Translation and back-translation methodology in health research – a critique

ABSTRACT

Introduction

While back translation has been widely used in medical research surveying linguistically diverse populations, research literature often fails to document this complex translation process. Our study examines inadequacies in the use of back translation, suggests improvements, as well as suggesting where other translation strategies may be more appropriate.

Areas covered

This paper cites numerous metastudies showing how back translation is often uncritically adopted in validation of research instruments, pointing to potential methodological failings, before examining the back-translation processes in an Australian study of non-English speaking cancer patients. Our study of back translation applied to patient self-report questionnaires demonstrates that appropriate renditions of items are critically dependent upon both translator and researcher awareness of item purpose, overall project specifications and identification of linguistic ambiguities in source test items. The poor implementation and documentation of back-translation processes in many studies indicate alternatives to back translation may be appropriate.

Expert opinion

Where translations are used in research, translation processes need to be made explicit in research protocols and reports, and translation experts need to be part of the research team, with translation guidance and advice integrated into all stages of research design.

KEYWORDS:

• Australia
• back translation
• patient experience
• psycho-social research methodology
• questionnaire translation
• translation

Article Highlight

• Back translation has been widely adopted but often poorly implemented or documented in medical research on patient response in multilingual target populations.

• Back translation has too often been regarded as a merely technical or even outsourced activity, constituting a methodological flaw in research, as revealed in numerous metastudies.

• Our research project on migrant cancer patients demonstrated significant issues in back-translation methodology, which challenge both translators and research teams.

• Our study recommends improved protocols to ensure transparency of processes where back translation is used, and alternatives to back translation are discussed.

• The inclusion of translation experts in research teams is recommended, along with explicit consideration of translation issues in research project design.

Acknowledgments

The authors thank the participants of the INFORM study, RAs, and other staff at Peter MacCallum Cancer Centre for their essential contributions.

Declaration of Interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The INFORM study on which this article is based was funded by the National Health and Medical Research Council (#1047416). Additional funding for translation research came from the University of New South Wales, Faculty of Arts and Social Sciences research grant with ethics clearance HC15244.