Methodology

Forward translation

Purpose: To create a mistake-free translation which is accurate and relevant to the cultural environment of the target country. We use our vast experience in the area to make sure all the potential difficulties receive proper consideration at this very first step to create a solid basis for the following steps.

• All local project managers are trained in cultural adaptation to make sure that the resulting translation not only accurately reflects the original meaning but is also culturally relevant
• The two translations of the original are produced by two professional translators who are experienced in translating the type of documents in that subject
• These two translations are analyzed item by item by the local project manager, on which basis the first draft version is generated
• All translation difficulties are discussed between the parties until all issues are resolved

Back translation

Purpose: to allow parties not speaking the target language to participate in the validation process and to control for subtle differences in word use between the original language and the target language.

• The translation back into the original language is always done by a native speaker of the original language
• All of our back-translators are professional translators
• The back-translation and the original are compared item by item by the local project manager.  This comparative analysis is based on the existing linguistic research on the back-translation for cross-cultural research
• All discrepancies are analyzed and discussed between the parties until all issues are resolved.

Review by clinician

Purpose: to check domain-specific terminology and to ensure that the language used in the translated instrument is consistent with that usually used in doctor-patient communication

• The translated version is sent to a clinician specialized in treating patients the questionnaire is intended for
• The clinicians are debriefed on the methodology and all comments are summarized in a report
• All comments are analyzed by the local project manager and discussed between the parties until all issues are resolved

Cognitive debriefing (also referred to as Patient testing)

Purpose: to ensure that the translated instrument is clear and relevant for the target population. This is arguably the most important step of the validation process because it allows us to assess the validity of the translation within the context of patients’ experiences.  Since patients’ experiences differ across countries, unexpected translation issues might be uncovered.

• Our local project managers are trained in pilot testing so that they are able to elicit maximum feedback from patients
• A sample of patients from the target population is recruited through our vast network of clinicians
• The local project managers conduct individual face-to-face interviews; during the interview, the participant is asked to explain the meaning of each item in his/her own words
• All patients’ answers are recorded, translated to English, analyzed and summarized in a report by the local project managers
• All translation difficulties are discussed between the parties until all issues are resolved

Proof-reading

Purpose: to ensure that no spelling, grammar or formatting mistakes are left in the target version

• The final version is sent to the local project manager and to an independent proof-reader
• The proof-reading comments from both are summarized and analyzed by the local project manger