DESIGN AND IMPLEMENTATION OF A MOBILE ENGLISH-TO-MAJOR NIGERIAN

LANGUAGES TRANSLATION OF DISEASE RELATED TERMINOLOGIES

ABSTRACT

Communication is cornerstone of medicine without which medical practitioners cannot effectively

interact with patients. However, effective communication is greatly threatened by language barrier
challenges experienced by medical practitioners in Nigeria. Medical practitioners practicing in
various states of the country may not be familiar with the local languages of the general community
and of their patients. Patients with limited English proficiency may have difficulty in describing
their symptoms in English or in interpreting diagnosis or medical instructions. A mobile
application may assist the medical practitioner to relate key words to patients in their local
language for emphasis or in the case of perceived misunderstanding. The aim of this paper is to
document the process of designing and developing an android application (NaijaMMed Translator
app) that shows compilations of symptoms, and other disease related terminologies, defined, and
interpreted to three of the major Nigerian Languages: Hausa, Ibo and Yoruba. The research
included user-involvement studies conducted in order to ascertain the relevance and
appropriateness of a prototype of the application. Results indicated that the application was void
of complexities and easy to be used by medical practitioners. It conveyed symptoms that could be
beneficial to common health challenges faced by Nigerian patients.

Keywords: Language barrier, mobile computing, translator, user-centered design, android, disease
related terminologies.
1. Introduction

Background on the Incorporation of Mobile Computing into Medical Fields

Computers are increasingly becoming the backbone of the information systems of factories, offices
and other enterprises and are improving the industrial efficiency and optimal operation
(Ramaswamy, 2001). Virtually everyone regardless age group, status or profession has benefitted
from its services in that fact information technology has taken over nearly every aspect of our daily
lives from commerce (buying and selling) to leisure and even culture. With recent progression of
mobile computing, this has only become more profound.

Mobile computing can be defined as a computing environment over physical mobility. The user
of a mobile computing environment will be able to access data, information or other logical objects
from any device in any network while on the move. Mobile computing system allows a user to
perform a task from anywhere using a computing device in the public (the web), corporate
(business information) and personal information spaces (medical record, address book (Asobe &
Roopa, 2012).

Since the introduction of mobile technologies in the early 1990s, it has become a valuable and
important tool to be incorporated into various medical related fields used by multiple disciplines
(Ranson, 2007). The term mhealth (mobile health) embraces this incorporation of mobile
technology into medical related fields. Put in other words, mobile Health is the intersection
between Electronic health (ehealth) and smartphone technology. It is the practice of ehealth
assisted by smartphones which are used to capture, analyze, process, and transmit health-based
information (Adibi & Sasan, 2015).

Medical professionals around the world are already widely using a variety of apps to assist with
diagnoses, patient tracking, pharmaceutical interaction data, and much more. And its use by health
care professionals (HCPs) has transformed many aspects of clinical practice (Wallace, Clark, &
White, 2012). This research work was motivated by a need to contribute to this recent trend of
application of mobile computing to the medical profession having identified language barrier as a
major challenge to medical practitioners in Nigeria.
Effect of Language Barrier on Healthcare

Communication is the cornerstone of medicine, without which medical practitioners cannot

interact with their patients (Brindley, Smith, Cardinal, & Leblanc, 2014). The ideal patient-
physician relationship is based on thorough knowledge of the patient, on mutual trust, and on the
ability to communicate (Dennis, et al., 2005). Nigeria as a nation has over 520 languages with 9
languages been considered as the common languages (Nigeria, n.d.). Yoruba in the western region,
Hausa in the northern region and Igbo in the Eastern region according to the British colonial point
of view are considered to be the three major languages. Studies show that the Hausa language is
spoken by over fourteen million people in Nigeria, Niger, and the Sudan, Yoruba by over five
million people in Nigeria, Dahomey, and Togo, and Igbo, also by over five million people but
spoken only in Nigeria (Shaibu, 2010). The English language however has been generally accepted
as the country’s principal language. Being a former colonial language, English was chosen to
facilitate cultural and linguistic unity of the country.

Especially in rural areas, which makes up three-quarter of the Nigerian population, a large
population of Nigerians are more proficient in their local languages than in the English language.
In 2015, the Nigeria adult (15+) literacy rate was at the level of 59.6% (Knoema, n.d.). For these
reasons, language barriers could exist between the medical practitioner and his/her patient.

Language is the means by which a physician accesses a patient’s beliefs about health and illness,
creating an opportunity to address and reconcile different belief systems (Woloshin, Bickell, Gany,
& Welch, 1995). Thus it is no surprise that a growing body of research suggests that language
barriers encountered in health care settings may compromise the quality of care for limited
English-proficient (LEP). Language barriers appear to decrease access to primary and preventive
care, impair patient comprehension, decrease patient adherence, and diminish patient satisfaction.
A few studies have also indicated that the use of language-concordant physicians is associated
with improved patient understanding, interpersonal processes of care, self-reported health status,
and patient recall (Elisabeth, Alice, Kevin, Frances, & Alicia, 2015).While studies have shown
that language-concordant physicians could be effective in reducing reports of adverse medication
effects and confusion with medication instructions (Manson, 1988), few have the luxury to afford
it.
The consequences of medical miscommunication can be severe. Patients become sicker because
they fail to stick to treatment regimens that they do not understand. They miss appointments. They
pass on infectious diseases because they do not know how often to take their medication or when
to return for follow-up care.

Doctors miss diagnoses, or get people to agree to procedures they do not fully understand. To
compensate for their sketchy knowledge of patients' symptoms, doctors order too many tests, some
very expensive, others potentially risky. (Esther, 1997)

Mobile Solutions to the Existing Problem

A smart phone application may provide handy and offline translations as a novel solution to the
challenges encountered by medical practitioners as they have to attend to Limited English
Proficient patients. Given the increase in available smartphone apps, it is important to document
the processes involved in designing and developing the application in order to enhance
trustworthiness of the mobile translator.

There are few existing mobile applications that give translations from English to a Nigerian
language of general words such as the “Yoruba English Translator”, “Nigerian Dictionary”,
“Hausa-English Translator” and “Igbo Bekee okowa okwu” which are available for download
from the google play store. The mobile application (NaijaMMed Translator App) developed in the
course of this research differs from these existing translators in that, rather than a vast vocabulary
of words it makes available a concise compilation of symptoms and other disease related
terminologies that would be instrument for communication particularly in the medical field. Other
applications whose functionalities are closest to that of the application been designed are limited
to a singular language. The NaijaMMed Translator translates into 3 of the major Nigerian
languages; Yoruba, Ibo, and Hausa to enlarge its sphere of usefulness for the medical practitioner.
It also supports audio voicing for a few words in the local languages to enable the medical
practitioner to correctly repeat the word.

The mobile application is not designed to replace a translator to an illiterate patient, one who has
almost no applicable knowledge of the English Language, in that it does not translate entire
sentences or phrases. On the contrary, it is meant to assist the medical practitioner to relate an
interpretation of key words to Limited English Proficient patients for the purpose of clarity or
emphasis in preventing or correcting misunderstanding.

2. Mobile Application Design and Development

Important criteria for successful smartphone apps including those with medical related application
are content quality, usability, the need to match apps to consumers’ literacy levels, app security
and user privacy (Boulos, Brewer, Karimkhani, Buller, & Dellavalle, 2014) These criteria were
considered throughout the application development process illustrated in the diagram below

Figure 1. Iterative process for the design and implementation of the NaijaMMed
Translator App

Research and Information Gathering

Information gathering methods are essential skill for all system analysts. It is a classical set of
techniques used to collect information about system problems, opportunities, solution, requirement
and priorities. The first stage in the design of the application was to source for legit information as
a platform for the language and medical terminological features of the mobile application to be
designed. Information was gotten through the following methods:

1. Informal Discussions
2. Internet Surfing
3. Reading of Published Materials

Informal Discussion

Basically, Informal discussion means a conversation between a person eliminated from

consideration in the internal appointment process and the decision-maker. The purpose of informal
discussion is to share information or to get information in informal way. With no set of rules or
format, informal discussion is intended to be a free-flowing and frank conversation between
researcher and system dynamics group members, Information gathering helps the individual and
the organization to undertake complicated tasks that would otherwise be extremely hard to
accomplish if not out rightly impossible (TeamReporter, n.d.). During the development of this
project, the researcher had several discussions with medical personnel to ascertain their
expectations from the mobile application to be developed. This was motivated by the
foreknowledge that informal discussion promotes transparency and is intended to improve
communication during the process before a final decision is made. From time to time researcher
had informal discussion with prospective application users until the final modeling had been
modeled and ready to be used in the application development process.

Internet Surfing

The internet serves as a platform through which lot of information can be acquired. The research
took advantage of the available resources on relevant web sites on the internet. Lots of information
were thus collected for documentation of the research work, system design and implementation.

Reading of Published Materials

A lot of published literatures have been read in order to gather information on the users’ need,
system development’s needs and technical issues of the proposed system. All these can be
categorized into printed materials such as books and journals and non-printed materials such as
electronic documents.
Common Diseases in Nigeria and their Symptoms

Research and information gathering was done with a major goal of ascertaining the common
diseases in Nigeria and their associated terminologies including symptoms, disease causing or
promoting agents and activities, body parts affected and other general related terminologies.
According to the information gotten from research, Nigerians are vulnerable to some diseases, the
most common of them being malaria, typhoid, cold, hypertension, cholera and HIV/ AIDS
(Common Diseases In Nigeria ; Causes, Symptoms And Prevention, n.d.), as well as diabetes,
Diarrhoea and Asthma. A list of associated symptoms was compiled from the Symptom by
Symptoms Chartfinder by the British Medical Association. (Dr. Michael, 2006)

Translations of terminologies in major languages

The translations of the words used in the mobile application was based on the dictionaries “A
dictionary of the Yoruba Language” by the Church Missionary Society, “Igbo Dictionary:
KayWilliamson Education Foundation.” by Kay Williamson and “Dictionary of the Hausa
Language” by Charles Henry Robinson D. D..

The “Igbo Dictionary: KayWilliamson.” is a much revised and expanded version of the Igbo
dictionary published by KayWilliamson Education Foundation and made available in a
downloadable web format. (Kay Williamson Education Foundation, 1972). The Yoruba
Dictionary relied on, “A dictionary of the Yoruba Language”, was prepared building on the
foundation of the first Dictionary of the Yoruba language which was published in the year 1843,
compiled by Samuel (afterwards Bishop) Crowther and English-Yoruba Dictionary was published
in 1911 under the general editorship of the Rev. E. J. Sowande, both of which are presently out of
print (Church Missionary Society, 1918).

Development of the NaijaMMed Translator App

The NaijaMMmed App was designed to meet the requirements of an accurate and easy-to-use
mobile translator. The use case diagram below illustrates the expected interaction between the
mobile application and the user.
Figure 2: Use Case Diagram for the NaijaMMed Translator App

The Graphical User Interface and features was designed on the App inventor platform, thus
developed for smartphones running one of the most popular operating systems, Android Operating
System. (Gartner, 2015)

The application could be placed on App Store where after been tested, it can be available for
download.

User Involvement Studies

User-involvement may be described as an iterative development process that engages users in

conceptualization, design and final production of a smart phone mobile app. (LeRouge, Ma, Sneha,
& Tolle, 2013) Involvement of users from the beginning of the development process has been
shown to increase appeal and user-friendliness of mobile app (Buller, et al., 2013)

For the incorporation of user-involvement studies into the research, a questionnaire was distributed
to twenty (20) medical practitioners in 6 different states in Nigeria alongside with a prototype of
the NaijaMMed Translator App. The questions was intended to be a tool through which application
users in the medical field could assess the mobile application to ascertain its level of relevance,
content quality and usability.

3. Results and Discussions

Relevance of the Mobile Application to Medical Practitioner

Each of the 20 respondents to which the questionnaire and prototype was distributed acknowledged
language barrier as a major challenge in their years of practice as medical practitioners. 85% of
the respondents considered the NaijaMMed translator App an optimum solution to this challenges.
Some comments however indicated that it was too limited in scope to make significant impart.
One of the respondents suggested an inclusion of a translation of herbs/leaves known only in local
dialects as this would widen the utility of the mobile application. (Dr. Adebusoye, 2017)

Ease of Use

All respondents considered the application easy to use and navigate around. Mobile application
users appreciated the lack of complexities involved in having to use the application few had need
of using the help option.

Presentation of the NaijaMMed Translator App

A review of mobile apps highlights the importance of simple and understandable design, content,
and menu navigation to development of a suitable medical device (Arnold, Quade, & Kirch, 2014).
Developing time and skill to the graphical user interface design in development of the application
was crucial. Feedback from respondents however suggested an improvement in the graphical user
interface.

NaijaMMed Translator Main Content

The NaijaMMed Translator app orders the list of disease related terminologies into unique
compilations, using just four icons in order to avoid overloading the user and encourages quicker
application response time as the database to be queried would contain fewer information per
compilation. Figure 3A presents these four icons. By selecting the first icon, “Symptoms”, the user
is directed to a list of 80 common symptoms (Figure 3B) where he/she can selected the word of
interest. The other three icons, “Disease Causing Agents”, “Body Parts”, and “Other Related
Words” work similarly. The Application provides translation for a total of 212 words. On selecting
a word, the application displays definition and translation of the selected word. Provision is made
for the user to automatically search for a word from any of the compiled lists of words (Figure
3D). An added feature of the mobile application is the “Recent” view area (3A) that allows the
mobile application user the see the recent words searched for during the time frame when the
mobile application was open and in use.

A B C D

Figure 3: Presentation of the NaijaMMed Translator app (shown on an android phone interface):
(A) four main icons (symptoms, disease causing agents, body parts and other related words) of the
NaijaMMed Translator smartphone app; (B) Compiled List of Words (C) Definition of Terms and
Translation to the Local Languages and (D) Search Option for alternative navigation

4. Limitations

The number of participants in the user-involvement studies was limited and the time frame for the
analysis of the basic functionalities short (less than a month). Never the less information derived
from analysis of the responses would encourage and improvement in the quality of the mobile
application
Also, the translations of the words are based on existing dictionaries and have not been analyzed
by individuals proficient in the language to ascertain accuracy of translations. Words that could
not be found in the dictionary were substituted with words from Google Translate which according
to a research study has only 57.7% accuracy when used for medical phrase translations.

5. Conclusions

This paper contains details of developing a mobile translator for medical practitioners. The
resulting app, NaijaMMed Translator App, is an Android application that provides a compiled list
of symptoms, parts of the human body, disease causing/promoting agents, and other disease-
related terminologies for the prevalent diseases in the country.

Close collaboration with health professionals while developing the smartphone app ensured that
the mobile application is relevant to medical practitioners in general. In other to improve quality
of translation, the app will further be evaluated by language experts on the three selected Nigerian
Languages, Yoruba, Ibo and Hausa.

Acknowledgements

Special thanks goes to he medical practitioners who dedicated time and effort to ensuring the
relevance of the application to the medical field including though not restricted to Dr. Adebusoye
Steve Oluwaseun, Dr. Omanudohwo Kennedy, Dr. Kawoh Simeon, Miss. Akpevwe, and Nurse
Otuokere.

References
Adebusoye, S. O. (2017, August 4). Relevance of the NaijaMMed Translator. (A. Oluwadamilola,
Interviewer)

Adibi, & Sasan. (2015). Mobile Health: A Technology Road Map. Springer.
Arnold, M., Quade, M., & Kirch, W. (2014). Mobile applications for diabetics: A systematic
review and expert-based usability evaluation considering the special requirements of
diabetes patients age 50 years or older. J. Med. Int. Res, doi:10.2196/jmir.2968.

Asobe, K. T., & Roopa, R. Y. (2012). Mobile Computing Technology, Applications, and Service
Creation.

Boulos, M. N., Brewer, A. C., Karimkhani, C., Buller, D. B., & Dellavalle, R. P. (2014). Mobile
Medical and Health apps: State of the art, concerns, regulatory control and certification.
Public Health Inform, p. 4814.

Brindley, P. G., Smith, K. E., Cardinal, P., & Leblanc, F. (2014). Improving medical communication
skills for a complex (and multilingual) clinical world. Cam Respir, 21:89-91.

Buller, D., Berwick, M., Shane, J., Kane, I., Lantz, K., & Buller, M. .. (2013). User-centered
development of a smart phone mobile application delivering personalized real-time
advice on sun protection. . Translational behavioral medicine , 3, 326–334.

Church Missionary Society. (1918). A Dictionary of the Yoruba Language. Lagos: Church
Missionary Society Bookshop.

Common Diseases In Nigeria ; Causes, Symptoms And Prevention. (n.d.). Retrieved from
Information Parlour: confirm.confirm.com

Dennis, L. K., Eugene, B., Anthony, S. F., Stephen, L. H., Dan, L. L., & J, L. J. (2005). Harrison's
Principles of Internal Medicine. McGrawHil Companies Inc.

Dr. Michael, P. (2006). Family Doctor Home Adviser. London: Dorling Kinder ltd.

Elisabeth, W., Alice, C., Kevin, G., Frances, W., & Alicia, F. (2015). Effects of Limited English
Proficiency and Physician Language on Health Care Comprehension. J Gen Intern Med,
800-806.

Esther, B. (1997, November 23). Language Barriers Are Hindering Health Care. Retrieved from
New York Times: confirm.comfirm.com
Gartner, I. (2015). Gartner Says Sales of Smartphones Grew 20 Percent in Third Quarter of 2014.
CT: Stanford.

Kay Williamson Education Foundation. (1972). Igbo Dictionary: KayWilliamson. Cambridge: Kay
Williamson Education Foundation.

Knoema. (n.d.). Nigeria - Literacy - Adult (15+) literacy rate. Retrieved from Knoema:
https://knoema.com/atlas/Nigeria/topics/Education/Literacy/Adult-literacy-rate

LeRouge, C., Ma, J., Sneha, S., & Tolle, K. (2013). User profiles and personas in the design and
development of consumer health technologies. Int J. Med Inf., 82, e251-e268.

Manson, A. (1988). Language concordance as a determinant of patient compliance and

emergency room use in patients with asthma. Med Care, 26:1119–28.

Nigeria. (n.d.). Retrieved from Ethnologue: https://www.ethnologue.com/country/NG

Patil, S., & Patrick, D. (2014). Use of Google Translate in medical communication: evaluation of
accuracy. BMJ, 349.

Ramaswamy. (2001). elements of computer science. Delhi: Sanjeev Kumar Kataria.

Ranson. (2007).

Shaibu, S. D. (2010). Language Policy: Nigeria and the Role of English Language in the 21st
Century. European Scientific Journal, 1857- 7431.

TeamReporter. (n.d.). Information Gathering. Retrieved from Teamreporter:

http://www.teamreporterapp.com/information-gathering/

Wallace, S., Clark, M., & White, J. (2012, August 2). "It's on my iPhone": attitudes to the use of
mobile computing devices in medical education, a mixed-methods study. BMJ, p.
001099.

Woloshin, S., Bickell, N., Gany, F., & Welch, H. (1995). Language Barriers in Medicine in the
Unigted States. JAMA, 273(9):724-728.