A good practice guide for translating and adapting hearing-related questionnaires for different languages and cultures

Figures & data

Figure 1. Key messages from Sections 1–6, recapping on the important steps in the process of cross-cultural adaptation.

Table 1. Preparation.

Item no.	Checklist item	Rationale	What are the risks of not doing this?	Who could do this?	Source
1a	Identify whether a target language version already exists, who did the development, whether it has certification documenting the process, and how it is intended to be used	To evaluate if this version is fit for purpose	Unnecessary duplicate effort	T. Lead	5 pp.436
1b	Explore permission to use and translate the questionnaire, and requirements needed for gaining approval of the translated version	To respect copyright, where appropriate	Breach of copyright	T. Lead	4 pp.98
1c	Invite the source-language Questionnaire Developer to be involved	To clarify concepts or any ambiguities behind the items	Misinterpret concepts and items	T. Lead	1 pp.5152 pp.31883  pp.14234 pp.98
1d	Set out the key objectives for the process to follow, customised to the end users	To manage the project with a detailed plan	Objectives will be missed or the project will not run to plan	T. Lead	N/A
1e	Create template documents for recording the translation and adaptation process	To track all the translations and decisions across the process in a single document	Inefficient project with a high volume of documentation	T. Lead	N/A
1f	Develop definition of concepts for each questionnaire item	To enable cultural adaptation	Misinterpret concepts, meanings and items	T. Lead/QD	1 App.14 pp.98

Checklist of common steps in various recommended procedures for cross-culturally adapting patient-reported health status questionnaires.

For brevity, the published sources are abbreviated as follows: 1 = Acquadro et al. (2008), 2= Beaton et al. (2000), 3 = Guillemin, Bombardier, and Beaton (1993), 4= Wild et al. (2005), 5= Wild et al. (2009). Other abbreviations are: App.= Appendix, F = Facilitator, T. Lead = Translation Lead, P = Patient, pp.= pages, PR = Proof Reader, QD = source-language Questionnaire Developer, Rev = native-speaking in-country Reviewer, T = Translator. In-country residents specifically refer to residents of the target country.

Table 2. Translating the source language into the target language (forward translation).

Item no.	Checklist item	Rationale	What are the risks of not doing this?	Who could do this?	Source
2a	Recruit at least two dual-language translators whose first language is the target language and who are in-country residents wherever possible, with a dialect that is representative of the target population	To enable appropriate linguistic relevance and cultural representation	Questionnaire may not be linguistically and culturally appropriate	T. Lead	1 pp.511–5132 pp.31883 pp.14214 pp.98-95 pp.434-5, 437
2b	Brief the translators on the instrument, clinical concepts underlying the health condition of interest and the concept definitions for each questionnaire item	To provide conceptual equivalence from a clinical perspective	Lose original concept	T. Lead	1 pp.511, 5162 pp.31883 pp.14214 pp.99
2c	Instruct translators on the requirements of the translation (i.e. equivalence, accessibility, and acceptability of wording) and preferred terminology	To improve quality of translation	Questionnaire may differ from the source or not be useable by the target population	T. Lead	1 pp.510, 5162 pp.3187–31893 pp.1420 and 1421, 14234 pp.995 pp.431–433, 436 and 437
2d	Working independently, each translator produces a written record of forward translation	To ensure that the range of viewpoints is not compromised and to provide detailed information of the process	Translation reflects an individual personal style and process is not transparent	T	1 pp.511–523, 515 and 5162 pp.3187–31883 pp.14214 pp.995 pp.434-5
2e	Reconcile the forward translations to create a single forward translation; producing one written record with comments, when needed	To resolve discrepancies between the independent translations, to seek agreement between personal style and preferences, and to provide one version for the back translation	To have multiple possible translations and use research resources inefficiently at the next steps	T. Lead/T/Rev	1 pp.5152 pp.3187 and 31884 pp.995 pp.437

For brevity, the published sources are abbreviated as follows: 1 = Acquadro et al. (2008), 2= Beaton et al. (2000), 3 = Guillemin, Bombardier, and Beaton (1993), 4= Wild et al. (2005), 5= Wild et al. (2009). Other abbreviations are: App.= Appendix, F = Facilitator, T. Lead = Translation Lead, P = Patient, pp.= pages, PR = Proof Reader, QD = source-language Questionnaire Developer, Rev = native-speaking in-country Reviewer, T = Translator. In-country residents specifically refer to residents of the target country.

Table 3. Translating the target language back to the source language (back translation).

Item no.	Checklist item	Rationale	What are the risks of not doing this?	Who could do this?	Source
3a	Recruit at least one new dual-language translator who is an in-country resident with experience in target culture and whose first language is the target language	To enable appropriate cultural representation and linguistic relevance	Translation may not be linguistically and culturally appropriate	T. Lead	1 pp.512 and 13, 515 and 5162 pp.3187 and 31883 pp.14225 pp.434 and 435
3b	Working independently, each translator produces a written record of back translation	To ensure that the range of viewpoints is not compromised and to provide detailed information of the process	Translation reflects an individual personal style and process is not transparent	T	1 pp.512 and 513, 5152 pp.3187 and 31883 pp.14225 pp.434 and 435
3c	Review the back translations against the source language	To refine the translation by ensuring the semantic equivalence of the translation, to identify and address problematic items	A mistranslation or omission may be overlooked	T. Lead/T/ QD	1 pp.5153 pp.14224 pp.1005 pp.437

For brevity, the published sources are abbreviated as follows: 1 = Acquadro et al. (2008), 2= Beaton et al. (2000), 3 = Guillemin, Bombardier, and Beaton (1993), 4= Wild et al. (2005), 5= Wild et al. (2009). Other abbreviations are: App.= Appendix, F = Facilitator, T. Lead = Translation Lead, P = Patient, pp.= pages, PR = Proof Reader, QD = source-language Questionnaire Developer, Rev = native-speaking in-country Reviewer, T = Translator. In-country residents specifically refer to residents of the target country.

Table 4. Committee review.

Item no.	Checklist item	Rationale	What are the risks of not doing this?	Who could do this?	Source
4a	Appoint a multi-disciplinary committee that includes at least one bilingual member (preferably a linguist) whose first language is the target language and who are in-country residents with experience of the target culture, and one healthcare professional	To provide an additional quality control step	Cross-cultural equivalence may not be achieved (or is presumed when it may not be possible)	T. Lead	1 pp.512 and 513, 515 and 5162 pp.3187 and 31883 pp.14225 pp.434 and 435
4b	Review the translation report which includes the forward and back-translations of the questionnaire, the instructions and response scale with each other and with the source, and review the previously identified problematic items. Share translation solutions, and refer difficult items to the source-language Questionnaire Developer	To detect and deal with any translation discrepancies between the language versions and to reach a consensus	Translation includes differences between language versions making it difficult to conduct comparisons	T. Lead/T/ Rev/ QD	1 pp.512, 5152 pp.3188 and 31893 pp.1422-34 pp.101

For brevity, the published sources are abbreviated as follows: 1 = Acquadro et al. (2008), 2= Beaton et al. (2000), 3 = Guillemin, Bombardier, and Beaton (1993), 4= Wild et al. (2005), 5= Wild et al. (2009). Other abbreviations are: App.= Appendix, F = Facilitator, T. Lead = Translation Lead, P = Patient, pp.= pages, PR = Proof Reader, QD = source-language Questionnaire Developer, Rev = native-speaking in-country Reviewer, T = Translator. In-country residents specifically refer to residents of the target country.

Table 5. Field testing.

Item no.	Checklist item	Rationale	What are the risks of not doing this?	Who could do this?	Source
5a	Recruit a small sample of patients from the target population	To promote appropriate and diverse cultural representation	Missing or inaccurate data due to patients misunderstanding instructions, items or response options	T. Lead	1 pp.512–5162 pp.31893 pp.14244 pp.1015 pp.437
5b	Assess whether the new version meets the requirements (i.e. equivalence, accessibility and acceptability of wording) and preferred terminology	To ensure that the translation can be understood by the target population, is acceptable to them, and is equivalent (i.e. conceptual, item, semantic and operational) to the original	Missing or inaccurate data due to patients misunderstanding instructions, items or response options scale	F/P	1 pp.515 and 5162 pp.31893 pp.1422, 14244 pp.1015 pp.437

For brevity, the published sources are abbreviated as follows: 1 = Acquadro et al. (2008), 2= Beaton et al. (2000), 3 = Guillemin, Bombardier, and Beaton (1993), 4= Wild et al. (2005), 5= Wild et al. (2009). Other abbreviations are: App.= Appendix, F = Facilitator, T. Lead = Translation Lead, P = Patient, pp.= pages, PR = Proof Reader, QD = source-language Questionnaire Developer, Rev = native-speaking in-country Reviewer, T = Translator. In-country residents specifically refer to residents of the target country.

Table 6. Reviewing and finalising the translation.

Item no.	Checklist item	Rationale	What are the risks of not doing this?	Who could do this?	Source
6a	Review the results of the field testing and finalise the translation	To incorporate findings of the field testing to improve performance of the translation	Translation may include words or phrases that are not familiar or not commonly used, subsequent data collected may include a high level of missing data or may be inappropriate to aggregate	T. Lead/ Rev/ QD	1 pp.515 and 5162 pp.31893 pp.14244 pp.101 and 1025 pp.437
6b	Formatting and proofreading the finalised translation	To check for minor errors which have been missed during the translation process	A final translation that contains spelling, typographical and/or other errors	PR (or Rev)	4 pp.1025 pp.437
6c	Submit all reports and other relevant documentation to the source-language Questionnaire Developer, and request for approval if applicable	To enable the source-language Questionnaire Developer to keep track of all translated versions.	The source-language Questionnaire Developer is unaware of the details of what was done	T. Lead	1 pp.5152 pp.3189
6d	Finalise and archive a report	To clearly explain the reasons for all translation choices	Work may be duplicated or translation may not be used because of inadequate reporting of methods used in development	T. Lead	1 pp.5152 pp.31894 pp.102

For brevity, the published sources are abbreviated as follows: 1 = Acquadro et al. (2008), 2= Beaton et al. (2000), 3 = Guillemin, Bombardier, and Beaton (1993), 4= Wild et al. (2005), 5= Wild et al. (2009). Other abbreviations are: App.= Appendix, F = Facilitator, T. Lead = Translation Lead, P = Patient, pp.= pages, PR = Proof Reader, QD = source-language Questionnaire Developer, Rev = native-speaking in-country Reviewer, T = Translator. In-country residents specifically refer to residents of the target country.

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