A systematic survey instrument translation process for multi-country, comparative health workforce studies

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Abstract

Background

As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems.

Objectives

To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey.

Design and settings

We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe.

Participants

Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field.

Methods

The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context.

Results

The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation.

Conclusions

The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation.

Section snippets

Background

Only a few researchers have attempted to translate the administrative and role-based hierarchies found in organizations that comprise health systems or organizations (Choi et al., 2009, Gibson et al., 2003, Hyrkäs et al., 2003). When it comes to the language of health and health services delivery, subtle differences in the conceptual meaning of words can often create completely different survey question structures and alter language use (Mason, 2005, Peña, 2007, Ramirez et al., 2006, Temple,

Methods

The countries and languages participating in RN4CAST include Belgium (Dutch, French, and German), England (British English), Germany (German), Finland (Finnish), Greece (Greek), Ireland (Irish-English), the Netherlands (Dutch), Norway (Norwegian), Poland (Polish), Spain (Spanish), Sweden (Swedish), and Switzerland (Swiss French, Swiss German, Swiss Italian). The overall methodology included the finalization of a core battery of instruments, forward/backward translation, and three levels of

Results

A total of 117 nurses out of 131 invitees (89%) served as raters for the evaluation process. With one exception (Germany with only five raters participating), each country had a minimum of 7 raters and a maximum of 11. Complete scale-level results of the CVI with chance correction evaluation processes are found in Table 3. The US S-CVI score was .70, which established the baseline criteria for comparisons with other countries. For all other countries, the initial S-CVI country average ranged

Discussion

Overall, the pre-data collection approach developed for the RN4CAST study appears to be able to identify where problems with the survey might occur and if the problem is specifically related to relevance or translation. Important for this study, it helped to assess if questions were relevant to nursing practice in the country before data collection.

The findings produced many salient points for discussion. To begin, the significant differences between the initial S-CVI and TS-CVI scores

Conclusion

The instrument verification method based on the CVI-with-chance-correction grounded approach provided valuable insights into the overall relevance of the instrument in different contexts and a quantifiable measurement of those features. It resolved several methodological issues that emerged in the literature related to quantifying the different aspects of translation and improving the speed at which translation validation methods could occur. For the RN4CAST research team, it offered a way to

Acknowledgements

The authors would like to thank all members of RN4CAST country teams for their contributions to the study.
Conflict of interest statement

None declared.
Funding

This research is funded by the European Union's Seventh Framework Programme FP7/2007-2013 under grant agreement no. 223468 (W. Sermeus, PI) and the National Institute of Nursing Research, National Institutes of Health (P30NR05043 L. Aiken, PI). The Norwegian Nurses Association funded the Norwegian part of this study. The Swedish Association

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