Cross-cultural adaptation of an anxiety measure in a disadvantaged South African community context: Methodological processes and findings

Abstract

An important challenge to enhancing community access to mental health interventions in marginalised, transcultural settings is the development of culturally relevant screening measures. Cross-cultural adaptation (CCA) and translation methods offer guidelines for the adaption of existing screening measures for use across cultures with the aim of preserving semantic and construct equivalence as well as validity. Yet, the application of CCA methods has been inconsistent and validation strategies have focused predominantly on expert review and quantitative validity testing. Additionally, potentially important context-specific interpretations of measure items have been lost in translation-heavy approaches. The missing link in the CCA of existing measures may be the addition of culturally sensitive, community-based evaluative methods. This paper presents a report of the application of a seven-step CCA method developed by the first author to address the issue of cultural relevance in the translation and cross-cultural adaptation of the Spence Child Anxiety Scale (SCAS) an anxiety measure for use in a specific South African community context. The findings emphasise the surprising context-specific interpretations of items in measures applied transculturally, which support the case for qualitative, community-based validation of translated, CCA screening measures used to explore the effectiveness of mental health interventions across cultural contexts.

Translation and cultural adaptation of drug use stigma and HIV stigma measures among people who use drugs in Tanzania

“…After translation and adaptation, most of the of the items were understood and relevant to the participants, although some challenges were identified which required adaptation of items, wording, and response options. These results are similar and consistent with the literature around linguistic translations and cultural adaptation [ 31 – 34 ].…”

“…Translating items of measures from the original language can result in having alternatives of words to use in the target language [ 31 , 35 ]. Our results are similar to this observation where during the translation, we encountered the challenge of having one English word which could be translated in multiple choices of words in Swahili.…”

“…In Tanzania, PWUD typically do not interact with community or social workers; we hence dropped items referring to these providers. A similar challenge of measures referencing health care worker not commonly used in a community was observed when adapting a measure in Afrikaans in South Africa [ 31 ].…”

“…During translation and cultural adaptation of measures, items can be revised as a result of the cultural differences between the original and target language [31,38]. The revisions are made using the words that are understood and fit the context of the target language and PLOS ONE population.…”

Contextualized Measurement Scale Adaptation: A 4-Step Tutorial for Health Psychology Research

“…Measurement scales for behavior and its determinants need to guarantee an objective, reliable, and valid assessment of the measured construct [3]. When using measurement scales in new contexts (e.g., different environment, target population, or behavior), the translation and psychometric validation of the instrument are necessary but not sufficient if the validity of the psychological concept behind a measurement scale has not been researched [4]. The present paper highlights this often-overlooked issue and provides systematic guidance on how to tackle this in health psychology.…”