Translation, Adaptation and Validation Process of Research Instruments

Abstract

The process of translating, adapting and validating research instruments or scales is crucial for international research projects, as it will facilitate safe comparisons. Versions of research instruments or scales in different languages need to be reliable and valid but also have semantic equivalence between them. This is very important since diversity among people worldwide exists. It is particularly important for nursing research due to the different definitions widely given for the same concept. This chapter focusses on the most common methodological approaches that can be used by researchers who want to translate, adapt and validate a research instrument or scale into a different language.

Appendix

Examples of the methods used to translate and adapt the Individualised Care Scale into different languages and cultures

Authors	Aim	Methods-tests	Findings
Suhonen et al. [18]	To describe the development of ICS (finish settings) for use among patients (preliminary study)	Literature review to define individual care, items included in first scale draft, expert panel to review draft (including CVI), pilot test among patients (internal consistency), larger study (patients) testing Cronbach’s alpha, stability over time (Pearson’s correlation coefficient, test-retest), factor analysis	Three-factor solution suggested, useful, quick and easy-to-use scale, stable over time, adequate Cronbach’s alpha
Suhonen et al. [19]	To describe the development of ICS, to evaluate its validity and psychometric properties	Data collected from patients being discharged from hospitals. Internal consistency and content validity index of the scale examined. Factor analysis to examine the scale’s structure	The reliability and validity properties of ICS (patient version) demonstrated. Three-factor solution confirmed, alpha >0.9 for both parts
Suhonen et al. [20]	To develop the nurse version of ICS and to test its reliability and validity	Items for nurses’ version produced from the patients’ version. Content validity index evaluated by expert nurses, pilot test (Cronbach’s alpha coefficients, inter-item and item-to-total correlations), main testing (internal consistency, construct validity)	Easy to administer, good content validity properties, acceptable internal consistency (Cronbach’s alpha >0.72), three-factor structure produced
Suhonen et al. [21]	To investigate the associations between three concepts: professional practicenvironment, ethical climate and individualised nursing care from the perspective of nurses working in care settings for older people in Finland	Cross-sectional study with the use of three research instruments (including ICS). ANOVA, Pearson’s correlations coefficients and stepwise multiple regression analysis were employed	Significant correlations were observed between ethical climate and individualised care and between individualised care and practice environment
Suhonen et al. [22]	To investigate the association between professional nursing caregivers’ work satisfaction and individualised care	Three instruments were used (including the ICS, nurse version). ANOVA and multiple regression analyses were conducted. Internal consistency was tested with Cronbach’s alpha	Support of patients’ individuality from nurses was supported. Significant correlations between aspect of the support of individuality and work satisfaction were observed
Suhonen et al. [23]	To investigate nurses’ assessments of individualised care and explore if demographic characteristics affect their opinion on individuality	Exploratory study with the participation of nurses working in long-term care institutions. ANOVA was used to explore any associations, Cronbach’s alpha to test the scale’s internal consistency and factor analysis to examine its validity	Three-factor structure was supported, and all alphas (for both parts and all subscales) were >0.77. The results indicated that individuality was supported by nurses; however it was not practised on the same level
Charalambous et al. [24]	To explore, from the nurses’ point of view, the individualised care and professional practice environment and potential associations between them	Exploratory correlational study in which nurses and nurse managers participated and two scales (including ICS) were used. Mean scores were computed, and Spearman’s rho correlations were employed to test for associations between the two concepts. Reliability of the scale was tested with Cronbach’s alpha	Internal consistency for both parts and all subscales was satisfactory (alpha ≥0.7). Findings demonstrated association between individualised care and professional practice environment
Suhonen and Leino-Kilpi [25]	To explore and compare the perceptions of older orthopaedic patients and patients of working age regarding individualised care	A descriptive and comparative study. Descriptive and inferential statistics were used	Both support and realisation of individualised care were evaluated as good. Older patients expressed more positive evaluations
Rodríguez-Martín et al. [26]	To explore nurses’ possible association between nurses’ views and their characteristics and organisational factors in older people health-care settings	A cross-sectional study. Means, percentages and frequencies were computed. Inferential statistics (Spearman’s rho correlation and t-tests) were also computed. Internal consistency was evaluated with Cronbach’s alpha	The perception of individualised care provided was perceived as positive. Correlations were observed between age and type of organisation on the one hand and assessments of individualised care provided on the other. Internal consistency of the scale was satisfactory
Köberich et al. [27]	To assess the psychometric properties of the German version of ICS (patient version)	Cross-sectional, methodological study. Analysis included assessment of internal consistency (Cronbach’s alpha), confirmatory factor analysis. In addition, concurrent validity was evaluated	German version of the ICS established as a reliable and valid instrument for use
Köberich et al. [28]	To explore factors (individual and organisational) that influence patients’ perception of individualisation in their care	Cross-sectional study among German patients (use of ICS and other research instruments)	Several factors extracted as influential. Decision-making process was the only one controlled by nurses. Other factors included self-rated health and educational level
Acaroglu et al. [29]	To assess the psychometric properties of the Turkish version of ICS (patient version)	Cross-sectional study. The English version was used for translation into Turkish (forward-back translation). Expert reviews on the scale’s content. Statistical analysis included evaluation of internal consistency (Cronbach’s alpha) and factor analysis	German version of the ICS established as a reliable and valid instrument for use
Ceylan and Eser [30]	To explore the perceptions of orthopaedic and trauma patients regarding individualised nursing care	Cross-sectional study among patients. Descriptive statistics were employed, and internal consistency was measured with Cronbach’s alpha coefficients	All alphas ≥0.79. Mean scores regarding interventions that support individuality in care were found to be lower than mean scores indicating the practice of individualised care
Gurdogan et al. [31]	To assess the perception of individualised care among internal medicine and surgical patients and also any relationship between individualised care and satisfaction with nursing care	A descriptive, cross-sectional study (ICS was one of the instrument used). Descriptive statistics were computed. Correlations were examined with Pearson’s correlation coefficients. Internal consistency was tested with Cronbach’s alpha	Positive correlation was observed satisfaction from nursing care and perception of individualised care. Mean score concerning perception of individualised care was higher than realisation of individualised nursing care. Cronbach’s alpha for both parts was >0.9
Land and Suhonen [32]	To explore orthopaedic and trauma patients’ perceptions of individualised nursing care	A descriptive study, employing both descriptive and inferential statistics. Internal consistency was measured with Cronbach’s alpha coefficients. Spearman’s rho correlation coefficients, Mann-Witney U-test and Kruskal-Wallis were used to test possible associations between demographics and ICS	Significant associations were observed between demographics and ICS (e.g. duration of stay in hospital). All alpha >0.8
Petroz et al. [33]	To explore the psychometric properties of ICS (patient version, both parts)	A cross-sectional study. Internal consistency (Cronbach’s alpha) and factor analysis were employed	Alpha values (both parts) = 0.94. Factor structure of the Canadian version did not support the original one (part B consisted of two factors instead of three)
Amaral et al. [34]	To translate and explore the psychometric properties of the Portuguese version of ICS (patient version)	A cross-sectional survey. Forward and back translation was done to achieve semantic validity. Experts verified the translated version in terms of fluency. Internal consistency was evaluated with Cronbach’s alpha coefficients and construct validity via factor analysis	All alphas (except for subscale clinical situation—part B) ≥0.77. A three-factor solution was extracted base on factor analysis, supporting the original theoretical model
Rasooli et al. [35]	To examine patients’ opinion regarding nurses’ support of individualised care (patient version, part A)	A descriptive, cross-sectional study. Mean scores were computed as well as reliability tests	Mean scores were lower than other studies. Cronbach’s alpha was adequate
Berg et al. [36]	To explore orthopaedic patients’ assessment concerning nurses’ support of individuality	A descriptive, cross-sectional study. Descriptive and inferential statistics were used for data analysis. Factor analysis and Cronbach’s alpha coefficients were also used to test the scale’s reliability and validity	Factor structure of the Swedish version supported the original structure, and internal consistency was demonstrated. Patients assessed support of individuality as an important factor of nursing care
Papastavrou et al. [37]	To examine the perceptions of individualised care that Cypriot nurses have and any potential associations between individualised care and professional practice environment	A cross-sectional, descriptive, correlational study, using the ICS (among others). Pearson’s correlation coefficients were used to examine potential associations. Means were used to measure the perception and Cronbach’s alpha coefficients to test internal consistency of the ICS	Nurses in Cyprus support the idea of individuality, which is practised to a lesser degree. Significant associations were observed between individualised care and aspects of professional practice environment
Papastavrou et al. [38]	To study and compare Cypriot nurses’ and patients’ perception’s on individualised care	A cross-sectional, comparative study that use two research instruments (including ICS)	Disagreement between patients and nurses was observed on what is individualised care
Suhonen et al. [23]	To compare nurses’ and patients’ perceptions of individualised care in five European countries	A cross-sectional and comparative study. Both versions (nurse and patient) administered to 960 patients. Descriptive statistics as well as t-test, chi-square, ANOVA and ANCOVA tests were employed	Differences observed between nurses and patients. Nurses reported that they support patients’ individuality more often. Differences between countries in means of ICS were observed
Suhonen et al. [22]	To assess the association between individualised care and patient satisfaction	A cross-sectional study among patients in five European countries. Descriptive statistics and ANOVA and Pearson’s correlation coefficients were used	Patients expressed satisfaction with the care received by nurses; however they reported a moderate overall support of their individuality. Difference between countries on the perception of individuality was observed, and positive correlation between patient satisfaction and level of individualised care received was shown
Papastavrou et al. [17]	To explore patients’ and nurses’ perceptions of patients’ decisional control over their care	A cross-sectional and comparative study among 1315 patients and 960 nurses in five European countries. Descriptive and inferential statistics and Cronbach’s alpha coefficients for studying the scale’s internal consistency were used	Nurses and patients perceived different perceptions on patients’ decisional control over their own care. Cronbach’s alpha values were adequate
Suhonen et al. [39]	To translate and adapt the ICS (patient version) in different languages	A cross-sectional and comparative study with the participation of 1126 patients from Finland, Greece, Sweden, the United Kingdom and the United States. Internal consistency of ICS was tested with Cronbach’s alpha coefficients and its validity through factor analysis. Standard process of forward and back translations was followed	The ICS showed acceptable properties in terms of validity and reliability
Papastavrou et al. [16]	To explore possible associations between nurses’ professional practice environment and their perception on the level of care individualisation	A cross-sectional, exploratory study among nurses working in orthopaedic and trauma departments in seven countries. Descriptive statistics and multiple regression analysis were used	Findings demonstrated that aspects of nursing environment could influence individualised care
Idvall et al. [40]	To explore possible associations between nurses’ assessments of individualised care and personal characteristics	A cross-sectional, comparative, international study among nurses from seven different countries. Descriptive statistics were used, and general linear model were employed	Personal characteristics of nurses may affect the way they perceive and practice individualised care