Title: Translation and CrossCultural Equivalence of Health Measures
1Translation and Cross-Cultural Equivalence of
Health Measures
2Context
- Multinational companies international drug
trials - Cross-cultural research within Canada
- International health studies
- General sense of globalization but does this
downplay differences?
3Relevance 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
4Level 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
5Types 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?)
6Requirements for cross-cultural equivalence
- Conceptual/functional
- Equivalence in construct operationalization
- Item equivalence
- Scalar equivalence
- Hierarchical must have first before second
7Conceptual/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?
8Equivalence 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
9Item 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
-
10Scalar 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?
11Developing 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
12Strategies for ensuring cross-cultural equivalence
- Direct translation and comparison
- Better translation techniques
- Multi-trait, multimethod
- Item response theory methods
- Differential item functioning
13Strategies continued
- Response pattern method
- Factor analysis
- Multidimensional scaling
- Combined etic-emic approach
- Multi-strategy approach
14Methods 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
15Differential 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
16Differential 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
17Two 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
18When you find DIF or non-factorial equivalence
- Study reasons why
- Content experts
- Review item wording, translation, cultural
meaning.
19Translation
- Simply translate instrument and administer it
- Simple tests of difference assumes scalar
equivalence - Translation-back translation
20Issues 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
21Issues - 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?
22Quality 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
23Translation, 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)
24Words 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
25Translation 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
26Suggestions
- 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