英文原文
With the increase in the number of multinational and multicultural research projects, the need to adapt health status measures for use in other than the source language has also grown rapidly. Most questionnaires were developed in English-speaking countries, but even within these countries, researchers must consider immigrant populations in studies of health, especially when their exclusion could lead to a systematic bias in studies of health care utilization or quality of life. The cross-cultural adaptation of a health status self-administered questionnaire for use in a new country, culture, and/or language necessitates use of a unique method, to reach equivalence between the original source and target versions of the questionnaire. It is now recognized that if measures are to be used across cultures, the items must not only be translated well linguistically, but also must be adapted culturally to maintain the content validity of the instrument at a conceptual level across different cultures. Attention to this level of detail allows increased confidence that the impact of a disease or its treatment is described in a similar manner in multinational trials or outcome evaluations. The term "cross-cultural adaptation" is used to encompass a process that looks at both language (translation) and cultural adaptation issues in the process of preparing a questionnaire for use in another setting. Cross-cultural adaptations should be considered for several different scenarios. In some cases, this is more obvious than in others. Guillemin et al suggest five different examples of when attention should be paid to this adaptation by comparing the target (where it is going to be used) and source (where it was developed) language and culture. The first scenario is that it is to be used in the same language and culture in which it was developed. No adaptation is necessary. The last scenario is the opposite extreme, the application of a questionnaire in a different culture, language and country—moving the Short Form 36-item questionnaire from the United States (source) to Japan (target) which would necessitate translation and cultural adaptation. The other scenarios are summarized in Table 1 and reflect situations when some translation and/or adaptation is needed. The guidelines described in this document are based on a review of cross-cultural adaptation in the medical, sociological, and psychological literature. This review led to the description of a thorough adaptation process designed to maximize the attainment of semantic, idiomatic, experiential, and conceptual equivalence between the source and target questionnaires. Further experience in cross-cultural adaptation of generic and disease-specific instruments and alternative strategies driven by different research groups have led to some refinements in methodology since the 1993 publication. These guidelines serve as a template for the translation and cultural adaptation process. The process involves the adaptation of individual items, the instructions for the questionnaire, and the response options. The text in the next section outlines the methodology suggested (Stages I–V). The subsequent section (Stage VI) presents a suggested appraisal process whereby an advisory committee or the developers review the process and determine whether this is an acceptable translation. Although such a committee or the developers may not be engaged in tracking translated versions of the instrument, this stage has been included in case there is a tracking system. Records of translated versions not only can save considerable time and effort (by using already available questionnaires) but also avoid erroneous comparisons of results across different translated versions. The process of cross-cultural adaptation tries to produce equivalency between source and target based on content. The assumption that is sometimes made is that this process will ensure retention of psychometric properties such as validity and reliability at an item and/or a scale level. However, this is not necessarily the case: For instance, if the new culture has a different way of approaching a task that makes it inherently more or less difficult compared with other items, it would change the validity, certainly in terms of item-level analyses (such as item response theory, similar to Rasch). Further tests should be conducted on the psychometric properties of the adapted questionnaire after the translation is complete. This will be discussed briefly at the end of the guidelines. In fact, the translation process outlined in this article is the first step in the three-step process adopted by the International Society for Quality of Life Assessment (IQOLA) project. The other two steps are, first, verification of the scaling requirements (item performance, item weights) and, second, the validation of and establishing normative values for the new version. Guidelines for the Cross-Cultural Adaptation Process Figure 1 outlines the cross-cultural adaptation process being recommended. It is the method currently used by the American Association of Orthopaedic Surgeons (AAOS) Outcomes Committee as they coordinate the translation of the different components of their outcomes battery. The written documentation of each step helps to record that it was performed but can also serve as a memory aid at later stages. For instance, if an item is not working in the field testing, there will be a record showing whether the translators had difficulty with that item, and how they resolved it. Sample forms have been designed for one questionnaire so that the worksheets used for the translation can formulate the written report as well. The forms are available through the authors, or through the AAOS. Each stage in the recommended protocol is described in detail in the following sections. Stage I: Initial Translation The first stage in adaptation is the forward translation. Many recommend that at least two forward translations be made of the instrument from the original language (source language) to the target language. In this way, the translations can be compared and discrepancies that may reflect more ambiguous wording in the original or discrepancies in the translation process noted. Poorer wording choices are identified and resolved in a discussion between the translators. Bilingual translators whose mother tongue is the target language produce the two independent translations. Translations into the mother tongue, or first language, more accurately reflect the nuances of the language. The translators each produce a written report of the translation that they complete. Additional comments are made to highlight challenging phrases or uncertainties. Their rationale for their choices is also summarized in the written report. Item content, response options, and instructions are all translated in this way. The two translators should have different profiles, or backgrounds. Translator 1. One of the translators should be aware of the concepts being examined in the questionnaire being translated (functional disability or neck and shoulder disorders). Their adaptations are intended to provided equivalency from a more clinical perspective and may produce a translation providing a more reliable equivalence from a measurement perspective. Translator 2. The other translator should neither be aware nor informed of the concepts being quantified and preferably should have no medical or clinical background. This is called a naive translator, and he or she is more likely to detect different meaning of the original than the first translator. This translator will be less influenced by an academic goal and will offer a translation that reflects the language used by that population, often highlighting ambiguous meanings in the original questionnaire. Stage II: Synthesis of The Translations The two translators and a recording observer sit down to synthesize the results of the translations. Working from the original questionnaire as well as the first translator’s (T1) and the second translator’s (T2) versions, a synthesis of these translations is first conducted (producing one common translation T-12), with a written report carefully documenting the synthesis process, each of the issues addressed, and how they were resolved. It is important that consensus rather than one person’s compromising her or his feelings resolve issues. The next stage is completed with this T-12 version of the questionnaire. Stage III: Back Translation Working from the T-12 version of the questionnaire and totally blind to the original version, a translator then translates the questionnaire back into the original language. This is a process of validity checking to make sure that the translated version is reflecting the same item content as the original versions. This step often magnifies unclear wording in the translations. However, agreement between the back translation and the original source version does not guarantee a satisfactory forward translation, because it could be incorrect; it simply assures a consistent translation. Back translation is only one type of validity check, highlighting gross inconsistencies or conceptual errors in the translation. Once again, two of these back-translations are considered a minimum. The back-translations (BT1 and BT2) are produced by two persons with the source language (English) as their mother tongue. The two translators should neither be aware nor be informed of the concepts explored, and should preferably be without medical background. The main reasons are to avoid information bias and to elicit unexpected meanings of the items in the translated questionnaire (T-12), thus increasing the likelihood of "highlighting the imperfections." Stage IV: Expert Committee The composition of this committee is crucial to achievement of cross-cultural equivalence. 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 during this part of the process. The expert committee’s role is to consolidate all the versions of the questionnaire and develop what would be considered the prefinal version of the questionnaire for field testing. The committee will therefore review all the translations and reach a consensus on any discrepancy. The material at the disposal of the committee includes the original questionnaire, and each translation (T1, T2, T12, BT1, BT2) together with corresponding written reports (which explain the rationale of each decision at earlier stages). The expert committee is making critical decisions so, again, full written documentation should be made of the issues and the rationale for coming to a decision about them. Decisions will need to be made by this committee to achieve equivalence between the source and target version in four areas: 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. Experiential 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. 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). The committee must examine the source and back-translated questionnaires for all such equivalences. Consensus should be reached on the items, and if necessary, the translation and back-translation processes should be repeated to clarify how another wording of an item would work. The advantage of having all translators present on the committee is obvious, because tasks such as that could be undertaken immediately. Items, instructions, and response options must be considered. The translators should also make sure that the final questionnaire would be understood by the equivalent of a 12-year-old (roughly a Grade 6 level of reading), as is the general recommendation for questionnaires. Stage V: Test of the Prefinal Version The final stage of adaptation process is the pretest. This field test of the new questionnaire seeks to use the prefinal version in subjects or patients from the target setting. Ideally, between 30 and 40 persons should be tested. Each subject completes the questionnaire, and is interviewed to probe about what he or she thought was meant by each questionnaire item and the chosen response. Both the meaning of the items and responses would be explored. This ensures that the adapted version is still retaining its equivalence in an applied situation. The distribution of responses is examined to look for a high proportion of missing items or single responses. It should be noted that although this stage provides some useful insight into how the person interprets the items on the questionnaire, it does not address the construct validity, reliability, or item response patterns that are also critical to describing a successful cross-cultural adaptation. The described process provides for some measure of quality in the content validity. Additional testing for the retention of the psychometric properties of the questionnaire is highly recommended and will be discussed briefly later. Stage VI: Submission of Documentation to the Developers or Coordinating Committee for 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. They in turn probably have a means 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. Further Testing of the Adapted Version The goal of this article was to outline the process of translation and adaptation of self-report measures of health. Cross-cultural adaptation tries to ensure a consistency in the content and face validity between source and target versions of a questionnaire. It should therefore follow that the resultant version has sound reliability and validity if the original version did. However, this is not always the case, perhaps because of subtle differences in the living habits in different cultures that render that item more or less difficult than other items in the questionnaire. Such changes could alter the statistical or psychometric properties of an instrument. It is highly recommended that, after the translation and adaptation process, the investigators ensure that the new version has demonstrated the measurement properties needed for the intended application. The new instrument should retain both the item-level characteristics such as item-to-scale correlations and internal consistency; and the score-level characteristics of reliability, construct validity, and responsiveness. It is possible to work some of these tests of reliability and validity into the pretesting process (stage V of the adaptation), although often they need larger sample sizes. There are many examples of ways in which translated questionnaires have been tested for their psychometric comparability with the source version. Many are published in a special issue of the Journal of Clinical Epidemiology (1998, volume 51 number 11) dealing with the IQOLA project. Items are checked for the distribution of responses to them, and the correlation of each with its scale and not with other scale (if there is more than one dimension in the instrument). Ware suggests item response theory could play a role in verifying the calibration or location of each item on the underlying attribute of health. It would be anticipated that similar calibrations, and item–total correlations would be found in a well-translated item. The final step is a full assessment of the score level attributes: construct validity, reliability, and responsiveness. Comparisons of these tests are made against similar tests preformed in the original setting using the original instrument. It is expected that the adapted version would perform in a similar manner. For instance, correlations with other measures of overall health or comparisons between groups known to differ in their health should result in similar values in each culture (with the use of the appropriate version of the instrument). In this way, there is more confidence that the adapted instrument is measuring a construct comparable to the original. Several examples from the IQOLA project demonstrate the different types of adaptation that are needed—for instance the translation of the SF-36 for use in China—and then a retest of the translated version to see whether it is suited for Chinese-speaking persons living in the United States (a situation in which cultural adaptation could have been necessary). Another large project was the testing of the human immunodeficiency virus (HIV) version of the Medical Outcome Study short form so that it could be used in five different cultures and languages. Other examples show the need for adaptation even between English-language versions of the questionnaires used in the United Kingdom and the United States. Two examples of adaptations were found for self-report measures of low back pain. First, the Roland–Morris questionnaire was translated into German, using techniques similar to those described in this article. Second, Schoppink et al described the psychometric testing of the Dutch version of the Quebec Back Pain Questionnaire. Any of these papers could serve as examples of the types of testing that must be carried out in addition to the translation process. The final step would be determining normative data on relevant populations using the new instrument. Discussion The authors’ best understanding to date is that a poor translation process may lead to an instrument that is not equivalent to the original questionnaire. The lack of equivalence limits the comparability of responses across populations divided by language or by culture. In this article, a guideline for the process of adapting a questionnaire for use in a different setting has been presented (Table 1). The need has also been acknowledged for psychometric testing and normative data collection using the new instrument. The authors’ choice was to separate the adaptation from the testing, because the need for additional testing is the same as would have to be undertaken after any adaptation of any existing questionnaire whether it be shortening it or performing a cross-cultural adaptation. The authors concur with the IQOLA group recommendations for formal testing of the final instrument. The process described in this article is a process of translating and, if necessary, replacing items or scaling to make it relevant and valid in a new culture. Herdmann et al remind researchers to be aware that item-level translations can often work on the assumption that the same items, once translated, will be meaningful reflections of health in a new culture. The authors’ method allows for that adaptability, but it is useful to remember that attention must be paid not only to item equivalence, but to the others described as well. The key learning point is that the translation does not automatically provide a valid measure of another culture’s health, and this should be verified carefully throughout the process, and in the final testing. In this article, reference is made to submitting reports to a body such as the AAOS who are tracking the adaptation of Modems instruments. The same procedure should be followed whether or not a given instrument has a formal repository for translated versions. If there is such a gathering place, than submission of a report of the adaptation process and the resultant questionnaire will help ensure multiple translations are not in use and more importantly that the extensive amount of work entailed is not needlessly repeated. If there is no repository, efforts should be made to publish the adaptation so that other researchers can be made aware of the available version. Adaptation of a questionnaire for use in a new setting is time consuming and costly. However, to date the authors believe it is the best way to get an equivalent metric for whatever self-report attribute is being considered. It allows data collection efforts to be the same in cross-national studies or to avoid the selection bias that may be associated with studies that must exclude all patients who were unable to complete a form in English, for example, because there are no translated versions of the questionnaire.
中文翻译
随着跨国和多文化研究项目数量的增加，将健康状况测量工具适应于源语言以外的需求也迅速增长。大多数问卷是在英语国家开发的，但即使在这些国家内，研究人员在健康研究中必须考虑移民群体，特别是当排除他们可能导致医疗保健利用或生活质量研究中的系统性偏差时。将健康状况自评问卷跨文化适应于新国家、文化和/或语言需要使用独特的方法，以实现原始源版本和目标版本之间的等效性。现在认识到，如果测量工具要在不同文化中使用，项目不仅需要在语言上翻译得好，还必须在文化上适应，以在不同文化间保持工具在概念层面的内容效度。关注这一细节水平可以增加信心，确保疾病或其治疗的影响在多国试验或结果评估中以类似方式描述。“跨文化适应”这一术语用于涵盖在准备问卷用于另一环境时考虑语言（翻译）和文化适应问题的过程。跨文化适应应考虑几种不同情景。在某些情况下，这比其他情况更明显。Guillemin等人通过比较目标（将使用的地方）和源（开发的地方）语言和文化，提出了五个不同例子，说明何时应关注这种适应。第一种情景是它在开发的语言和文化中使用。无需适应。最后一种情景是相反的极端，将问卷应用于不同文化、语言和国家——例如将SF-36问卷从美国（源）移至日本（目标），这将需要翻译和文化适应。其他情景总结在表1中，反映了需要一些翻译和/或适应的情况。本文档描述的指南基于对医学、社会学和心理学文献中跨文化适应的回顾。这一回顾导致了对一个全面适应过程的描述，旨在最大化源和目标问卷之间语义、习语、经验和概念等效性的实现。自1993年发表以来，通用和疾病特定工具的跨文化适应经验以及不同研究组驱动的替代策略导致了一些方法上的改进。这些指南作为翻译和文化适应过程的模板。该过程涉及单个项目的适应、问卷说明和回答选项的适应。下一部分的文本概述了建议的方法（阶段I–V）。随后的部分（阶段VI）提出了一个建议的评估过程，由咨询委员会或开发者审查过程并确定这是否是可接受的翻译。尽管这样的委员会或开发者可能不参与跟踪工具的翻译版本，但这一阶段已包括在内，以防有跟踪系统。翻译版本的记录不仅可以节省大量时间和精力（通过使用已有的问卷），还可以避免不同翻译版本结果之间的错误比较。跨文化适应过程试图基于内容在源和目标之间产生等效性。有时做出的假设是，这一过程将确保在项目和/或量表层面保留心理测量特性，如效度和信度。然而，情况不一定如此：例如，如果新文化有处理任务的不同方式，使其相对于其他项目本质上更困难或更容易，这将改变效度，特别是在项目层面分析（如项目反应理论，类似于Rasch）方面。翻译完成后，应对适应问卷的心理测量特性进行进一步测试。这将在指南末尾简要讨论。事实上，本文概述的翻译过程是国际生活质量评估协会（IQOLA）项目采用的三步过程的第一步。其他两步是，首先，验证量表要求（项目表现、项目权重），其次，验证新版本并建立常模值。跨文化适应过程指南图1概述了推荐的跨文化适应过程。这是美国骨科医师协会（AAOS）结果委员会目前使用的方法，因为他们协调其结果电池不同组件的翻译。每个步骤的书面文档有助于记录其执行情况，也可以在后期阶段作为记忆辅助。例如，如果某个项目在现场测试中不起作用，将有记录显示翻译人员是否对该项目有困难，以及他们如何解决。已为一个问卷设计了样本表格，以便用于翻译的工作表也可以制定书面报告。表格可通过作者或AAOS获得。推荐协议中的每个阶段在以下部分详细描述。阶段I：初始翻译适应的第一阶段是正向翻译。许多人建议至少进行两次从原始语言（源语言）到目标语言的工具正向翻译。这样，可以比较翻译，并注意可能反映原始中更模糊措辞或翻译过程中差异的差异。较差的措辞选择在翻译人员之间的讨论中被识别和解决。母语为目标语言的双语翻译人员产生两个独立的翻译。翻译成母语或第一语言更准确地反映语言的细微差别。翻译人员各自完成翻译的书面报告。附加评论用于突出具有挑战性的短语或不确定性。他们选择的理由也总结在书面报告中。项目内容、回答选项和说明都以这种方式翻译。两位翻译人员应具有不同的背景或专业。翻译人员1。其中一位翻译人员应了解所翻译问卷中检查的概念（如功能障碍或颈肩疾病）。他们的适应旨在从更临床的角度提供等效性，并可能产生从测量角度提供更可靠等效性的翻译。翻译人员2。另一位翻译人员既不应了解也不被告知量化的概念，最好没有医学或临床背景。这被称为天真翻译人员，他或她更可能检测到原始的不同含义，而不是第一位翻译人员。这位翻译人员较少受学术目标影响，将提供反映该人群使用语言的翻译，通常突出原始问卷中的模糊含义。阶段II：翻译的综合两位翻译人员和一位记录观察员坐下来综合翻译结果。从原始问卷以及第一位翻译人员（T1）和第二位翻译人员（T2）的版本出发，首先进行这些翻译的综合（产生一个共同翻译T-12），并仔细记录综合过程的书面报告，每个解决的问题以及如何解决。重要的是通过共识而不是一个人妥协自己的感受来解决问题。下一阶段使用此T-12版本的问卷完成。阶段III：回译从问卷的T-12版本出发，完全不知道原始版本，翻译人员然后将问卷回译成原始语言。这是一个效度检查过程，以确保翻译版本反映与原始版本相同的项目内容。这一步通常放大翻译中不清晰的措辞。然而，回译和原始源版本之间的一致并不保证满意的正向翻译，因为它可能不正确；它只是确保一致的翻译。回译只是一种效度检查，突出翻译中的重大不一致或概念错误。再次，至少考虑两次这样的回译。回译（BT1和BT2）由两位以源语言（英语）为母语的人产生。两位翻译人员既不应了解也不被告知探索的概念，最好没有医学背景。主要原因是避免信息偏差，并引出翻译问卷（T-12）中项目的意外含义，从而增加“突出不完美”的可能性。阶段IV：专家委员会该委员会的组成对于实现跨文化等效性至关重要。最低组成包括方法学家、健康专业人员、语言专业人员以及参与过程至此的翻译人员（正向和回译人员）。问卷的原始开发者在过程的这一部分与专家委员会保持密切联系。专家委员会的作用是整合所有版本的问卷，并开发被认为是用于现场测试的问卷预最终版本。因此，委员会将审查所有翻译并就任何差异达成共识。委员会可用的材料包括原始问卷和每个翻译（T1、T2、T12、BT1、BT2）以及相应的书面报告（解释早期每个决定的理由）。专家委员会正在做出关键决策，因此，再次，应就问题和做出决定的理由进行完整的书面记录。该委员会需要做出决策，以在四个领域实现源和目标版本之间的等效性：语义等效性。词语是否意味着相同的东西？给定项目是否有多种含义？翻译中是否存在语法困难？习语等效性。口语或习语难以翻译。委员会可能必须在目标版本中制定等效表达。例如，SF-36中的术语“feeling downhearted and blue”通常难以翻译，委员会必须找到具有类似含义的项目。经验等效性。项目旨在捕捉和体验日常生活；然而，在不同国家或文化中，给定任务可能根本不被体验（即使它是可翻译的）。问卷项目必须替换为目标文化中实际体验的类似项目。例如，一个措辞为“Do you have difficulty eating with a fork?”的项目，当叉子不是目标国家使用的餐具时。概念等效性。词语在不同文化之间通常具有不同的概念含义（例如，“seeing your family as much as you would like”的含义在具有不同“家庭”定义概念的文化之间会有所不同——核心家庭与大家庭）。委员会必须检查源和回译问卷的所有此类等效性。应在项目上达成共识，如有必要，应重复翻译和回译过程以澄清项目的另一种措辞如何工作。所有翻译人员都在委员会中的优势是显而易见的，因为这样的任务可以立即进行。必须考虑项目、说明和回答选项。翻译人员还应确保最终问卷能被相当于12岁（大约六年级阅读水平）的人理解，这是问卷的一般建议。阶段V：预最终版本的测试适应过程的最后阶段是预测试。新问卷的现场测试旨在在目标环境中的受试者或患者中使用预最终版本。理想情况下，应测试30至40人。每个受试者完成问卷，并接受访谈，探讨他或她认为每个问卷项目和所选回答的含义。将探讨项目和回答的含义。这确保适应版本在应用情况下仍保持其等效性。检查回答分布以寻找高比例的缺失项目或单一回答。应注意，尽管这一阶段提供了关于个人如何解释问卷项目的一些有用见解，但它不涉及构念效度、信度或项目反应模式，这些对于描述成功的跨文化适应也至关重要。描述的过程为内容效度提供了一些质量测量。强烈建议对问卷心理测量特性的保留进行额外测试，稍后将简要讨论。阶段VI：向开发者或协调委员会提交文档以评估适应过程适应过程的最后阶段是向工具的开发者或跟踪翻译版本的委员会提交所有报告和表格。他们反过来可能有办法验证推荐阶段是否被遵循，并且报告似乎很好地反映了这一过程。实际上，这是一个过程审计，遵循所有步骤和必要报告。这个机构或委员会不负责更改内容，假设通过遵循这一过程已实现合理的翻译。适应版本的进一步测试本文的目标是概述健康自评测量的翻译和适应过程。跨文化适应试图确保问卷源和目标版本之间内容和表面效度的一致性。因此，如果原始版本具有，那么结果版本应具有可靠的效度和信度。然而，情况并非总是如此，可能是因为不同文化中生活习惯的细微差异使该项目相对于问卷中的其他项目更困难或更容易。这样的变化可能改变工具的统计或心理测量特性。强烈建议在翻译和适应过程后，研究者确保新版本已展示所需应用所需的测量特性。新工具应保留项目级特性，如项目与量表相关性和内部一致性；以及分数级特性，如信度、构念效度和反应性。可以将一些这些信度和效度测试纳入预测试过程（适应的阶段V），尽管通常需要更大的样本量。有许多例子展示了如何测试翻译问卷与源版本的心理测量可比性。许多发表在《临床流行病学杂志》（1998年，第51卷第11期）的特刊中，涉及IQOLA项目。检查项目的回答分布，以及每个项目与其量表的相关性，而不与其他量表相关（如果工具中有多个维度）。Ware建议项目反应理论可以在验证每个项目在健康基本属性上的校准或位置方面发挥作用。预期在翻译良好的项目中发现类似的校准和项目-总分相关性。最后一步是对分数级属性进行全面评估：构念效度、信度和反应性。将这些测试与使用原始工具在原始环境中进行的类似测试进行比较。预期适应版本将以类似方式表现。例如，与整体健康其他测量的相关性或已知健康不同的组之间的比较应在每种文化中产生类似值（使用适当版本的工具）。这样，更有信心适应工具正在测量与原始可比较的构念。IQOLA项目的几个例子展示了所需的不同类型的适应——例如将SF-36翻译用于中国——然后重新测试翻译版本，看是否适合居住在美国的华语人士（一种可能需要文化适应的情况）。另一个大型项目是测试医学结果研究短表的HIV版本，以便它可用于五种不同文化和语言。其他例子显示，即使在美国和英国使用的英语版本问卷之间也需要适应。发现了两个自评腰痛测量适应的例子。首先，Roland–Morris问卷被翻译成德语，使用类似于本文描述的技术。其次，Schoppink等人描述了魁北克背痛问卷荷兰版本的心理测量测试。任何这些论文都可以作为必须在翻译过程之外进行的测试类型的例子。最后一步将是使用新工具确定相关人群的常模数据。讨论作者迄今为止的最佳理解是，糟糕的翻译过程可能导致工具与原始问卷不等效。缺乏等效性限制了跨语言或文化划分的人群回答的可比性。在本文中，提出了将问卷适应于不同环境的过程指南（表1）。还承认了使用新工具进行心理测量测试和常模数据收集的必要性。作者选择将适应与测试分开，因为额外测试的必要性与任何现有问卷的任何适应后必须进行的相同，无论是缩短它还是进行跨文化适应。作者同意IQOLA小组对最终工具进行正式测试的建议。本文描述的过程是翻译并在必要时替换项目或调整量表以使其在新文化中相关和有效的过程。Herdmann等人提醒研究者注意，项目级翻译通常基于这样的假设：相同的项目一旦翻译，将在新文化中成为健康的有意义反映。作者的方法允许这种适应性，但记住不仅要注意项目等效性，还要注意其他描述的方面，这是有用的。关键学习点是翻译不会自动提供另一种文化健康的有效测量，这应在整个过程和最终测试中仔细验证。在本文中，提到向诸如AAOS这样的机构提交报告，该机构正在跟踪Modems工具的适应。无论给定工具是否有翻译版本的正式存储库，都应遵循相同的程序。如果有这样的聚集地，那么提交适应过程和结果问卷的报告将有助于确保不使用多个翻译版本，更重要的是，避免不必要地重复涉及的大量工作。如果没有存储库，应努力发布适应，以便其他研究者可以了解可用版本。将问卷适应于新环境是耗时且昂贵的。然而，作者认为迄今为止这是获得任何自评属性等效度量的最佳方式。它允许数据收集工作在跨国研究中相同，或避免可能与必须排除所有无法用英语完成表格的患者的研究相关的选择偏差，例如，因为没有问卷的翻译版本。
文章概要
本文介绍了跨文化自评量表目标澄清方法的指南，强调在多文化研究中，健康状态测量工具的适应需求日益增长。文章详细阐述了跨文化适应的六个阶段：初始翻译、翻译综合、回译、专家委员会评审、预最终版本测试和文档提交。指南旨在通过语义、习语、经验和概念等效性，确保源版本和目标版本之间的一致性。文章还讨论了适应后心理测量测试的重要性，并提供了实际应用案例，如SF-36问卷的翻译和适应。整体上，指南为研究者提供了系统的方法，以在跨国研究中实现有效的文化适应，避免偏差并提高数据可比性。
高德明老师的评价
用12岁初中生可以听懂的语音来重复翻译的内容：这篇文章就像是在教我们怎么把一份问卷从一种语言和文化变成另一种，让它在新地方也能用得好。比如，如果你有一个英文的健康问卷，想给中国小朋友用，不能只是简单翻译成中文，还要考虑中国小朋友的生活习惯和想法，这样问题才问得对。文章说，这需要六个步骤，比如先翻译两次，再请专家一起讨论，最后还要找一些人试试看问卷好不好用。这样做，就能让问卷在不同国家都有效，帮助医生更好地了解大家的健康。
焦点解决心理学理论评价：从焦点解决心理学的视角看，这篇文章展现了目标导向和资源导向的卓越实践。它不局限于问题本身，而是聚焦于如何通过系统化的跨文化适应过程，实现测量工具的有效性和可比性这一积极目标。文章强调共识构建和专家协作，这体现了焦点解决中“合作”和“利用现有资源”的原则，例如通过不同背景翻译人员的互补，最大化文化等效性。指南的结构化步骤鼓励逐步进展和反馈循环，类似于焦点解决中的“小步骤”和“例外寻找”，有助于在适应过程中识别和强化成功经验。整体上，文章传递了积极的可能性，即通过精心设计的方法，我们可以在多元文化背景下实现精准的健康评估，促进全球健康研究的协同发展。
在实践上可以应用的领域和可以解决人们的十个问题：在实践上，这些跨文化适应方法可应用于多个领域，如医疗健康研究、心理学评估、教育测量和社会调查。它们可以帮助解决人们的以下十个问题：1. 在跨国临床试验中，确保健康问卷在不同文化中准确反映患者的感受，避免因语言障碍导致的数据偏差。2. 帮助移民群体在健康研究中被公平纳入，提高医疗服务的包容性。3. 支持全球心理健康项目的实施，使心理评估工具适应本地文化，提升干预效果。4. 在教育领域，适应学习评估工具，促进跨文化教育比较研究。5. 在企业中，用于员工满意度调查的跨文化调整，改善跨国团队的管理。6. 在公共卫生项目中，确保健康促进材料的文化相关性，增强社区参与。7. 帮助研究者开发多语言研究工具，扩大科学研究的全球影响力。8. 在康复医学中，适应功能评估问卷，支持个性化治疗计划。9. 用于社会政策评估，使调查工具适应不同社会背景，提高政策制定的精准性。10. 在个人层面，帮助人们通过适应后的自评工具，更好地理解和表达自己的健康状况，促进自我健康管理。