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Translation and CrossCultural Equivalence of Health Measures

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Culture shapes the way we conceive of health and illness ... 'No ifs, ands, or buts' Scalar Equivalence. Measured on the same metric ... – PowerPoint PPT presentation

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Title: Translation and CrossCultural Equivalence of Health Measures


1
Translation and Cross-Cultural Equivalence of
Health Measures
2
Context
  • Multinational companies international drug
    trials
  • Cross-cultural research within Canada
  • International health studies
  • General sense of globalization but does this
    downplay differences?

3
Relevance of Culture
  • Culture shapes the way we conceive of health and
    illness
  • Influences customary behaviours, relationships
    with others
  • Influences relative values of symptoms
  • Reactions to pain, etc.
  • Expectations definitions of feeling good, etc.
  • Questionnaire sophistication of the group

4
Level of abstraction
  • Concepts can be
  • Abstract and general
  • Happiness, Ability
  • Concrete and specific
  • Number of hospital beds per capita
  • More abstract concepts
  • Applicable to different cultures, but
  • More imprecise
  • Specific concepts
  • Less cross-culturally applicable
  • More context dependent

5
Types of Cross-Cultural Equivalence
  • Is it operationalized in same way? (Same general
    measurement procedures)
  • Item equivalence Items should mean the same
    thing to people in one culture as in another
  • Scalar equivalence (E.g., is the distance between
    moderately severe and severe the same in both
    cultures?)

6
Requirements for cross-cultural equivalence
  • Conceptual/functional
  • Equivalence in construct operationalization
  • Item equivalence
  • Scalar equivalence
  • Hierarchical must have first before second

7
Conceptual/FunctionalEquivalence
  • Is there a universal situation?
  • Does construct mean the same thing in both
    cultures?
  • Can goal of behaviour be identified?
  • Are same antecedent-consequent relations
    demonstrable across cultures?
  • Does same situation result in same behaviour
    across cultures?

8
Equivalence in operationalization
  • Is it operationalized in same way?
  • Same procedure
  • E.g. measuring disability with
  • Questions on self-care
  • Measuring visual impairment with
  • Snellen chart

9
Item equivalence
  • Measured by same instrument
  • Items should mean the same thing to people in one
    culture as in another
  • E.g. on FAS test, items with identical meaning in
    French are not FAS, but T, N and P
  • No ifs, ands, or buts

10
Scalar Equivalence
  • Measured on the same metric
  • Numerical value on scale has same degree of
    intensity or magnitude of the construct
  • E.g. is the distance between 6 (moderately
    severe) and 7 (severe) the same in both cultures?

11
Developing cross-cultural measures
  • Sequential approach
  • Translate an instrument into another language
  • Simultaneous approach
  • Conceptualize develop measure in each culture
  • Set of equivalent items that reflect the same
    construct in different cultures
  • Core instrument plus culture-specific additional
    components

12
Strategies for ensuring cross-cultural equivalence
  • Direct translation and comparison
  • Better translation techniques
  • Multi-trait, multimethod
  • Item response theory methods
  • Differential item functioning

13
Strategies continued
  • Response pattern method
  • Factor analysis
  • Multidimensional scaling
  • Combined etic-emic approach
  • Multi-strategy approach

14
Methods for assessing equivalence
  • Factor analysis
  • Empirical analysis of how items relate to one
    another
  • Shows how many concepts scale measures and which
    items measure that scale
  • Confirmatory must have theory about how items
    go together
  • Simultaneous factor analysis in different
    populations
  • Factor structure should be the same
  • Test whether data are similar to be called equal
  • Same factor pattern-loadings
  • Same goodness of fit

15
Differential item functioning
  • Related to IRT theory
  • Needed because tests can have matching factor
    structures and still be biased
  • DIF analyses
  • Compare reference and focal groups
  • In translation from English to French, English
    reference and French focal

16
Differential Item Functioning
  • DIF a different in item score between two
    groups who are equal in ability.
  • First step match on ability (total score)
  • Internal test of item bias
  • 2nd step for each score group, compares
    performance of reference and focal group on each
    item

17
Two types of DIF
  • Uniform
  • Difference in difficulty between reference and
    focal group
  • Item may be more difficult for one group
  • Non-uniform
  • Difference in discrimination between reference
    and focal group

18
When you find DIF or non-factorial equivalence
  • Study reasons why
  • Content experts
  • Review item wording, translation, cultural
    meaning.

19
Translation
  • Simply translate instrument and administer it
  • Simple tests of difference assumes scalar
    equivalence
  • Translation-back translation

20
Issues to Consider
  • Goal to adapt measure for a new country, or to
    make comparisons across countries?
  • Translation or adaptation? Back-translation
    gives identity rather than equivalence
  • In most countries the official language differs
    from the vernacular. Which do we use?
  • We still know little about effect of linguistic
    variations within countries

21
Issues - continued
  • Why was this instrument chosen? Are these
    features relevant in another culture?
  • At least some of the content of most scales will
    be culture-specific (e.g., some of NHP seen as
    blasphemous in Arabic countries)
  • Was the scale developed on a particular cultural
    group?

22
Quality of Life
  • Quality of life is subjective value-specific
  • Invented in the USA not universal?
  • Definition will at least vary across cultures
    (naïve enthusiasm for QoL)
  • Handicap reflects impairment environment, so
    measures may perform differently in different
    environments

23
Translation, or Domination?
  • with refinements and changes introduced here
    and there in order to convey the meaning of the
    English questions as accurately as possible
    (A. Leighton)

24
Words Concepts
  • An etic approach (phonetic) describes the
    physical properties of the word, without
    referring to its functional meaning language
  • The emic approach takes account of the context,
    meaning and purpose of the word concepts

25
Translation Example
  • Does poor health prevent you from seeing your
    friends?
  • Meaning of friend differs in UK, US, and
    Australian English
  • Even more differences between Ami(e), Amigo and
    Freund

26
Suggestions
  • Plan cross-cultural applications from the outset
  • Consider relevance of quality of life carefully
    omit?
  • Avoid questionnaires!
  • Use DIF analyses
  • Run within-country analyses
  • Develop measures within each country
  • Seek core set of universal items (WHO QoL)
  • Make sure the values are explicit
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