gender were the first demographic categories. The majority of respondents were between the ages of 25-60 and those over 60 were under-represented as shown in Table 1. There was double the number of female respondents than male for each language group.

Education was another factor thought to be relevant for comparing the accessibility of the different versions of the texts. This was considered an important category in our interpretation of results due to variables impacting opinions arising from literacy levels, based on the influence of the formality and degree of educational training. The respondents showed a range of educational backgrounds but those with only secondary education tended to be under-represented.

The participants were also asked how long they had been in Australia and whether or not they speak any other languages. Sixty-nine of the total 98 who identified themselves as first language English speakers were born in Australia and the rest were born in other English-speaking countries such as the UK and US. Out of the total 98 of English native speakers, 28 said that they could speak another language fluently. Meanwhile, the majority of the Korean and Chinese speaking respondents had been in Australia between 1 and 20 years. The results for fluency in a language other than their first language were much higher than for the English first language speakers with 65 out of 75 Chinese speakers and 44 out of 73 Korean speakers stating they could speak another language fluently. The other language in most cases was English.

5.2. Survey results for readability

The participants were presented with two versions of each text and asked to choose the version that they found easier to understand. Comparing preferences for ease of understanding for both versions of the two texts from each language group, there is a clear preference for the revised versions to the original texts in all the language groups. The results on both texts are presented in Table 4. With respect to the first text Men Who Smoke, responses were noted for 55 English native speakers, 53 Korean native speakers and 50 Chinese speakers. All groups preferred the revised version (V2). Out of the three groups the preference rate of the English group (65.5%) is higher than those of the Chinese (50%) and Korean (49.5%) groups. Less than 10% of those surveyed in all three groups felt there was no difference between V1 and V2 in being easier to understand.

As for the second text, Do you Have a Breast Change?, responses were noted for 50 English native speakers, 53 Korean native speakers and 48 Chinese speakers. Again all groups found the revised version (V2) easier to understand. However, there were two noticeable outcomes from the Korean and Chinese responses. For the Korean language group, V2 of T2 was preferred by nearly 74% of the participants. This is a significant preference towards V2 as being more accessible. The Chinese group, on the other hand, had a less marked preference for either V1 or V2 (34%: 50%) with 16% identifying that there was no difference in accessibility of the text for either V1 or V2.

Demographic variables (age, gender, education, duration of stay in Australia, etc.) did not appear to play a critical role in determining a preferred version. However, certain groups such as those over 60 and those with secondary education only were under-represented in the study and therefore the results cannot be generalised and need to be investigated again in the next phase of the research.

It seems, however, that the order of presentation of the two versions of each text did appear to affect preference for accessibility. Roughly half of the participants were presented with the original version (V1) followed by the revised version (V2) (V1^V2) and the other half in the reverse order (V2^V1) to avoid any potential cognitive influence of their exposure to the first version on their perception of the second version. When the preference ratios for V2 were examined in each of two sub-groups divided by the order that the two versions were read (either V1^V2, or V2^V1--where, ^ means 'followed by'), the groups that read V1 and then V2 showed higher ratios of V2 preference. This would indicate that the accessibility is also influenced by the amount of previous exposure to the content, as well as by the text itself (where results differed more for T1 than T2) (see Table 5). In other words, some respondents might have felt V2 was easier to understand because they processed the same information in V1. However, in whatever order the two different versions of each text were presented, the revised versions were preferred in all three language groups.

5.3. Opinions on public health information

The participants were asked for their opinions in general on public health communication published by the Australian government. When they were asked how often they read health information brochures or pamphlets published by the government only about half of the respondents from all the different language groups claimed to read them frequently or sometimes and the other half to read them rarely or not at all.

However, more than 90% of those who had read them said that they found them to be useful or very useful. When Chinese and Korean speakers who had read health information frequently or sometimes were asked in which language they read health information, only 21% of Chinese and 26% of Korean respondents said that they read the health information in their mother tongue and 46% of Chinese and 36% of Korean respondents said that they read in both English and their mother tongue. Considering that 41% Korean respondents (30 out of 73) did not consider themselves to be fluent speakers of English, the fact that only 26% of them read health information in Korean made us wonder if this finding reflected their dissatisfaction about the quality of community translation.

6. Conclusion

This paper has reported on the major findings from the quantitative data of a survey on the accessibility of two health communication texts by English, Chinese and Korean readers. In summary, the revised versions were found to be easier to understand than the original in all three language groups. This is a clear indication that there is much room to improve the way in which health information is written in English for effective community-wide communication within a multilingual society. We suggest that in research in this area there is a need to take a linguistic approach to investigate what features embedded in less accessible texts might impede accessibility. Such analysis would provide an effective foundation for developing practical guidelines for writing texts for the general public that can go beyond generalised Plain English recommendations. Further research analysing translation shifts, and the reasons for shifts made by professional translators might also shed light on the problematic features of less accessible texts. As this research has shown that a majority of those who read health information found it to be useful or very useful, it would seem advisable to ensure that health information and its translation for the community are made as accessible as possible. We hope that the findings discussed in this paper contribute to further discussions about effective community-wide health communication within a multilingual society.

Appendix 1: Plain English Guidelines

1. Always consider your readers and adapt your writing to their needs rather than your personal preferences.

2. Clearly identify your main message and don't bury it in the detail.

3. Structure your documents to put the most important information first, followed by the details.

4. Pay attention to the design and layout as much as to the language.

5. Choose a formal but friendly tone that is neither too hip nor too heavy.

6. Use short familiar words where they match your meaning, and don't dress up the text with long words just to sound impressive.

7. Prefer the active voice ('I think you can finish') rather than the passive voice ('It is suggested consideration be given to the finishing of').

8. Be ruthless on clutter, minimising words and details that add little value.

9. Write with an average sentence length between 15-20 words, but vary individual sentences between 10 and 35 words.

10. Always check your text carefully for errors in spelling, grammar and punctuation.

Appendix 2

Text 1: Version 1 (Original English)

Men Who Smoke

Myth: I'm fit and healthy, smoking won't affect me.

Fact: Smoking reduces your fitness.

Carbon monoxide in cigarette smoke attaches readily to the substance in the blood responsible for transporting oxygen to the cells (haemoglobin). This means the blood is less able to carry oxygen around the body. Reduced oxygen uptake results in less oxygen being available for working muscles, which in turn reduces endurance. During exercise smokers are more easily exhausted, suffer shortness of breath, have reduced endurance and are slower to react.

Myth: The chemicals in cigarettes are not dangerous, smoking can't cause me harm.

Fact: Nicotine, carbon monoxide and tar have harmful effects on the body.

Nicotine causes increased heart rate, which means the smoker's heart has to work much harder to produce the same effects as a non-smoker's heart. Nicotine also causes constriction of the blood vessels, resulting in reduced blood flow, and increased blood pressure.

Nicotine and carbon monoxide act on the blood, making it thicker and harder for the heart and blood vessels to transport around the body. These two chemicals also aggravate the lining of blood vessels. Damaged blood vessels mean the body's blood transport system is less efficient.

Carbon monoxide is associated with the development of coronary heart disease. It also contributes to the development of many cancers. Carbon monoxide and other chemicals in cigarette smoke paralyse the small hairs that line the airways. This means toxic substances, including some cancer causing chemicals, cannot be removed from the airway lining.

Tar is made up of a range of chemicals, some of which are known to cause cancer. Tar is also the substance in cigarettes, which yellows the teeth, hands and skin.

Text 1: Version 2 (Revised English)

Men Who Smoke

Myth: I'm fit and healthy, so smoking won't affect me. Fact: Smoking reduces your fitness.

When you smoke, a chemical in cigarette smoke called carbon monoxide attaches itself to your haemoglobin. Haemoglobin is the substance in the blood which carries oxygen to your cells. Therefore smoking means the blood is less able to carry oxygen around the body. When you take in less oxygen, you have less oxygen for your muscles to work and this reduces your fitness and stamina. This is why during exercise smokers are easily exhausted, short of breath and slow to react.

Myth: The chemicals in cigarettes are not dangerous, so smoking can't cause me harm.

Fact: Nicotine, carbon monoxide and tar, the chemicals in cigarettes, are harmful to the body.

Nicotine makes the heart rate increase. This means that your heart has to work much harder to produce the same effects as a non-smoker's heart. Nicotine also narrows the blood vessels. This reduces blood flow around your body and increases your blood pressure.

Nicotine and carbon monoxide make the blood thicker and so it becomes harder for your heart and blood vessels to carry blood around your body. These two chemicals also affect the lining of the blood vessels. When your blood vessels are damaged, your body's system for transporting blood becomes less efficient.

Carbon monoxide is related to the development of coronary heart disease and many kinds of cancer. Carbon monoxide and other chemicals in cigarette smoke paralyse the small hairs that line your airways.

This means that toxic substances, including some other chemicals that cause cancer, cannot be removed from the lining of the airways.

Tar is made up of a range of chemicals. Some of them are known to cause cancer. Tar is also the substance in cigarettes that makes your teeth, hands and skin yellow.

Text 2: Version 1 (Original English)

Do You Have A Breast Change?

This information sheet is to help you better understand the cause of breast changes and the tests which may be needed to find the cause of your breast change. This information is based on what we know through research.

What causes a breast change?

Although it is quite common for women to experience breast changes, the vast majority of these breast changes are not breast cancer. Changes to the breast may be caused by:

Hormonal change

Hormonal change may cause swollen, tender or lumpy breasts at times during a menstrual cycle, or when taking the hormonal treatment for contraception or hormone replacement therapy (HRT). Fibroadenoma

Fibroadenoma is a smooth, firm, mobile lump made up fibrous and glandular tissue, more commonly found in younger women. They are not cancer and can usually be left alone once the tests show that it is a fibroadenoma. However, removal of the fibroadenoma by a surgeon may be necessary if it continues to enlarge or change shape.

Cysts

Cysts are fluid filled sacs found more commonly in women 35-50 years or those taking HRT. Cysts are not cancer and can be usually left alone. If the cyst is painful or is a lump which can be felt, then the fluid in it can be simply drained using a fine needle so that the lump disappears.

Breast cancer

Breast cancer occurs when abnormal cells in the breast grow out of control. It occurs more often in older women, with more than 74% of cases occurring in women 50 years and older. It is important that breast cancer is found and treated early, before cancer cells spread to other parts of the body.

Text 2: Version 2 (Revised English)

Do you have a change in your breast?

This information sheet will help you understand more about the causes of breast changes. The information is based on what we know from research.

What causes a breast change?

It is quite common for women to experience changes in their breasts. But most changes are not cancer.

Changes to the breast may be caused by:

Hormonal changes

Hormonal changes may sometimes cause swollen, tender or lumpy breasts. These breast changes can happen during a menstrual cycle, hormone treatment for contraception or hormone replacement therapy (HRT).

Fibroadenoma

Fibroadenoma is a smooth, firm lump in the breast that moves when you touch it. It is made up of fibrous and glandular tissue. Fibroadenomas are more common in younger women. They are not cancer and can usually be left alone once tests show that it is a fibroadenoma. However, it may need to be removed by a surgeon if it keeps getting bigger or changes shape.

Cysts

Cysts are sacs filled with fluid. They are more common in women aged 35 to 50, or women using HRT. Cysts are not cancer and can usually be left alone. If the cyst is painful or is a lump you can feel, the fluid in it can be simply drained. This is done with a fine needle so that the lump disappears.

Breast cancer

Breast cancer happens when abnormal cells in the breast grow out of control. It is more common in older women. More than 74% of cases affect women over the age of 50. It is important to find and treat breast cancer early, before cancer cells spread to other parts of the body.

Appendix 3

Text 1: Version 1 (Chinese translation of the original)

[TEXT NOT REPRODUCIBLE IN ASCII]

Text 1: Version 2 (Chinese translation of the revised)

[TEXT NOT REPRODUCIBLE IN ASCII]

Text 2: Version 1 (Chinese translation of the original)

[TEXT NOT REPRODUCIBLE IN ASCII]

Text 2: Version 2 (Chinese translation of the revised)

[TEXT NOT REPRODUCIBLE IN ASCII]

Appendix 4

Text 1: Version 1 (Korean translation of the original)

[TEXT NOT REPRODUCIBLE IN ASCII]

Text 1: Version 2 (Korean translation of the revised)

[TEXT NOT REPRODUCIBLE IN ASCII]

Text 2: Version 1 (Korean translation of the original)

[TEXT NOT REPRODUCIBLE IN ASCII]

Text 2: Version 2 (Korean translation of the revised)

[TEXT NOT REPRODUCIBLE IN ASCII]

Acknowledgments

Although we have co-authored this paper, the research would not have been possible without the collaboration and input of other team members. Our sincere thanks and acknowledgments go to Peter Todaro and Michael Camit (NSW MHCS) and Terry Chesher and Paula Goodyer (independent translation consultants) for their important and constant guidance, feedback and support.

This project started when the authors worked in the Department of Linguistics at Macquarie University and it was jointly funded by the MHCS and the Department.

References

Catford, J. C. (1965). A Linguistic Theory of Translation. London: Oxford University Press.

Eagleson, R. D. (1990) Writing in Plain English. Canberra: Australian Government Public Service.

Halliday, M. A. K. (1994). An Introduction to Functional Grammar (2nd ed.). London: Arnold.

Halliday, M. A. K. & Matthiessen, C. M. I. M. (2004). An Introduction to Functional Grammar (3rd ed.). London: Arnold.

Nevile, M. (1990) Translating texts into Plain English: The cost of increased readability. Australian Journal for Adult Literacy Research and Practice, 1(2), 27-38.

Reiss, K. and Vermeer, H. J. (1984). Grundlegung einer Allgemeinen Translationstheorie, Tubingen: Niemeyer.

(1) For example, Appendix 1 lists the advice currently provided by the Plain English Foundation, http://www.plainenglishfoundation.com.

Anne Burns

University of New South Wales

anne. burns@unsw. edu. au

Mira Kim

University of New South Wales

mira.kim@unsw.edu.au
Table 1: Age and gender of the respondents

                                    Age

                   18-24   25-40   41-60   Over 60   Totals

Language Group
(Male: Female)

English Speakers    23      29      41        5        98
(33:65)

Korean Speakers
(21:52)             10      34      29        0        73

Chinese Speakers
(21:54)             14      35      22        4        75

Table 2: Education

                     Secondary   Tertiary    Postgraduate

English speakers        12          53            33
Chinese speakers         9          42            24
Korean speakers          7          41            25

Table 3: Length of time in Australia

         Less than  1-5 yrs  6-10 yrs  11-20 yrs   Over    Born in
            1 yr                                  20 yrs  Australia

English      3         4        9          5        8        69
Chinese      9        28        15        21        2         0
Korean       8        22        22        14        7         0

Table 4: Percentages of preferences for text versions (unit: %)

                  English      Korean      Chinese    Combined

                 T1    T2    T1     T2    T1   T2    T1     T2

V1              29.1   24   41.5   20.8   30   34   33.5    26
V2              65.5   66   49.5   73.6   56   50    57     63
No difference   5.5    10   9.4    5.7    14   16   9.5    10.5

Table 5: V2 preference ratios by the order of presentation of
different versions

                  English speakers  Korean speakers   Chinese speakers

Order presented     T1       T2       T1       T2       T1       T2
V1^V2              74%      63%      61%      79%      67%      61%
V2^V1              50%      68%      36%      67%      46%      41%

Table 6: Frequency of reading health information

          Frequently       Sometimes       Rarely   Not at all

English    8      8%     49    50%     22    22%     19    19%
Chinese    7      9%     25    33%     26    35%     17    23%
Korean     3      4%     30    41%     24    33%     16    22%
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Date:Jan 1, 2011
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