Chinese Japanese Flipped Classroom Scene Translation Technology Based on Iterative Back Translation

Purpose: To describe the process of cross-cultural adaptation and present the Portuguese version of the instrument Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) for use in adolescents.Methods: The RDC/TMD adapted for adolescents was fully translated into Portuguese by a translator and then back translated into English by a second translator who was blind to the original text. The back translation was compared with the original by the author and the final version defined by consensus. Part I of the instrument was administered to 186 students aged 12 to 17 years in the town of Três Rios/Rio de Janeiro State, Brazil, to assess comprehensibility.Results: One question was considered inaccurate in the back translation. The young respondents struggled with five of other questions. The original version of the instrument in English and the final version in Portuguese were presented.Conclusion: The process of translation and back translation ensured the semantic equivalence of the original version relative to the translated version. The application of the questionnaire met wide acceptance and contributed to the final version of the instrument.

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.

Precise and unequivocal specification of intervention content is key to facilitating the accumulation and implementation of knowledge. The Behaviour Change Technique Taxonomy v1 (BCTTv1) is the most widely used classification of behaviour change techniques (BCTs), providing a shared, standardized vocabulary to identify the active ingredients of behavioural interventions. However, the BCTTv1 is only available in English and this hampers its broad use and adoption. The aim of the present article is to report the process of translation of the BCTTv1 into Spanish. A bilingual team led the translation of the BCTTv1, involving seven iterative steps: (i) establish a Committee, (ii) forward translation from English to Spanish, (iii) back translation from Spanish to English, (iv) comparison of original BCTTv1 and back translation, (v) opportunistic comparison against an independent BCTTv1 translation, (vi) empirical testing, and (vii) final Committee review. Changes as a result of the translation process included relabelling BCTs, amending definitions, and fixing conceptual and grammatical inconsistencies, yielding the final version. Very satisfactory inter-coder reliability in BCT identification was observed as part of the empirical testing (i.e., prevalence and bias-adjusted kappa scores > 0.8). This work provides the Spanish-speaking population with a rigorous and validated BCTTv1 translation which can be used in both research and practice to provide a greater level of intervention detail for evidence synthesis, comparison, and replication of behaviour change interventions. The translation process described here may prove helpful to guide future translation efforts in behavioural science and beyond.

Background The 13-MD is a new instrument designed to measure more globally the various aspects of the health-related quality of life. Its structure is balanced around physical, mental, and social aspects of health. Objective To translate the 13-MD into Canadian English and to ensure that it is conceptually equivalent to the original version in Canadian French. Methods Forward and back translations were conducted. A linguistic validation was performed in both Canadian French and Canadian English following an iterative process. This validation was conducted with 15 participants in each group (French and English speakers) using face-to-face cognitive debriefing interviews. This process was done in accordance with academic standards. Results The two forward translations resulted in 35.8% of identical sentences (59/165). Back translation indicated that 83.6% of the sentences were identical or almost identical to the original Canadian French version. The review of the back translation led to a few changes in the reconciled forward translation (4/165) and the original version (11/165), while the linguistic validation process led to 24 changes over a possibility of 165 sentences in the Canadian English version and 6 over 165 in the Canadian French version. Most changes provided were minimal and were done to ensure a better understanding of the 13-MD. Conclusion The translation and linguistic validation processes were successful in creating a valid 13-MD in Canadian English (13-MD-CE) that is conceptually equivalent to the original version.

Recently, the Standardised Tool for the Assessment of Bruxism (STAB) has been developed for use in clinical and research settings. The aim of the present study is to describe the process of forward and back translation and pilot testing of the STAB into Italian. The English version of the STAB was adopted as a template for translation into other languages, according to a step-by-step procedure led by the expert STAB bruxism panel and mother tongue experts in the field. In detail, the translation team was made up of 12 subjects: three study coordinators, two forward translators, two back-translators and five expert panellists. Following the translation process, a pilot test in patients, dentists and dental students was performed using the 'probing' method (i.e., subjects were questioned by the examiners about the perceived content and interpretation of the items) with the aim to assess the comprehensibility of the questions and response options, and the feasibility of the tool. This paper describes the translation process of the STAB and provides the outcomes of the pilot testing phase and the face validity assessment. The preliminary results suggest that, from a global point of view, the STAB reflects the characteristics required in clinical and research settings. Thanks to the translation process, the Italian version of the STAB can be assessed on-field and introduced in the clinical and research field to get deeper into the study of bruxism epidemiology in Italy.

PURPOSE To translate NANDA Taxonomy II into Brazilian Portuguese. METHODS Semantic equivalence was obtained through a process of translation and back translation, supervised by a professor (RN and PhD) expert in using nursing diagnoses taxonomy both in teaching and in clinical practice. Conceptual equivalence was attained by presenting the original text, the translation and the back translation of the labels, definitions, defining characteristics or risk factors, and related factors to a group of expert nurses from different specialties who are proficient in English in order to analyze them and to verify if the terms presented in each diagnosis are suitable to the Brazilian nurses' practice reality, making suggestions as appropriate. The results of this analysis and the suggestions were then discussed by a committee with expertise in this kind of work and nursing diagnosis until consensus could be reached. FINDINGS Some difficulties were found in the translation process because of the structural differences between English and Portuguese, and also because many diagnostic concepts are presented in different ways in the book. With the Portuguese translation, trouble occurs because of alphabetical order. Even if this is only a matter of organization, when discussing which one could be the correct form of these diagnostic concepts, a more important question emerged: What really composes the concept? We believe the concept is general, and should not contain components from the other axes. For instance, we think incontinence is better than bowel incontinence, because “bowel” is on the axis topology. We await a response from NANDA in order to continue the work. CONCLUSIONS Providing Brazilian nurses with NANDA Taxonomy II adapted to Brazilian nursing practice will allow them to continue clinical application of this classification, as well as develop research projects.

Performing high-quality and reliable cognitive testing requires significant resources and training. As a result, large-scale studies involving cognitive testing are difficult to perform in low- and middle-income settings, limiting access to critical knowledge to improve academic achievement and economic production in these populations. The NIH Toolbox® is a collection of cognitive, motor, sensory, and emotional tests that can be administered and scored using an iPad® tablet, reducing the need for training and quality monitoring; and thus, it is a potential solution to this problem. We describe our process for translation and cultural adaptation of the existing NIH Toolbox tests of fluid cognition into the Swahili and Dholuo languages for use in children aged 3-14 years in western Kenya. Through serial forward and back translations, cognitive interviews, group consensus, outside feedback, and support from the NIH Toolbox team, we produced translated tests that have both face validity and linguistic validation. During our cognitive interviews, we found that the five chosen tests (one each of attention, cognitive flexibility, working memory, episodic memory, and processing speed) were generally well understood by children aged 7-14 years in our chosen populations. The cognitive interviews informed alterations in translation as well as slight changes in some images to culturally adapt the tests. This study describes the process by which we translated five fluid cognition tests from the NIH Toolbox into the Swahili and Dholuo languages. The finished testing application will be available for future studies, including a pilot study for assessment of psychometric properties.

West Nile Virus Knowledge among Hispanics, San Diego County, California, USA, 2006

A lack of high-quality provider education hinders the delivery of standard-of-care delirium detection and prevention practices in the intensive care unit (ICU). To fill this gap, we developed and validated an e-learning ICU Delirium Playbook consisting of eight videos and a 44-question knowledge assessment quiz. Given the increasing Spanish-speaking population worldwide, we translated and cross-culturally adapted the playbook from English into Spanish. To translate and culturally adapt the ICU Delirium Playbook into Spanish, the second most common native language worldwide. The translation and cross-cultural adaptation process included double forward and back translations and harmonization by a 14-person interdisciplinary team of ICU nurses and physicians, delirium experts, methodologists, medical interpreters, and bilingual professionals representing many Spanish-speaking global regions. After a preeducation quiz, a nurse focus group completed the playbook videos and posteducation quiz, followed by a semistructured interview. The ICU Delirium Playbook: Spanish Version maintained conceptual equivalence to the English version. Focus group participants posted mean (standard deviation) pre- and post-playbook scores of 63% (10%) and 78% (12%), with a 15% (11%) pre-post improvement (P = 0.01). Participants reported improved perceived competency in performing the Confusion Assessment Method for the ICU and provided positive feedback regarding the playbook. After translation and cultural adaptation, the ICU Delirium Playbook: Spanish Version yielded significant knowledge assessment improvements and positive feedback. The Spanish playbook is now available for public dissemination.

Hispanics represent the largest minority group within the US population accounting for an estimated 55.4 million individuals. Enrolling Hispanics into clinical outcome studies is important in order for study populations to be externally valid and representative of the US population. Inclusion of Mexican-Americans in clinical studies is frequently limited by the lack of validated outcome measures. The goal of this study was to validate a Spanish version of the American Academy of Orthopaedic Surgeons Foot and Ankle Outcomes Questionnaire (AAOS-FAOQ) in Mexican-Americans with traumatic foot and ankle injuries. The translation and cross-cultural adaptation procedure was performed by a committee of bilingual speakers using the following steps: (1) forward translation and adaptation, (2) synthesis, (3) back translation, (4) committee review, and (5) pilot testing. The validation was performed in 100 Mexican-Americans with traumatic foot and ankle injuries. A total of 41 females and 59 males were enrolled in this study. The mean age was 42.98 years (range 18-88). The Spanish version of the Global Foot and Ankle Scale of the AAOS-FAOQ showed statistically significant correlations with all 8 subscales of the Spanish SF-36 as well as the Physical Component Summary scale and the Mental Component Summary scale (P < 0.05). The Global Foot and Ankle scale of the Spanish AAOS-FAOQ demonstrated a test-retest reliability of 0.68. We provide a Spanish translation and cross-cultural adaptation of the AAOS-FAOQ. The instrument demonstrates appropriate psychometric properties in Mexican-Americans with traumatic foot and ankle injuries.

The evaluation of quality of life (QoL) and satisfaction with care in palliative care patients and their relatives is an important aspect of palliative care research, likewise important to get a direct feedback for the success of treatment. Here, questionnaires are important tools for measuring outcomes of care in medicine. Several validated, predominantly English, questionnaires already exist. These have been translated in different languages but German. The Functional Assessment of Chronic Illness Therapy (FACIT) is an established tool for the evaluation of QoL in cancer patients. The FACIT-Pal, a 46-itemquestionnaire of this group of questionnaires, measures the QoL in palliative care patients. It includes a new palliative care subscale which is not yet available in German. The FAMCARE-2, a 17-item-questionnaire, evaluates the relatives' satisfaction with the care and support they received from palliative care team. The translation process followed a protocol including multiple independent translators as well as a forth and back translation. A German version of FAMCARE-2 and FACIT-Pal was translated based on the original questionnaire. Relevant differences between the English original versions and the back translations weren't revealed by the original scale developers. The final versions of the German translations have been authorized by the scale developers. The FAMCARE-2 and the FACIT-Pal are now available in German and can be used for research and quality control purposes.

Background Breast cancer-related lymphedema (BCRL) significantly affects health-related quality of life (HR-QOL). The LYMPH-Q Upper Extremity (UE) Module is a patient-reported outcome measure (PROM) designed to assess HRQL in individuals with BCRL. Recently, two new scales, Lymphedema Worry and Impact on Work, were developed to expand the module’s comprehensiveness. This study aimed to perform a translation and cultural adaptation of these scales for use in Denmark. Methods The translation process followed best-practice guidelines from the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the World Health Organization (WHO). The methodology included a forward and back translation, an expert panel review, and cognitive debriefing interviews with patients to ensure linguistic and cultural equivalence. Results The forward translations revealed eight minor discrepancies in terminology, which were resolved through discussion. The back translation identified one item requiring refinement to align with the original English meaning. The expert panel participants suggested modifications regarding three items to enhance cultural relevance. Cognitive debriefing interviews with patients (n = 10) confirmed that the translated items were clear and comprehensible. The final proof reading led to minor modifications which resulted in the final Danish version of the LYMPH-Q Lymphedema Worry and Impact on Work scales. Conclusions The rigorous translation and cultural adaptation process resulted in a conceptually equivalent Danish version of the LYMPH-Q UE module Lymphedema Worry and Impact on Work scales. These scales will provide valuable insight into the occupational and psychological burdens of BCRL among Danish patients. Level of evidence Not ratable.

We have previously validated the English version of the Systemic Lupus Erythematosus Quality of Life Questionnaire (SLEQOL) in our patients with lupus. Many of our Chinese patients are not fluent in English and therefore a Chinese version (SLEQOL-C) has been adapted for their use. Two independent translators translated the SLEQOL into Chinese. A consensus version was derived from both sets of translations. Back translation of this version was performed by another 2 independent translators who had neither been involved in the forward translation nor encountered the SLEQOL. The final version, SLEQOL-C, was finalized after rectifying the discrepancies revealed by the back translation. Linguistic validity was tested in open interviews with bilingual patients with lupus. The SLEQOL-C and SLEQOL were administered to patients to determine whether they displayed differential item functioning (DIF). In general, most of the items in English could be expressed in Chinese precisely, although a few instructions had to be altered slightly to make them more idiomatic. The forward and back translations of the SLEQOL were accomplished without major difficulties. A total of 638 patients were interviewed (62.8% with the SLEQOL and 37.2% with the SLEQOL-C). Using DIF analysis, there was no detectable test bias due to language use after controlling for repeated observations, age, sex, and ethnicity. The SLEQOL-C has semantic, idiomatic, and conceptual equivalence to the SLEQOL. The rigorous process of cross-cultural translation provides some measure of quality in the content validity.

The uptake of cancer screening is significantly associated with participants' health beliefs about cancer screening. Scales measuring health beliefs of cancer screening are available; however, the scales that were developed and validated for the US population may lack cultural appropriateness, which could compromise the reliability and validity of the scales when applied to different ethnic groups or populations. The aim of this study was to summarize, analyze, and compare the methods used in the cross-cultural instrument adaptation and validation processes of health beliefs about cancer screening. A systematic review design with narrative methods was used. Electronic databases, including PubMed, Google Scholar, CINAHL, and PsycINFO, were searched. A total of 18 articles were eligible. Results showed (1) the translation methods included committee translation and back translation, which were further refined by using professional translators, using professional interpreters and/or involving the first author, using bilingual individuals, and involving bilingual investigators; (2) the modification methods included embedded and afterward modification; and (3) the validation methods included testing construct validity, internal consistency reliability, item-total subscale correlations, test-retest reliability, content validity, predictive validity, and face validity. Back translation and afterward modification were most frequently used for translating existing instruments to another language. Validity and reliability were most frequently established by construct validity, content validity, face validity, predictive validity, internal consistency reliability, test-retest reliability, and item-total subscale correlation after instruments were translated. Clinicians should evaluate the translation and adaptation process for translated versions of instruments before using them to provide culturally appropriate and sensitive care.

BackgroundTo better quantify the impact that breast cancer-related arm lymphedema (BCRL) has on health-related quality of life (HR-QOL), a disease-specific patient-reported outcome measure (PROM) is needed. The LYMPH-Q Upper Extremity Module was recently developed for patients with BCRL. The aim of this study was to perform an advanced translation and culturally adapt the LYMPH-Q Upper Extremity Module for use in Denmark.MethodsThe LYMPH-Q Upper Extremity Module was translated into Danish according to the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the World Health Organization (WHO). The process included two forward and one back translation, an expert panel meeting, and cognitive debriefing interviews with patients. The focus of the translation was to develop a Danish version that used appropriate patient-friendly language while maintaining the meaning of the items, instructions and response options.ResultsThe two forward translations resulted in minor differences in terminology. These discrepancies were discussed among the translators and a harmonized Danish version 1 was achieved. Comparison of the back translation to the original English version identified 14 items/instructions/response options that required re-translation. Subsequently, experts helped to identify and resolve the language for 10 items/instructions/response options that did not maintain the same meaning as the English version. Participants in the cognitive debriefing interviews did not report any difficulties with understanding the items/instructions/response options.ConclusionsThe translation and cultural adaption process led to the development of a conceptually equivalent Danish version of the LYMPH-Q Upper Extremity Module.Level of Evidence: Not gradable