Linguistic explicitness and lay‑adapted translation in health communication: A randomized controlled trial of prostate cancer screening communication among elderly Chinese males.

Abstract

Prostate cancer incidence in China is rising rapidly, yet health communication remains hindered by cultural stigma, low health literacy, and a lack of linguistically accessible materials. This study investigates how translation strategies prioritizing lay-friendliness and cultural relevance impact comprehension of prostate-specific antigen (PSA) screening benefits and risks among elderly Chinese males-a demographic underrepresented in health literacy research. We conducted a randomized controlled trial comparing two translated versions of PSA screening guidelines: a largely word-for-word translation (WWT, reflecting minimal adaptation for lay readers) and a lay-adapted translation (LAT) prioritizing readability, semantic clarity, and contextual adaptation for lay readers through systematic adaptation strategies. Participants (N = 82, aged 40-86) were stratified by age, education, and baseline prostate cancer knowledge (self-assessed). Validated comprehension questions assessed understanding of screening risks/benefits, with statistical analysis (Mann-Whitney U, Bonferroni correction) evaluating cohort-specific improvements. The LAT group showed significant improvements in comprehension versus WWT, particularly among males aged ≥ 57 (d = 1.035, p = 0.0027), those with education above Year 9 (d = 0.903, p = 0.0017), and participants with limited baseline knowledge (self-assessed) (d = 0.748, p = 0.0029). Key enhancements included familial risk narratives (e.g., "more relatives with cancer = earlier screening") and explicit clarifications (e.g., "false negative = misdiagnosis"). However, LAT had minimal impact on younger or highly educated cohorts, highlighting persistent health literacy disparities. Lay‑adapted translations that prioritize readability, terminological explicitation, and age‑appropriate examples significantly improve PSA screening comprehension for elderly, less‑educated Chinese males but require complementary strategies to address broader health‑literacy gaps. Rather than claiming full cultural adaptation, we treat these adaptations as purpose‑driven, text‑level strategies that modestly enhance comprehension for specific low‑literacy populations.