Outcome assessmentTranslation and validation of study instruments for cross-cultural research
Section snippets
The problem
Cross-cultural research has specific methodological problems, most relating to translation quality and the comparability of results in different cultural and ethnic groups. These technical traps may lead to erroneous research conclusions that, although due to methodological flaws, are undetectable as such and considered to be substantive in nature.
It is not enough to translate a questionnaire literally. The additional challenge is to adapt it in a culturally relevant and comprehensible form
Translation
There are 2 sets of baseline circumstances for instrument development in cross-cultural research. In the first, a research instrument is developed de novo for use in 2 or more languages and can be molded in an ongoing reciprocal process. An assumption underlying this approach is that neither language is primary (no source language). It allows for greater creativity and provides the opportunity to align the 2 versions more closely.
In the more usual set of circumstances, clinicians do not develop
Fine tuning of translated instruments
The back-translation technique is preferred even though it is time consuming and can be expensive. However, it also has potential traps. Good translators can achieve a back translation that is similar to the source even though the original translation is not good.14 This “accomplishment” provides a methodological disservice. It can occur because back translators may intuitively make sense of poorly written language, in effect, correcting it. They also may retain the grammatical form of the
Validation of the translation
Several methods can be used to validate translation; none is fail-safe. One method is evaluation by teams of experts, bilinguals, or focus groups of potential research subjects. In one variation, the instrument in its original version and its source version are given to bilingual persons in alternating language order and assessed accordingly. The use of bilingual subjects for pretesting also creates methodological problems. The translated instrument is intended ultimately for monolingual
Testing comparability and interpretability
Our method uses 2 measures of comparison to evaluate the success of the translation process: comparability of language and similarity of interpretability. Likert scales ranging from 1 (extremely comparable/extremely similar) to 7 (not at all comparable/not at all similar) are used. Table 1 shows the rating sheet used for this evaluation. Comparability of language refers to the formal similarity of words, phrases, and sentences. If the questions are judged to be identical or extremely
Conclusion
This report presents methodological issues associated with translating questionnaires for use in cross-cultural research in a manner relevant to clinicians and health care practitioners. Translation is the most common method of preparing instruments for cross-cultural research. It has pitfalls that threaten validity. Some of these problems are difficult to detect and may have detrimental effects on study results.
A method of translation validation is presented in detail as an example. The
References (15)
- et al.
Validity of the King’s Health questionnaire in the assessment of quality of life of patients with urinary incontinence. The King’s Group
Med Clin (Barc)
(2000) - et al.
Cross-cultural variation in disease-related concerns among patients with inflammatory bowel disease
Am J Gastroenterol
(2001) - et al.
Validation of a questionnaire to assess fecal incontinence and associated risk factorsFecal Incontinence Questionnaire
Dis Colon Rectum
(2000) - et al.
Patient and surgeon ranking of the severity of symptoms associated with fecal incontinencethe fecal incontinence severity index
Dis Colon Rectum
(1999) - et al.
Standards of efficacy for evaluation of treatment outcomes in urinary incontinencerecommendations of the Urodynamic Society
Neurourol Urodyn
(1997) - et al.
Fecal Incontinence Quality of Life Scalequality of life instrument for patients with fecal incontinence
Dis Colon Rectum
(2000) - et al.
Measuring the psychosocial impact of urinary incontinence. The York Incontinence Perception Scale (YIPS)
J Am Geriatr Soc
(1995)