Only 15.7% of LEP adults understood treatment intent after reading a translated SACT booklet regardless of translation method

Description #

After reading a translated SACT information booklet, only 19 of 121 LEP participants (15.7%) correctly understood treatment intent, and comprehension was uniformly low across both translation arms despite the booklet being designed for accessibility (European Easy-to-Read standard). The authors read this as evidence that translated written information alone is insufficient, and that low health literacy or other communication barriers persist beyond mere availability of a translation.

"In total, 19/121 (15.7%) of participants in the Booklet Component achieved the primary outcome of correctly understanding treatment intent" (Hibbs, 2026, p. 4)

"Despite the clear difference in translation quality in the two arms of the Booklet Component, we observed a low level of comprehension in participants after reading translated written patient information, whichever translation method (machine or professional) they were randomised to." (Hibbs, 2026, p. 6)

"This is despite choosing a booklet designed for accessibility and readability, suggesting that low health literacy or other communication factors may be additional barriers beyond the availability of translated resources." (Hibbs, 2026, p. 6)

Methods Context #

What? #ⓘ

The observable: the proportion of participants correctly understanding treatment intent (myeloma SACT is non-curative) after reading the translated booklet.

"We chose a primary outcome of the proportion of participants understanding treatment intent: specifically, that the myeloma SACT regimen would not cure myeloma but instead aims to increase lifespan and quality of life." (Hibbs, 2026, p. 3)

How? #ⓘ

Each participant read a Bengali translation of an English Easy-Read myeloma booklet (professional or machine translation) and immediately completed the validated Booklet Comprehension Tool.

"Each participant was given a Bengali translation of an English booklet ("Easy Read: How is myeloma treated?", Myeloma UK)" (Hibbs, 2026, p. 3)

"Immediately after reading their allocated booklet, participants were asked to complete the Booklet Comprehension Tool." (Hibbs, 2026, p. 3)

Who? #ⓘ

121 analysed healthy Bengali-/Sylheti-speaking adults with LEP in London; 42.1% female, most aged 45–64, and 76% rated their own English ability as "Fair", "Poor" or "Very Poor".

"Of the 121 participants analysed, 42.1% were female, the majority were between the ages of 45–64 and 76% rated their ability to use English as either "Fair", "Poor" or "Very Poor"" (Hibbs, 2026, p. 4)

Other Notes #

This booklet-phase comprehension rate (15.7%) is far below the consent-phase rate reported in the companion consent EVDs (34.8% English-only, 60.0% bilingual), which the authors attribute to cumulative learning plus the added benefit of an interpreted verbal consultation.

Caveats #

• No formal Bengali health-literacy measure, limiting attribution of low comprehension The study did not include a formal, validated measurement of health literacy in Bengali. Because health literacy was not measured, the low comprehension observed after reading the translated booklet cannot be cleanly attributed to translation quality versus underlying health literacy or other communication barriers — limiting the interpretation that translated written information alone is the binding constraint.
• Healthy-volunteer, simulated group consent with immediate no-recall comprehension measurement The findings come from healthy volunteers rather than patients with cancer, in a simulation of only partial fidelity to real practice (participants completed consent consultations in small groups rather than individually), with comprehension and confidence measured immediately after each intervention rather than as later recall. Real cancer patients face additional psychological and cognitive demands and greater salience of treatment intent that this design cannot capture, and immediate post-test measurement may overstate durable understanding. Together these external-validity gaps limit direct extrapolation of the comprehension and confidence estimates to real interpreter-mediated oncology consent.