The Six-Step Translation Method for Cross-Cultural

Adaptation of Self-Report Measurement: Why & How?

Assist. Prof. Dr. Samoraphop Banharak Ph.D., GNP., RN

Faculty of Nursing, Khon Kaen University
 SCOPE
 Why do we need to stickily follow the translation guideline?
 Why the cross-cultural adaptation is important?
 What is the six-step translation method for cross-cultural
adaptation of self-report measurement?
 The Six-step Translation Method: Step by Step
 Results & Their Psychometric Properties
 Strengths & Weaknesses
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 Q&A
 Why do we need to stickily follow the
translation guideline?
Experts Decreased Languages &
Creditability
Approval Bias Cultural Limitation

English-Thai Translation in Context Comparable with

Guideline in Thai The Original

Validity &
Reliability
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Why the cross-cultural adaptation is important?
Based on English
Language

Multiple
Linguistic Cultural Guidelines
Cross Cultural
Guideline

Validity is about the Comparable Reliability is about the

accuracy of a measure. with Original consistency of a measure.

Validity &
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Reliability
What is the six-step translation method?

Stage VI: Submission of 5

Documentation to the Developers
The six-step translation method: Step by Step

Stage I: Initial Translation

Stage II: Synthesis of The Translations
Stage III: Back Translation
Stage IV: Expert Committee
Stage V: Test of the Prefinal Version
Stage VI: Submission of Documentation to the
Developers or Coordinating Committee for
Appraisal of the Adaptation Process
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 Stage I: Initial Translation
The 8-instrument From Four Concepts
• The 12-item Short Acculturation Scale (Marin et al., 1987)
• The 15-item Knowledge of AMI Symptoms (Centers for Disease Control and Prevention
[CDC], 2014)
• The 15-item Coronary Artery Disease Risk Factors (Centers for Disease Control and
Prevention [CDC], 2014)
• The 4-item Perceived Susceptibility (McClendon, 2010)
• The 4-item Perceived benefits (McClendon, 2010)
• The 15-item Perceived Seriousness of Consequences of AMI Scale (PSC-AMI) (Al-
Hassan & Omran, 2005)
• The 15-item Perceived Barriers to Health Care-seeking Decision-making Scale
(PBHDS) (Al-Hassan & Omran, 2005)
• The 1-item Decision Making in an AMI Situation (Centers for Disease Control and
Prevention [CDC], 2014)
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 Stage I: Initial Translation
The 8-instrument From Four Concepts

• 12-item Short Acculturation Scale (SAS)

• 27-item Knowledge of AMI symptoms and CAD risks
• 38-item Individual Beliefs of Acute Myocardial Infarction
• 1-item Decision Making in Acute Myocardial Infarction
Situation

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 Stage I: Initial Translation
Permission for Modification and Translation

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 Stage I: Initial Translation Forward
Translation

The 8-instrument From Four Concepts

Ph.D. Nursing Version T1

• 12-item Short Acculturation Scale (SAS)
• 27-item Knowledge of AMI symptoms and CAD risks
• 38-item Individual Beliefs of Acute Myocardial Infarction
• 1-item Decision Making in Acute Myocardial Infarction Situation

Ph.D. Nursing Version T2

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Independent Process
Stage II: Synthesis of The Translations

The 8-instrument From Four Concepts

Ph.D. Nursing Version T1

12-item Short Acculturation Scale (SAS)
27-item Knowledge of AMI symptoms and CAD risks Version T12
38-item Individual Beliefs of Acute Myocardial Infarction
1-item Decision Making in Acute Myocardial Infarction Situation

Ph.D. Nursing Version T2

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Stage III: Back Translation Backward
Translation
Not be informed of the
concepts explored
Ph.D. Education
(linguistics/English) Version BT1

Version T12 Information bias and to Highlighting

12-item Short Acculturation Scale (SAS)
27-item Knowledge of AMI symptoms and CAD risks elicit unexpected the
38-item Individual Beliefs of Acute Myocardial Infarction meanings of the items imperfection
1-item Decision Making in Acute Myocardial Infarction Situation

Ph.D. Chemistry Version BT2

& Science
Should preferably be 12
without medical background
Stage IV: Expert Committee

Gerardo Marin Helen Lach

The minimum composition comprises

methodologists, health professionals, language
professionals, and the translators (forward and
back translators) involved in the process up to
this point.
The original developers of the questionnaire
are in close contact with the expert committee
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during this part of the process.
Stage IV: Expert Committee
Conceptual Equivalence: Often words hold different conceptual meaning
between cultures (for instance the meaning of “seeing your family as much as you
would like” would differ between cultures with different concepts of what defines
“family”—nuclear versus extended family)
Experiential OR Cultural Equivalence: Items are seeking to capture and
experience of daily life; however, often in a different country or culture, a given task
may simply not be experienced (even if it is translatable). The questionnaire item
would have to be replaced by a similar item that is in fact experienced in the
target culture. An example might be in an item worded: Do you have difficulty
eating with a fork? when that was not the utensil used for eating in the target
country.
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Stage IV: Expert Committee

Semantic Equivalence: Do the words mean the same thing? Are

their multiple meanings to a given item? Are there grammatical
difficulties in the translation?
Idiomatic Equivalence: Colloquialisms, or idioms, are difficult to
translate. The committee may have to formulate an equivalent
expression in the target version. For example the term “feeling
downhearted and blue” from the SF-36 has often been difficult to
translate, and an item with similar meaning would have to be found by
the committee.
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Stage IV: Expert Committee

Short Acculturation Scale

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Stage IV: Expert Committee

Gerardo Marin Helen Lach

1. The word, usually, seems to be addressing quantity
rather than quality, then the respond item should be
more than in stead of better than. Answer: YES
2. Since the media context of the world has
changed, asking about visiting website is better
than TV & Radio. Answer: Should not, except use
that scale separately
3. Acute myocardial infarction is medical term and
heart attack was replaced when asking lay people.
้ วใจ
What should we translate into Thai? ภาวะกล้ามเนื อหั 17
ตายเฉี ยบพลัน vs. หัวใจล้มเหลว Answer: NO
Stage IV: Expert Committee

Gerardo Marin Helen Lach

Version T1 Version BT1

Version T12 Version BT2

Version T2 Final Version 18

Stage V: Test of the Prefinal VersionMono Lingual &
Bilingual Test
Readability & Understandable
for 12 years old children

5 Experts
30 Lay people
545 Sample Size

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Stage V: Test of the Pre-final Version

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Results & Their Psychometric Properties

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Short Acculturation Scale
Results & Their Psychometric Properties

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Short Acculturation Scale
Results & Their Psychometric Properties Test Retest
Reliability: KR21 = .78

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Results & Their Psychometric Properties Test Retest
Reliability: KR21 = .90

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Results & Their Psychometric Properties

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Results & Their Psychometric Properties

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Results & Their Psychometric Properties

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Results & Their Psychometric Properties

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Results & Their Psychometric Properties

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Results & Their Psychometric Properties

Belief Of Acute
Myocardial
Infarction

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Results & Their Psychometric Properties

Belief Of Acute
Myocardial
Infarction

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Stage VI: Appraisal of the Adaptation Process

The final stage in the adaptation process is a submission of all

the reports and forms to the developer of the instrument or the
committee keeping track of the translated version. This process
should be done to verify that the recommended stages were
followed, and the reports seem to be reflecting this process
well. In effect it is a process audit, with all the steps followed
and necessary reports followed. It is not up to this body or
committee to alter the content, it is assumed that by following
this process a reasonable translation has been achieved.
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 Strength & Weakness
1. Uncomplicated processes: Only 6 steps
2. Cross cultural adaptation
3. Following standard guideline & Rigidity
4. The original instrument owner taking part in the process
5. The experts come from various disciplines
6. Various populations and large sample size
7. Proving by 3 studies 345 Native speakers (Original Version), 10 Thai
professional immigrants & 545 Thai & Laotian Immigrants (Bilingual
Test), & 405 Thais (Monolingual Test)

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Quality and credibility
Strength & Weakness
345 Native
speakers

545 Thai & Laotian 405 Thais

Immigrants (Monolingual Test)

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Strength & Weakness
1. Experts finding
2. Bilingual translators finding
3. Cultural and context barrier

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 Thank
You For
Your
Attention
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