Translation and Validation
RM II
Cross cultural adaptation
• Cross-cultural psychology – study of individuals in context of culture
(Harkins, 2016)
• In absence of tools, cross-cultural adaptation called for – produce
comparable results
• Equivalence is essential for cross-culture comparability (Lauth et al,
2008)
• Culturally appropriate translated instruments are conceptually and
technically equivalent to the source language, culturally competent,
and linguistically appropriate for the target population.
• Need for standard, valid practices for cross-culture adaptation.
Challenges of Cross cultural adaptations
• Requires resources and trained professionals
• Demands investment
• Long term/ time consuming
• To ensure equivalence
• Large sample size is need for establishing psychometric properties
Adopting an instrument
• Adopting is taking instrument nearly as it is.
• Simple and requires very little effort
• There can be few modifications e.g. intrinsic motivation inventory
measures general variable but if a researcher is interested in specific
activity it can be modified
I enjoyed doing this activity so I enjoyed the maths program so
much much
• This is still adopting because only a reference to “this activity” is changed.
• Always cite the author of the instrument you are adopting.
Adopting an instrument
• when you are Adopting an instrument
• reliability and validity of research studies that have been conducted on that
instrument can be applied.
• You Don’t have to collect validity evidence
• links your study to all other research studies
• Whenever possible, it is best for an instrument to be adopted. When this is
not possible, the next best option is to adapt an instrument. However, if there
are no other instruments available, then the last option is to develop an
instrument (Korb, 2012).
Adapting an instrument
• Adapting is significantly altering the instrument.
• In adapting, researcher follow general design of an instrument but
can;
• Add or remove items
• Substantially changes the content of each item
• Examples of adapting may include;
• Instrument was developed for university students but you want to use it on the primary
school children. (instrument will be so advanced for children so rephrasing of items will be
required)
• The cultural manifestation of the variable which instrument is measuring is different. (Like a
scale for motherly attention may have items developed for western culture but in eastern
and African cultures motherly attention is different)
• The “cross-cultural adaptation” is a process that looks at both
language (translation) and cultural adaptation issues in the process of
preparing a questionnaire for use in another setting.
• If measures are to be used across cultures, the items must not only be
translated well linguistically, but also must be adapted culturally to
maintain the content validity of the instrument at a conceptual level
across different cultures
Possible scenario where translation or
adaptation is needed
Equivalence
Guidelines for cross cultural translation
• No single standard procedure.
• Major Guidelines using the process of Forward and Back- translations:
• Brislin Model (1970)
• Antunes (2012)/ Sousa & Rojjanasrirat (2010)
• Secer (2015)
• WHO Guidelines
Brislin Model
Step 1. Forward Translation
• Translation from the original language (source language) to the target
language.
• At least two forward translations. (the translations can be compared)
• Bilingual translators whose mother tongue is the target language.
• One of the translators should be aware of the concepts being
examined in the questionnaire.
• The other translator should neither be aware nor informed of the
concepts being quantified and preferably should have no medical or
clinical background.
Step 2. Consultation of experts
• After forward translation is done, a committee of experts is being called
• They evaluate and compare different forward translation and agree upon one final
forward version of the translation.
• A bilingual (in English and the target language for translation) expert panel should
be convened by the researcher.
• To identify and resolve the inadequate expressions/concepts of the translation
• Any discrepancies between the forward translation and the existing or comparable previous
versions of the questions if any.
• The expert panel may question some words or expressions and suggest
alternatives.
• The result of this process will produce a complete translated version of the
questionnaire.
Step 3. Blind back-translation
• Using the same approach, instrument translated back to English:
• By an independent translator, whose mother tongue is English and who has no knowledge of
the questionnaire
• This is a process of validity checking to make sure that the translated
version is reflecting the same item content as the original versions.
• Back translation is only one type of validity check, highlighting gross
inconsistencies or conceptual errors in the translation.
• Minimum two back-translators with the source language (English) as
their mother tongue; totally blind to the original version; preferably
without medical background.
Step 4. Comparing both versions
• After that both original and back translation version are compared.
• The minimum composition of committee comprises methodologists,
health professionals, subject matter experts, and the translators
(forward and back translators).
• The expert committee’s role is to consolidate all the versions of the
questionnaire and develop what would be considered the pre-final
version of the questionnaire for field testing.
• Consensus should be reached on the items. To achieve equivalence
between the source and target version
Pretesting
• Pretest of the new questionnaire.
• Pre-test respondents:
• Represent population
• Ideally, between 30 and 40 persons should be tested.
• Each subject completes the questionnaire, and is interviewed to probe the
meaning of the items and the chosen responses.
• Comment on words and sentences that were difficult to understand.
• Systematically debriefed
• What they thought the question was asking; whether they could repeat the question in
their own words; what came to their mind when they heard a particular phrase or term;
explain how they choose their answer.
Revision if required
• Unclear words and items identified in the pretest should be discussed
with members of the expert committee and target population.
• Final adjustments should be made based on the judgement of the
research team after discussions with members of the expert
committee and target population.
• After the final adjustments of the instrument, the instrument
format, instructions, mode of administration and measurement
methods should be assessed.
WHO Translation Guidelines
• The aim of this process is to achieve different language versions of the English instrument that are
conceptually equivalent in each of the target countries/cultures.
• the instrument should be equally natural and acceptable and should practically perform in the same way.
• The focus is on cross-cultural and conceptual, rather than on linguistic/literal equivalence.
• A well-established method to achieve this goal is to use forward-translations and back-translations.
• This method has been refined in the course of several WHO studies to result in the following guidelines.
• Implementation of this method includes the following steps:
[Link] translation
[Link] panel
[Link]-translation
[Link]-testing and cognitive interviewing
[Link] version
Step 1 Forward Translation
• One translator, preferably a subject matter expert, familiar with terminology of the
area covered by the instrument.
• The translator should be knowledgeable of the English-speaking culture but his/her
mother tongue should be target language.
• Instructions and guidelines for translator
1. Translators should always aim at the conceptual equivalent of a word or phrase,
not a word-for-word translation
2. Translators should strive to be simple, clear and concise in formulating a question.
3. The target language should aim for the most common audience. Translators should
avoid addressing professional audiences
4. Translators should avoid the use of any jargon and technical terms
Step 2 Expert panel
• A bilingual (in English and the target language for translation) expert panel should be
formed.
• The goal in this step is to identify and resolve the inadequate expressions/ concepts
of the translation, as well as any discrepancies between the forward translation and
the existing or comparable previous versions.
• The expert panel may question some words or expressions and suggest alternatives.
E
• The number of experts in the panel may vary. In general, the panel should include
the original translator, experts in subject matter, as well as experts with experience in
instrument development and translation.
• The result of this process will produce a complete translated version of the
questionnaire.
Step 3 Back-translation
• Using the same approach as that outlined in the first step, the instrument will then be translated
back to English by an independent translator, whose mother tongue is English and who has no
knowledge of the questionnaire.
• Back-translation will be limited to selected items that will be identified in two ways. The first will
be items selected by the WHO based on those terms / concepts that are key to the instrument
or those that are suspected to be particularly sensitive to translation problems across cultures.
These items will be distributed when the English version of the instrument is distributed.
• The second will consist of other items that are added on as participating countries identify
words or phrases that are problematic. These additional items must be submitted to WHO for
review and approval.
• As in the initial translation, emphasis in the back-translation should be on conceptual and
cultural equivalence and not linguistic equivalence. Discrepancies should be discussed and
further work (forward translations, discussion by the bilingual expert panel, etc.) should be
iterated as many times as needed until a satisfactory version is reached.
• Particularly problematic words or phrases that do not completely capture the concept addressed
by the original item should be brought to the attention of WHO.
Step 4 Pre-testing and cognitive
interviewing
• It is necessary to pre-test the instrument on the target population. Each module or section will be fully tested
using the methodologies outlined below.
1. Pre-test respondents should include individuals representative of those who will be administered the
questionnaire.
2. Pre-test respondents should number 10 minimum for each section. They should represent males and females
from all age groups (18 years of age and older) and different socioeconomic groups.
3. Pre-test respondents should be administered the instrument and be systematically debriefed. This debriefing
should ask respondents what they thought the question was asking, whether they could repeat the question in
their own words, what came to their mind when they heard a particular phrase or term
4. The answers to these questions should be compared to the respondent’s actual responses to the instrument for
consistency.
5. Respondents should also be asked about any word they did not understand as well as any word or expression
that they found unacceptable or offensive.
6. Finally, when alternative words or expressions exist for one item or expression, the pre-test respondent should
be asked to choose which of the alternatives conforms better to their usual language.
7. This information is best accomplished by in-depth personal interviews although the organization of a focus
group may be an alternative.
8. It is very important that these interviews be conducted by an experienced interviewer.
Step 5 Final version
• The final version of the instrument in the target language should be
the result of all the iterations described above.
• Instructions for providing the electronic version of the final translated
instrument to WHO will be provided.
