Translation and cross-cultural adaptation of instruments to the Brazilian Portuguese language

Abstracts

TEMA: tradução e adaptação transcultural de instrumentos estrangeiros para o Português Brasileiro. OBJETIVO: no Brasil, a escassez de instrumentos formais e objetivos comercialmente disponíveis para avaliação e diagnóstico, na área da Fonoaudiologia é significativa e uma forma que alguns pesquisadores têm encontrado para amenizar esse problema é traduzir instrumentos já disponíveis em outras Línguas. Além disso, tal procedimento pode contribuir para a realização de estudos transculturais, que podem trazer maiores esclarecimentos acerca dos quadros de distúrbios da comunicação e de suas especificidades nas diferentes Línguas. O objetivo deste estudo é discutir os procedimentos que devem ser adotados nesse processo. CONCLUSÃO: no processo de tradução e adaptação de instrumentos estrangeiros é fundamental que sejam adotados procedimentos metodologicamente apropriados.

Linguagem Infantil; Testes de Linguagem; Avaliação; Tradução; Diagnóstico

COMMENTARY

Translation and cross-cultural adaptation of instruments to the Brazilian Portuguese language^*

Elisabete GiustiI, ¹; Débora Maria Befi-Lopes^II

^IFonoaudióloga. Doutora em Lingüística e Semiótica Geral pela Faculdade de Filosofia, Letras e Ciências Humanas da Universidade de São Paulo

^IIFonoaudióloga. Professora Livre-Docente do Curso de Fonoaudiologia da Faculdade de Medicina da Universidade de São Paulo. Coordenadora do Laboratório de Investigação Fonoaudiológica em Desenvolvimento da Linguagem e suas Alterações

ABSTRACT

BACKGROUND: translation and cross-cultural adaptation of instruments to the Brazilian Portuguese language.

AIM: in Brazil, in the area of Speech-Language Pathology, there is a significant lack of commercially available formal and objective instruments that have as a purpose the evaluation and diagnosis of different communication disorders. Some researchers have tried to ease this problem by translating instruments available in other languages. Such procedure also contributes to the development of cross-cultural studies, which can bring knowledge about the communication disorders and their specificities in different languages. The aim of the present study is to discuss the procedures that should be adopted in this process.

CONCLUSION: it is fundamental to adopt appropriate methodological procedures when translating and adapting foreign assessment instruments.

Key Words: Child Language; Language Tests; Evaluation; Translation (Process); Diagnosis.

In Brazil, there's a significant lack of commercially available formal and objective tests indicated to the evaluation and diagnosis in the area of Speech-Language Pathology (SLP). It is known that the actual objectives of an evaluation process can only be fulfilled when appropriate instruments and procedures are used.

In other countries, such as United States, the context is different. SLP professionals count with a great number of formal tests available to speech and language evaluation. The 2006 edition of the Directory of Speech-Language Pathology Assessment Instruments, from American Speech-Language-Hearing Association, lists over one hundred tests.

In Brazil, in the child language area, for example, only two instruments are commercially available: the ABFW Test (1), a child language test that evaluates phonology, vocabulary, fluency and pragmatics of children from two to 12 years old; and the Behavioral Observation Protocol (PROC) (2), for the evaluation of early linguistic and cognitive aspects, indicated for children from 12 to 48 months old.

The lack of formal and objective instruments not only reflects on the diagnosis, but also on the definition of therapeutic procedures and on the elaboration of intervention plans, even compromising the efficacy and efficiency of the treatments offered by Speech-Language Pathologists (3, 4).

A way that some researchers have found to ease this problem is to translate instruments available in other languages instead of creating new instruments. Besides easing the need for formal evaluation instruments, such procedure might contribute to another aspect that also has great scientific relevance, which refers to the accomplishment of transcultural studies. This type of studies may help the clarification and better comprehension of communication disorders and their specificities in different languages.

The practice of translating foreign instruments have been increasing in the last few years, and was theme of the 5th International Conference on Psychological and Educational Test Adaptation Across Language and Cultures, carried out in 2006. Recently, one of the aspects considered by the editors in the creation of a new test has been the possibility of its translation into other languages.

The translation and adaptation of foreign instruments might be a solution, but the procedures adopted in this process must be detailed and careful, because translating and adapting is as important as creating a new instrument. It's even necessary to redo the reliability and validity in the new context.

The search for maximum equivalence between the original instrument and its translated version must guide the whole process, avoiding even the minor, subtle forms of distortion (5, 7).

Duarte and Bordin (8) emphasize that the elaboration and testing of an evaluation instrument in the area of children mental health, for example, is a complex task. Therefore, according to these authors, in different cultures, it's advisable to use versions of instruments already tested, instead of developing a new instrument in each country that carries out the same kind of investigation. However, a series of steps must be followed to assure that an instrument can be used in a new cultural context.

The first step is the forward translation of the original instrument. This is a complex task, because the translation must be equivalent to the original in many aspects, such as cultural, semantic, technical, conceptual, and also in content and criterion. A useful technique, in this sense, for authors, is the backtranslation, through which the translation of the instrument is translated again (or backtranslated) into the original language. The backtranslation must be carried out by a bilingual translator, preferentially with experience in both cultures. Both versions (original and backtranslated) are, then, compared. It's important that this comparison keeps the equivalence in all the different aspects previously cited. Moreover, it is especially relevant to obtain evidence of the validity of the instrument in the new cultural context, verifying whether the instrument measures what it's supposed to measure (5, 8).

In some researches related to this theme, it is referenced that, in the translation of a specific instrument, there have been modifications regarding its original format, such as withdrawal of an item or addition of other items, changes in the score criteria or even in the application of the test. Such modifications can, many times, compromise the equivalence between the original test and the translated version and, consequently, its characteristics and applications.

Nascimento and Figueiredo (9) refer that the use of a foreign instrument without adequate adaptation can endanger the validity and precision of the evaluation carried out. On the other side, these authors emphasize that, although the guidelines recommended by the International Tests Commission regarding the adaptation process are vital sources to the development of adaptation researches, they were faced, in their studies, with the shortage of practical references about procedures and analysis involved in the construction and adaptation of psychological instruments.

Freitas et al. (7) presented the translation and adaptation process, into Portuguese, of the Binge-Eating Scale (BES), that assess binge eating severity in obese individuals. The authors relate the procedures adopted in the translation and version or backtranslation of the instrument: two professionals with experience in eating disorders and fluent in English carried out independent translations that were subsequently discussed, and the first version was concluded; two other translations were carried out by licensed English teachers. For each item of the scale, the semantic equivalence was analyzed between the Portuguese and English versions, and then a synthetic version of the scale was prepared. This version was backtranslated into English by a teacher and sent to one of the authors of the original scale, who suggested some semantic changes, and the final version was concluded. The conclusion of the study was that the Portuguese version of the scale was considered adequate for clinical purposes.

Capovilla and Capovilla(10) carried out studies in which they supplied the Brazilian translations of the Peabody Picture Vocabulary Test (PPVT)(11) and the Language Development Survey (LDS)(12) or Expressive Vocabulary Evaluation List (LAVE) (13). They also carried out a preliminary study that had the purpose to adapt the International Dyslexia Test, a test that evaluates different cognitive abilities related to the acquisition of reading and writing abilities, into Brazilian Portuguese. No references were found in these studies regarding the procedures adopted in the translation and adaptation of the respective tests.

Scala, Naspitz and Solé (15) carried out a study that had the purposes to translate and adapt, into Portuguese (Brazilian culture), the Pediatric Asthma Quality of Life Questionnaire (PAQLQ) (16), for use with children and adolescents with asthma, and to validate the adapted version. The authors related the procedures for the adaptation of the instrument in the study: initially, it was translated into Portuguese, and then back translated into English by an English teacher that was not familiar with the instrument. No discrepancies were found between original and translated versions. After the translation, the questionnaire was experimentally used with 20 patients with asthma.

Besides the concern and methodological care that researches regarding the translation and application of foreign instruments demand, it's also important that the application and interpretation of the test is careful. The guidelines of the International Test Commission cover the responsibilities that the users must have, as well as the personal competences necessary to apply and interpret the scores.

Another important aspect described in literature is the need to train the examiners before using the test. The tests are technical instruments, and their management needs trained people, who know the application rules (17, 18).

In some websites that sell tests, the buyer can only acquire a test after going through training. In SLP graduate programs in United States, for example, there are disciplines regarding application and utilization of formal tests. This is a very important aspect, because, if a quality instrument is not used for the right purpose or if it's not administered adequately, it might be impractical.

Researches regarding this thematic have been broadly implemented, resulting in the availability of a greater number of diagnosis instruments for SLP, in a near future. However it's important to follow the steps previously referred, so the translation and adaptation process is properly done and the adopted procedures are methodologically appropriate. Besides the impact that these instruments will have in clinical practice and research, they'll constitute a fundamental step for the identification of the most frequent problems and its risk factors, allowing better planning of child health policies and the evaluation of intervention and treatments offered by Speech-Language Pathologists.

References

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*

Trabalho Realizado no Departamento de Fisioterapia, Fonoaudiologia e Terapia Ocupacional do Curso de Fonoaudiologia da Faculdade de Medicina da Universidade de São Paulo (FMUSP).

Publication Dates

• Publication in this collection
  07 Oct 2008
• Date of issue
  Sept 2008

History

• Accepted
  28 July 2008
• Reviewed
  02 June 2008
• Received
  08 Oct 2007