12 Multi-Language Management
Chapter Leads: Lise DeShea, Thomas Wilson
12.1 What is the Purpose of Multi-Language Management?
Researchers often need to recruit study participants from a variety of backgrounds. A study with greater variability in participants may be more generalizable to a larger population. Language can be a barrier to some participants joining a study. When researchers can offer a survey in the participants’ languages, there is a better chance of expanding the patient pool, which might be crucial if the researchers are studying a rare condition.
The first step toward enrolling patients in most studies is obtaining informed consent. Electronic consent is possible in REDCap, and we have provided a chapter on that topic callout here Creating an e-consent process that also allows multiple languages means the e-consent chapter must go hand-in-hand with this one. This chapter will assume you are at a spot in creating an e-consent where you need to enable Multi-Language Management (MLM) and will lead you through the process. MLM also can be used with surveys and other uses. The information presented here can be generalized beyond the e-consent process.
12.2 When to Enable MLM in an e-Consent
We will start at the point in an e-consent project where you already have created the instruments for Consent and HIPAA; uploaded pdf files of those forms; created fields for every spot where the patients will need to enter information or sign their names; and designated the forms as surveys.
The e-Consent Framework is the REDCap module that was designed to handle electronic consenting processes. Before you enable e-Consent Framework, you must enable Multi-Language Management (MLM). If you do these two steps in the wrong order, you will have to re-create a lot of the work you already completed.
12.3 Enabling MLM
The left-hand column in your project has the REDCap logo. Under the second Applications you will see Multi-Language Management (MLM). Click that link.
Follow the instructions in the Languages tab of the page, as shown below.
You see the above instructions because no languages have been specified in the MLM. Read those instructions carefully. MLM is picky and has a lot of details. We will be following those steps: specifying the languages being used in the e-consent (or survey), providing translations of REDCap features, and testing the project. We will start by specifying a base language, which usually is English. Click the green button that says, “+ Add a new language.” You will see the window shown below.
There is a white button that is barely visible next to the red words “by creating the language from scratch.” Click there, then Continue. We are starting with English as the base language. Type the Language ID for English, which is en. “Language Display Name” is what will appear to people who will be asked to sign the e-consent. Type English there. So the window now looks like this.
Click the blue “+ Add Language” button. The window will close, and now the page shows English as the base language. Let’s add Spanish as the next language. Click the green “+ Add a new language” button again. Again, click the nearly invisible button next to “by creating the language from scratch,” then Continue. We will use es as the Language ID. For Language Display Name, we need it in Spanish for those who will select that language: Español. To get the tilde over the n in this word, you can google Espanol and copy it from a webpage and paste it in this box. Then click the blue “+ Add Language” button.
You may notice the yellow-orange button that says Save Changes. Unlike many functions in REDCap, this module has the save function at the top of the page, not the bottom. This same button will be used for changing any of the tabs to its left. If it is yellow, then changes have not been saved. Click it now to save the changes made so far. You should see the button change to gray font.
12.4 Touring the MLM Tabs
MLM has tabs embedded in tabs – and tabs embedded within those tabs! It is easy to get lost and sometimes hard to find certain functions. Let’s click through these tabs and familiarize ourselves with them.
The Forms/Surveys tab has two tabs embedded within it: English and Español. First you see the base language with a blue tab and an asterisk to the left of the word English. When you click on the word Español, you are switched to that tab, which now is the blue one.
We will not cover the next two tabs, Alerts and Misc because they usually are not used in e-consent projects.
Click on the User Interface tab. If you left the Forms/Surveys tab on its embedded Español tab, then that’s the tab in blue here. The purpose of the User Interface tab is to translate some text that the user of the e-consent will see from the base language (English) to our second language (Spanish). Notice that this page has a third layer of embedded tabs, shown in the blue box below.
Let’s click through those tabs.
- We could look at everything option under the All tab, but that can be overwhelming.
- By default the Common tab is selected. You can scroll down to see the kinds of notifications to the user that you could translate. For an e-consent project, you often have only a few of these notifications that need to be translated.
- Now click on the Field Types tab. If your project has Yes/No fields, then you would need to translate “Yes/No” on this tab. If your project has a Date field that uses a “Today” button, you will need to translate that word. There are far more options on this tab than you are likely to need to translate.
- Let’s click next on the Settings tab. We won’t make any changes on this tab in this chapter.
At this point we have put English as the base language and Spanish as the second language. But we have not activated them. On the Languages tab, toggle the sliders to Active.
Notice the Save Changes button is yellow-orange again. Click it to save your current settings.
12.5 Creating Translations
Go to the Forms/Surveys tab and select the Español tab. Toggle the sliders in the column under Survey. These sliders will enable the e-consent user to view the translated version of the instruments. Be sure to click the yellow-orange Save Changes button. It doesn’t hurt to click that button after every change you make! It’s better than losing your work.
Notice in the above screenshot that the word Translate appears next to each instrument in the Fields and Survey Settings columns. There are more functions to access by clicking each place that it says Translate. Let’s start with Translate under the Fields column on the Consent row. This page shows the variable names inside REDCap. The Spanish-speaking participant using the e-consent survey will never see those variable names. Unless you have staff needing translation inside the REDCap project, we don’t have to make any changes here. This Fields page will show a link to the Survey Settings for this instrument. Click that link.
This is where you can translate the survey title and prompts that users will see as they go through the e-consent process. For example, the e-consent used as an example in this chapter is set up so that upon completing the e-consent, the user sees a message, “Thank you!” Below is shown the translation of that message.
Notice on the top row of text in the above screenshot, there is a link to Fields. Click that link. Now you will see the Field Labels that correspond to the variables in your e-consent. You will need to translate those Field Labels. For example, if you have “PARTICIPANT NAME (printed)” as the label for a field called participant_name_printed, you would need to enter the translation “NOMBRE DEL PARTICIPANTE (en letra imprenta).” As always, click the yellow-orange Save Changes button.
To look at translations needed on the HIPAA form, click the Languages tab and back to the Forms/Surveys tab.
- Now you will see the two rows marked Consent and HIPAA again.
- Click Translate in the Fields column to make any changes needed there.
- Then click Translate in the Survey Settings column to make any changes needed on the HIPAA instrument.
- If the Save Changes button has not turned yellow-orange, then click outside of the field your cursor was on, and the color will change.
Now let’s do translations in the User Interface tab. Again, staying on Español next to Select a language, click the Common tab. Make any translations needed, then click Save Changes.
The next tab inside User Interface is Field Types. Look for any fields your e-consent or survey will need translated, enter the translations, and click Save Changes.
We will skip the Data Entry tab inside User Interface. In the Survey tab of User Interface, you may find several items that need to be translated. Here are some messages listed under the eConsent section of the Survey tab:
Look for any fields that you need to translate. Here are a couple of common ones.
12.6 Enable e-Consent Framework
Finally we can enable the e-Consent Framework, the REDCap module that was designed to handle electronic consenting processes.
Link here to return to the chapter on e-Consent
This step must occur after the surveys (Consent and HIPAA) are created. In Online Designer we click the Enable button under Survey Options, shown above the list of instruments.
You will be taken to a page called Settings for e-Consent & PDF Snapshots.
Click the big green button that says Enable the e-Consent Framework for a survey. You will get a window that says Enable e-Consent for a Survey. You will select Consent from the drop-down menu.
Another window will open, called Enable e-Consent.
Under Primary settings, the first two fields ask you to specify the variables for the first and last names of the participant.
Scroll down to Additional settings and use the drop-down menu for Signature field #1 to select the participant’s signature, as shown below.
Select participant’s signature field Scroll down to Location(s) to save the signed consent snapshot.
A copy of the signed form should be saved in the File Repository because the IRB sometimes audits these e-consent REDCaps to make sure the study’s protocol is being followed and patients’ rights have been respected.
Save consent snapshot
Save those settings to close the window. You will return to the page that says e-Consent Framework Settings. This is where you will upload the pdf of the consent form. Click on the link that says Add consent form.
Number the consent form (e.g., 1.0) next to Consent form version.
Use the dropdown menu next to Placement of consent form to choose the placeholder variable you called consent.
Click on the tab for *Consent Form (Inline PDF).
Click Browse and find the pdf on your computer.
Click Add new consent form to save your work
Upload consent form
Next we need to get a snapshot pdf of the signed HIPAA form.
Click on the tab for PDF Snapshots of Records.
Click on the button that says Add new trigger.
Add trigger for HIPAA snapshot Name the trigger and select the HIPAA survey
Under STEP 2: Scope of the snapshot, click the pencil in the box
Deselect the consent form, leaving only the HIPAA form as a trigger; the consent form is being saved separately
Save these settings
Name trigger, select HIPAA survey 
Limit snapshot to HIPAA
12.7 Test the e-Consent
Before putting any REDCap project into production, it is important to test it and make sure everything is working right and looks correct. It is a good idea to enlist the researchers and those who will collect e-consent in the testing process.
In the REDCap project, click on Survey Distribution Tools in the left column
This page will provide you with a public survey link that you can email to the researchers and consent collectors. To test the project yourself, click Open public survey.
You will be taken to the e-consent as it will appear to participants.
Scroll through pages, fill out the pertinent fields with names like Test Subject, and sign it.
After you submit the HIPAA form, you will get an “end of survey” message.
Go back into the REDCap project.
On the left side you will see a link for File Repository, which you will click.
Link to File Repository Click on the folder labeled PDF Snapshot Archive.
You will see a list of pdfs that were automatically created for the test records.
Click on any of those pdfs and see how REDCap saved the original pdf, plus the fields you created in REDCap, and the data and signature added by the participant or test subject.
PDF Snapshots in File Repository
12.8 Updating Consent Forms
Studies with IRB oversight must check in annually and update the IRB about the study’s status. Among other tasks the researchers must obtain re-approval of their consent form. When you create an e-consent project, it is a good idea to put a note on your Outlook calendar reminding you to check with the researchers before their consent form expires. Then you will be ready to replace the consent and HIPAA forms with the latest versions, with the new expiration date given.
When it is time to replace the consent form with a new one:
- Notify the people who will be collecting the study’s informed consent that you will be working on the e-consent in REDCap and that they should pause using the e-consent until you inform them the new forms have been uploaded
- In Online Designer, there will be a yellow box at the top saying the project is in production status and asking if you want to enter draft mode to make changes; click the Enter Draft Mode button.
- Where the Data Collection Instruments are listed in Designer, click on the e-Consent button under Survey Options.
- Click Add Consent Form
- Specify the version number and upload the consent form
- Save the new version
- Ask for the project to be moved back into Production Mode
- After being notified that the project is in production, go to the survey and create a test record by completing the forms, using a name like Testing REDCap
- If everything is working correctly, notify those collecting informed consent that the e-consent REDCap is back in production with the new forms, and they may see a test record in REDCap
- Congratulate yourself, because it is no small accomplishment to complete an e-consent REDCap project!
This chapter was last edited in April 2026. If you have suggested modifications or additions, please see How to Contribute on the book’s welcome page.