Challenges and Strategies of Instrument Translation

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2006 28: 310West J Nurs ResWen-Ling Wang, Hwei-Ling Lee and Susan Jane Fetzer

Challenges and Strategies of Instrument Translation

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10.1177/0193945905284712Western Journal of Nursing ResearchWang et al. / Instrument T ranslation

Challenges and Strategiesof Instrument TranslationWen-Ling WangHwei-Ling LeeNational Cheng Kung University, Tainan, Taiwan

Susan Jane FetzerUniversity of New Hampshire, Manchester

The often-cited back translation procedure used for the translation of researchinstruments has not been consistently described in cross-cultural literature.Translation errors resulting in conceptually dissimilar instruments can com-promise comparisons of cross-cultural health initiatives. This report describesa five-step translation procedure and equivalence and reliability testing pro-cess used to develop the High School Questionnaire: Profile of Experiences(HSQ) in Mandarin. Each step of the translation process provided additionalinformation and detected discrepancies between the English and Mandarinversions of the HSQ. Issues related to grammatical translation, cultural usageand experience, syntax, and concept interpretation were exposed by the trans-lation process. The procedures used in this 18-month study were rigorousenough to create an instrument that was both linguistically appropriate andculturally relevant.

Keywords: instrument translation; translation equivalence; back transla-tion; adolescent health; Chinese

Ideal cross-cultural instruments can separate the variance because of truedifferences in the phenomena of interest from the variance because of cul-

tural and linguistic differences (Kim & Han, 2004). Once the true variancecan be discriminated by cross-cultural instruments, interventions deemedeffective in one culture can be tested and applied in a different culture. Meth-odological flaws, however, created by instrument translation errors directlythreaten the validity of cross-cultural research. In a review of 47 articles

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Western Journal ofNursing Research

Volume 28 Number 3April 2006 310-321

© 2006 Sage Publications10.1177/0193945905284712

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Authors’Note: The study was funded by a National Cheng Kung University research grant. Weare sincerely grateful to the study participants for their pivotal role in contributing and collectingdata. We would also like to thank Dr. L. L. Eggert, Dr. J. R. Herting, Dr. E. A. Thompson, and Dr.R. Brooke for the support they provided in the process of translation.

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describing instruments that were translated as part of the primary study,Maneesriwongul and Dixon (2004) concluded that “the quality of processesused for instrument translation varies widely” (p. 184). Documenting themethods used in the translation process and testing equivalence is a crucialactivity. Data obtained from translated measures that have not been evaluatedfor equivalence are meaningless (Sperber, Devellis, & Boehlecke, 1994).Cross-cultural comparisons are neither valid nor appropriate until equiva-lence has been established (Goulet, Polomeno, Laizner, Marcil, & Lang,2003). Without equivalence, conclusions thought to be based on differencesand similarities between cultures on the phenomenon being measured mayactually be based on errors in translation.

Cross-cultural measurement tools to measure health indicators arerequired to meet the goals of the World Health Organization (WHO) agenda.One in every five people in the world is an adolescent, with 1.2 billion adoles-cents worldwide. With 1.7 million youth dying each year from preventable ortreatable illnesses and accidents, WHO has outlined an approach to supportadolescent health. These global-level actions include the development ofindicators for planning and evaluating adolescent health initiatives world-wide. Cross-cultural research is needed to identify valid differences and sim-ilarities among adolescent populations with diverse cultural backgrounds tobuild on the knowledge base of each culture.

The High School Questionnaire: Profile of Experiences (HSQ) was devel-oped by Eggert, Herting, and Thompson (1994) to measure adolescents’ lifeexperiences related to family, school, and friends. The HSQ includes 311items in five subscales: Support and Help, Activity, Drug Knowledge andInvolvement, Life Experience, and Demographic Questions. The HSQ re-quires 60 minutes to complete, and the reliability and validity of the Eng-lish version are well established (Eggert, Herting, & Thompson, 1996;Thompson, Moody, & Eggert, 1994). An appropriate measure of adolescentexperiences could not be identified for Mandarin speaking youth.

Translation Challenges

Cultural and linguistic variations between English and Mandarin makeinstrument translation problematic. The most widely used and acceptedtranslation method for obtaining equivalence between the source language tothe target language is back translation (Yu, Lee, & Woo, 2004). The backtranslation process uses a forward translation from source language to targetlanguage, a back translation from target language to source language, andthen a comparison of the two source language translations. The back transla-

Wang et al. / Instrument Translation 311



tion method must be used with caution as a false positive translation canoccur.

One source of error occurs when the forward and back translators share acommon educational or socioeconomic background but do not represent thetarget population. In this situation, the source translations are equivalent butnot meaningful. Cultural relevancy can be lost. A false positive error can alsooccur when the forward translation is inadequate but compensated for andcorrected by an expert translator. Semantic equivalence can be lost. Finally,error is introduced if the translators insist on maintaining grammaticalnuances of the source language when producing the target instrument(Brislin, 1970; Marin & Marin, 1991). If this occurs, bias toward the cultureof the original version can be introduced (Yu et al., 2004).

Strategies to minimize error when using back translation include appro-priately selecting translators, employing a review team, and pilot testing onthe target population. When selecting translators, a proficient forward trans-lator is fluent in both the source and target language and knowledgeable inthe purpose and intent of the instrument (Streiner & Norman, 1995). Theback translator is equally qualified but must not be familiar with the originalversion of the instrument. The translators are blind to each other. These strat-egies can reveal inconsistencies, including the use of cultural idioms (Munet-Vilaro & Egan, 1990). Locating translators who are bilingual and familiarwith the semantic content of the instrument is not easy.

A review team of bilingual translators can decrease translation errors(Jones, Lee, Phillips, Zhang, & Jaceldo, 2001). Once the forward translationhas occurred, a review team conducts independent, but simultaneous, backtranslation while also validating the cultural relevance of the translation pro-cess. One of the greatest challenges in instrument translation is “to adapt theinstrument in a culturally relevant and comprehensible form while maintain-ing the meaning of the original items” (Sperber et al., 1994, p. 502).

Pilot testing using a mono-cultural, monolingual target population seeksto identify problems in grammatical and syntactical translation. The pilotgroup is asked to identify words, items, or sentences that seem awkward orunusual in the target language. Once the ambiguous terms are clarified andedited, back translation to the source language can proceed (Philips, deHernandez, & de Ardon, 1994; Sperber et al., 1994). Maneesriwongul andDixon (2004) strongly recommended monolingual test procedures duringinstrument translation. Sperber and colleagues (1994) further suggested theuse of a bilingual sample to complete the instrument in both the source andtarget languages.

312 Western Journal of Nursing Research



Purpose

The purpose of this study was to develop an appropriate measure to inves-tigate the problem behaviors of Mandarin-speaking adolescents and test amodified translation procedure to maximize the translation equivalence andminimize the chance of false positive translation.

Design

Based on Brislin’s (1970) model, a modified back translation procedurewas employed to maximize the translation equivalence of the HSQ fromEnglish into Mandarin and to minimize the chance of false positive transla-tion (see Figure 1).

Sample

Bilingual translators, monolingual and bilingual speakers, monolingualand bilingual adolescents, and language experts participated in the five-stepprocedure carried out during 18 months.

Method and Results

Step 1: Translation and Pilot Testing

Two bilingual translators, competent in both English and Mandarin, inde-pendently translated the source HSQ-English into Mandarin. Version I wascreated by a translator who taught English for a high school in Taiwan. Ver-sion II was created by a graduate student majoring in English at a Taiwaneseuniversity. Once completed, Mandarin Versions I and II were reviewed bythree Taiwanese high school students. The high school students were askedto mark the items, words, or phrases that sounded strange or were not com-monly used by their peer group.

Step 2: Cultural Appropriateness Testing

Two PhD-prepared researchers, whose native language is Mandarin butwho had lived in the United States for more than 6 years, composed thereview team that independently reviewed Mandarin Versions I and II for con-tent validity. After examining and discussing the high school students’ com-




ments, the review team selected the most linguistically appropriate translatedsentences from each version to produce the target instrument, the HSQ-Mandarin (HSQ-M).


HSQ (Egger et al. 1994)

Items = 311

Mandarin MandarinVersion I Version II

Reviewed for peer group congruence

Best translated and culturally appropriate

phrases selected

HSQ-MItems = 315

Back translated

Editing of back translation

HSQ-M-EItems = 315

Monolingual testing Bilingual testing

Reliability testing

for similarity and comparability for equivalence

Figure 1Development and Testing of the HSQ-M

Note: HSQ is High School Questionnaire: Profile of Experiences. HSQ-M is HSQ-Mandarin.HSQ-M-E is HSQ-Mandarin-English.



The review team also evaluated the cultural appropriateness of the HSQ-M. As a result of differences between high schools in the United States andTaiwan, modifications were made in the HSQ-M. Most Taiwanese studentsspend a considerable amount of time after school attending additional classesthat prepare them for the national university entrance examination. There-fore, a question asking about after school activities common to Taiwaneseyouth was added to the HSQ-M Activity subscale. Because of the length ofthe HSQ, questions describing specific activities were listed by asking Tai-wanese students for their top three primary activities and the hours they spentin the activity. The review team believed that Mandarin speaking adolescentswho consumed alcohol might respond differently than those who used drugs.Therefore, the single question in the HSQ-M Drug Involvement scale wasseparated into two questions, one related to alcohol consumption and onerelated to illegal drug use. Finally, the term I in each item of the HSQ-M waschanged to you. Culturally, questions are phrased from the perspective of theperson asking the questions, not from the perspective the person answeringthe question. The 311 items of the HSQ resulted in 315 items for the HSQ-M(see Table 1).

Step 3: Blind Back Translation

A Taiwanese graduate student, a university language arts major who wasnot familiar with the HSQ or HSQ-M, served as the first back translator. TheHSQ-M was translated back into English. A language arts professor at thesame university reviewed and edited the back translation of the HSQ-M tocreate the HSQ-Mandarin-English (HSQ-M-E).


Table 1Number of Items in English and Mandarin Versions of HSQ and the

Cronbach’s Alpha Value for Internal Consistency

Subscale HSQ Items HSQ α HSQ-M Items HSQ-M α

Support or help 48 .78-.84 10 .77-.80Activity 49 .67-.88 25 .50-.94Drug involvement 87 .70-.87 104 .70-.96Life experience 87 .69-.89 87 .62-.90Goals or ambitions 20 .82-.84 20 .76-.78General information 20 — 28 —Total 311 315

Note: HSQ is High School Questionnaire: Profile of Experiences. HSQ-M is HSQ-Mandarin.



Step 4: Translation Equivalence Testing

Translation equivalence between the HSQ and the HSQ-M-E was evalu-ated using monolingual and bilingual speakers. First, in the monolingual test,two native English speakers compared the HSQ and the HSQ-M-E. Twomethods of comparison, comparability of language and similarity of inter-pretation, were used to evaluate the success of the translation process. “Com-parability of language refers to the formal similarity of words, phrases, andsentences. Similarity of interpretability refers to the degree to which the twoversions would engender the same response even if the words are not thesame” (Sperber et al., 1994, p. 506). Each English speaker compared thewords and phrases in the HSQ with the words and phrases in the HSQ-M-Eon comparability and similarity using 7-point scales ranging from extremelycomparable to not at all comparable and extremely similar to not at all simi-lar. Lower values indicated that the difference between the English versionswas small. Adequacy of translation was determined as a score of less than 4,with any items scoring 4 and above considered problematic.

Including the items on the questionnaire (n = 223) and the instructionalphrases (n = 10), 233 phrases were compared during the monolingual equiv-alence testing. The monolingual speakers disagreed on 19 (8.2%) of the 233items with respect to comparability and 15 (6.5%) of the 233 items withrespect to similarity. There were 23 items that were ranked greater than 4 byboth speakers in either comparability or similarity. These items could beproblematic in cross-cultural research. For items with scores greater than 4 inboth similarity and comparability, the similarity scores were equal or ex-ceeded the comparability scores. This seems to indicate that the monolin-gual, native English speakers had greater concern for the ability of the item torender the same response than for the comparability of the translation.

The review team rechecked, discussed, and revised the HSQ-M itemswhere the native English speakers agreed that the HSQ-M-E version did notadequately represent the meaning of the source HSQ. For example, the HSQitem, “My mom (dad) complains about feeling depressed,” was back trans-lated in the HSQ-M-E version as, “Your mother (father) always complainsanxiously.”

A bilingual test for translation equivalence included 32 bilingual highschool students. The principal of the highest-ranking high school in southernTaiwan was contacted, and permission to conduct the study was obtained.The principal identified the academic top 10% of the 12th grade Englishclass and invited them to attend a research meeting. At the meeting, the re-searcher explained the study, obtained verbal consent from each student, andadministered the HSQ. To decrease measurement error caused by memory




while seeking to minimize any change in score because of life experiences,each student completed the HSQ-M 1 week later. The HSQ and HSQ-Mwere coded to be analyzed as individual matched data; however, no identify-ing marks were placed on the instruments, making it impossible for theresearcher to identify individual student responses.

Translation equivalence was assessed for 194 of the HSQ items. The HSQActivity scale was not tested during this step of the translation equivalenceprocedure because of the time constraints of the students. Only 1 hour for theHSQ and 1 hour for the HSQ-M was allowed by the school principal, andtherefore it was the decision of the researchers to delete the Activity scalefrom the bilingual testing.

Group mean total scores, subscale mean scores, and item mean scoreswere calculated for the HSQ and HSQ-M. To evaluate equivalence, correla-tion statistics were calculated (see Table 2). Any HSQ and matching HSQ-Mitem with a correlation of less than .5 was reexamined by the review team.Changes were made if the HSQ-M did not adequately represent the meaningof the HSQ.

A review of the data from the bilingual participants revealed that the ado-lescents had knowledge of the commercial names of illegal drugs but not thechemical names. Therefore, it was decided that any HSQ-M item referring to


Table 2Correlation Between HSQ and HSQ-M-E From

Bilingual Test for Equivalence

Item Correlations

Numberof

Subscale Items > .8 .5-.8 < .5 M Range

Support and help 9 2 6 1 .70 0.48-0.87Goals and ambitions 10 0 2 8 .38 0.16-0.56Life experience 87 14 48 25 .63 0.04-1.0Drug knowledge or

involvementa 21 13 3 5 .75 0.21-1.0Drug knowledge or

involvement 66 39 14 15 .77 0.03-1.0Total score 193 .69 0.03-1.0

Note: HSQ is High School Questionnaire: Profile of Experiences. HSQ-M-E is HSQ-Mandarin-English.a. These items provided nominal data and were analyzed with the (1967) coefficient test.



an illegal drug would use both the commercial and the popular or street nameused among Taiwanese youth. For example, the question, “How often haveyou used stimulants (amphetamines, crystal, speed, etc.)?” was translatedinto two questions: “How often have you used amphetamines?” and “Howoften have you used the shaking-head pills?”

Step 5: Reliability Testing

The HSQ-M was tested for reliability using a convenience sample of 10thgrade students in southern Taiwan. Permission to invite the students to partic-ipate was granted by the school administrator. The HSQ-M was distributed toall students (N = 594), and 547 (92%) provided completed questionnaires.The mean age of respondents was 16.0 years (SD = 0.4), and 58.8% (n = 321)were males. Cronbach’s alpha for each subscale ranged from .50 to .96 andwas similar to HSQ reliability data reported by Eggert et al. (1994) and Wang(2000).

Discussion

Each step of the translation process provided additional information anddetected discrepancies among the HSQ, HSQ-M, and HSQ-M-E. The vari-ability in the scores during the translation equivalency testing (step 4) isindicative of the difficulties in creating culturally appropriate instruments.When items in the HSQ were modified for cultural differences during theMandarin translation, the result, as might be expected, was a slightly differ-ent description during the back translation. For example, the HSQ item, “Ifeel stressed out,” was back translated as a HSQ-M-E item, “You feel heavypressure and you can stand it.” Although this cultural adaptation may havecontributed to the low correlations from the monolingual speakers, a literaltranslation does not guarantee equivalence.

Differences in educational systems may have also affected comparabil-ity and similarity values. Taiwanese students are cohorted in classes, takingall subjects with the same group of classmates. For example, one HSQphrase, “The amount of support from classmates in my favorite class,” wasmodified for the HSQ-M and back translated as, “The amount of sup-port from your favorite classmates.” The equivalence was rated as mid tohigh noncomparability and nonsimilarity and had a poor correlation of.48. As Yu et al. (2004) noted, however, there are differences between theEnglish and Mandarin languages in grammatical, syntactical styles andword usage. Although the HSQ and HSQ-M-E are different, the meaningequivalence is maintained. On final review, the researchers determined that




translation equivalence cannot rely solely on statistical data, but each itemmust be reviewed for semantic and conceptual equivalence (Varricchio,2004).

The results of the bilingual equivalence test provided moderate corre-lations between the HSQ and HSQ-M. The Goals and Ambitions subscaleshowed the lowest correlation between items, yet the monolingual test for thesame subscale had good correlations for similarity and comparability. It ispossible that the bilingual students discriminated two distinct meanings. Thecultural perspective of collectivism in Taiwanese may have contributed to thelower correlation on the Goals and Ambitions subscale. Yu et al. (2004) referto this phenomenon as “differences in cultural experience with a concept”(p. 313). The HSQ requests a response for how well a goal is being met inrespondents’ lives. The items require the respondents’reflection on their owngoals and a comparison with their own performance. The HSQ-M prefacesthe subscale items with external expectations placed on students as membersof a generation. Respondents are required to reflect on society’s goals andcompare this external view with their own performance. Thus, as a highachieving group of students, the students in the bilingual test group may havebelieved they were meeting their own internal goals but not those of theexternal society, resulting in a lower correlation. For example, two items withsimilar mean comparability and similarity scores of 4 resulted in differentcorrelations of r = .16 versus r = .52.

There is no one perfect translation technique with multiple techniquesrecommended to improve the semantic equivalence of cross-cultural instru-ments (Maneesriwongul & Dixon, 2004). The cost of instrument translationincluding translator effort and participant burden is considerable. In thetranslation of the HSQ-M, the monolingual and bilingual tests had smallsample sizes (n = 3 and n = 32, respectively). The bilingual testing used a con-venience sample of female adolescents who were judged to be good studentswith limited knowledge and experience in drug and alcohol use. These par-ticipants may not have been representative of the population of monolingual,Mandarin-speaking youth of Taiwan.

Conclusion

Establishing equivalence of cross-cultural instruments is both challeng-ing and rewarding. The back translation procedures used to develop a Man-darin version of the HSQ described in this study were rigorous enough to cre-ate an instrument that was both linguistically appropriate and culturallyrelevant. The challenges were met by ongoing review of translation and the




use of both monolingual and bilingual testing. Additional research is neededto test the translated instrument for other types of validity. The equivalencytesting data in this study revealed a moderately adequate translation; theempirical findings assisted the researchers in reviewing, discussing, and re-fining the HSQ-M.

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Wen-Ling Wang, PhD, RN, is an assistant professor in the Department of Nursing, Medical Col-lege, National Cheng Kung University.

Hwei-Ling Lee, PhD, is an associate professor in the Department of Public Health, NationalCheng Kung University.

Susan Jane Fetzer, PhD, RN, is an associate professor in the School of Health and Human Ser-vices, Department of Nursing, University of New Hampshire.




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Challenges and Strategies of Instrument Translation