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Center for Aging in Diverse Communities, Measurement and Methods Core University of California, San Francisco http://medicine.ucsf.edu/cadc/cores/measurement/methods.html Last Updated June 2007 1 Annotated Bibliography Guidelines for Translating Surveys in Cross-Cultural Research Prepared by the Measurement and Methods Core of the Center for Aging in Diverse Communities, University of California San Francisco Introduction As the population become more diverse, it is important to conduct health research within non- English speaking populations. Only recently have health researchers begun to identify best practices for the translation and assessment of translations of survey instruments into other languages. Current standards for translation procedures are lacking and few researchers report their methods of translation. Often, time and money are not dedicated to the proper translation and adaptation of measures, and thus the cultural and conceptual equivalence often suffers. A well-translated survey instrument should have semantic equivalence across languages, conceptual equivalence across cultures, and normative equivalence to the source survey. Semantic equivalence refers to the words and sentence structure in the translated text expressing the same meaning as the source language. Conceptual equivalence is when the concept being measured is the same across groups, although wording to describe it may be different. Normative equivalence describes the ability of the translated text to address social norms that may differ across cultures. For example, some cultures are less willing to share personal information or discuss certain topics than other cultures. If possible, both surveys should be developed simultaneously, preventing the survey from being based too deeply within one culture and language. Furthermore, some researchers have begun to consider whether the same questions should be asked of all populations, or whether cultural considerations may require slightly different questionnaires in several cases (issues specific to religion, health beliefs, etc). Below we provide a list of journal articles, book and book chapters that describe recommended methods of translation of survey instruments into multiple languages. While this in not an exhaustive list of all works published on translation methods, we have tried to include key articles that provide in-depth explanations of the methods used to translate materials and/or practical approaches for handling the different problems encountered during the translation process. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Recommendations for the Cross-Cultural Adaptation of Health Status Measures. Rosemont (IL): American Academy of Orthopedic Surgeons; revised 2002. This article provides a concise guide to adapting self-report measures for cross-cultural use. The authors suggest a six stage process of Translation, Synthesis, Back Translation, Expert Committee Review, Pretesting, and Submission and Appraisal. According to this source, translation should involve at least 2 independent forward translations by bilingual translators which can then compare their versions to identify discrepancies indicative of ambiguous wording within the original survey or other problems. During synthesis a third bilingual person mediates a discussion between the two translators to develop one version of the survey. Written documentation of the process is encouraged. Another person blind to the original survey then back translates the new survey into the source language and compares it to the original document to check the validity of the translation. An expert committee, comprised of the translators and health and language professionals, meets with the purpose of consolidating the different versions of the survey to produce a final form and ensure equivalence between the source and new versions. The translated survey should then be pretested in a sample of 30-40 persons from the target Center for Aging in Diverse Communities, Measurement and Methods Core University of California, San Francisco http://medicine.ucsf.edu/cadc/cores/measurement/methods.html Last Updated June 2007 2 population using standard cognitive interviewing techniques. This document also puts forth common questions and answers that researchers have when translating instruments and provides an appendix with sample forms used during the translation process to track each iteration of translation, document discrepancies between different translations, and document how the final decisions were made by the review committee. Behling O, Law KS. Translating Questionnaires and Other Research Instruments: Problems and Solutions. Thousand Oaks, CA: Sage Publications Inc. 2000: pp63. This small booklet provides an overview of key issues involved in the translation of questionnaires including achieving semantic equivalence across languages, conceptual equivalence across cultures, and normative equivalence across societies. The authors explore these three levels of equivalence and the problems one may have at each level across different types of questions asked (demographic, behavioral reports, knowledge, etc). For example, it is relatively easy to achieve semantic and conceptual equivalence of demographic questions across languages, since the words and ideas are more general and commonly used. However, it is harder to achieve normative equivalence, since cultures differ on how willing they are to share personal information. On the other hand, it is much more difficult to achieve all types of equivalence when translating and asking questions about attitudes and opinions since the ideas are more abstract, the concept may not be relevant throughout the world, and some cultures may resist discussing certain beliefs with strangers. The authors review and rate 5 methods often used to establish semantic equivalence when translating a survey from an existing survey including direct translation, back translation, and random probes. Practical advice is also given for achieving semantic equivalence when creating a new survey including writing with translation in mind, decentering, and using multicultural teams. Empirical tests that can be used to test conceptual equivalence of survey items (factor analysis, item response theory) are discussed. Normative problems that can arise in cross cultural research include social norms about openness with strangers, political opinions, tendency to conform or assert oneself, and more. The authors provide several ideas for addressing these issues: develop close relationships with respondents or use individuals who are trusted within the sample to recruit or interview for the survey; use multicultural teams when translating the survey; and pilot test the survey. The booklet concludes with additional practical tips for researchers when translating questionnaires. Forsyth BH, Kudela MS, Levin K, Lawrence D, and Willis GB. Improving Questionnaire Translations and Translation Processes. Paper presented at Q2006, European Conference on Quality in Survey Statistics, April 25, 2006. Cardiff, Wales, UK. This paper explores procedures for developing and evaluating questionnaire translations for surveys administered in multiple languages. The authors focus on a case study in which they translated an English-language questionnaire on tobacco use into Mandarin, Cantonese, Korean and Vietnamese. A team of three translators each translated the survey from English into one of the target languages, and kept detailed records of the specific translation challenges they encountered and the decisions they made to deal with the challenge. Four survey language consultants (SLC) were hired to review the new translations and coordinate pretesting activities. A formal process was established by which SLCs could review the survey, identify problematic areas, document their findings and suggest a revision. These written documents were used in the final adjudication phase. The survey translations were pretested using cognitive interviews, and the results were used to make final changes to the surveys. The authors detail the five step translation, evaluation and review process they used and the lessons learned at each step. Some of the important lessons learned include engaging survey reviewers early during translation to reduce the need for large-scale revisions later on, and provide translators with unambiguous instructions, including the reasons for and structure of the survey interview. Center for Aging in Diverse Communities, Measurement and Methods Core University of California, San Francisco http://medicine.ucsf.edu/cadc/cores/measurement/methods.html Last Updated June 2007 3 Harkness J, Pennell BE, Schoua-Glusberg A. Survey Questionnaire Translation and Assessment. In: Presser S, Rothgeb J, Couper M, et al. Methods for Testing and Evaluating Survey Questionnaires. Hoboken, N.J.: John Wiley & Sons, Inc. 2004:453-473. This chapter identifies several key difficulties when translating existing surveys including maintaining the intended meaning of the questions and matching the semantic content and structure across languages in both questions and answer scales. Existing survey questions may be slightly ambiguous as to their intended meaning, forcing translators to either leave their translation ambiguous or decide on a single interpretation and translate the survey accordingly. This allows for the possibility of different meanings of questions across languages. The authors provide examples of common problems that arise when a questionnaire is translated too closely, meaning the translation focuses on the words and not the meaning of the questions. Possible problems include creating a different question than the original, creating an unnecessarily complicated or awkward text, and the unidiomatic or improper use of the target language. The authors also lay out issues regarding the translation of answer scales. For example, in some languages the difference between ‘disagree’ and ‘not agree’ does not exist, and therefore response options must be altered from the source language. The authors detail the benefits of using a team approach to translation and review, and outline several qualitative (cognitive interviews, interviewer and respondent debriefing, back translation) and quantitative (statistical tests) approaches that can be used in the review process. The chapter concludes with an emphasis on the type of documentation necessary for a successful translation including background documentation that should be provided to translators, record keeping uploads/Litterature/ translation-guide.pdf