Shared decision making and the practice of community translation in presenting a pre-final Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire: a proposal for improved translation and cross-cultural adaptation

Abstract

Background Translation and cross cultural adaptation of patient reported outcome measures (PROMs) involves a step referred to as harmonisation, following forward and backward translation of the measure. This article proposes the introduction of methods not previously included in the process of harmonisation. The aim of the study was to introduce shared decision making (SDM) and the practice of community translation (CT) during the harmonisation of the Afrikaans for the Western Cape version of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, a PROM that measures symptoms and activity and participation in persons with upper limb conditions. Methods A broader approach to harmonisation is proposed by incorporating CT and SDM in addition to existing methods toward harmonisation. Participants ( n = 8) involved in the harmonisation meeting included the principal investigator, a linguistic expert, occupational therapists with knowledge of the target population, context and the DASH questionnaire and members of the target population with and without upper limb conditions. A partnership was formed with the participants (a principle of SDM) and the principles of non-parallel CT and the CT approach were applied during harmonisation. Employing CT principles ensures that the norm for the translation is set by the population the translation is intended for. Results Forward and backward translation of the DASH questionnaire presented a version of the measure in the target language for consideration during harmonisation. There were however a significant number of conceptually problematic items on the version presented at the meeting. Only seven items (7 of 30) remained unchanged. Conclusion SDM and CT was used during the harmonisation of the Afrikaans for the Western Cape DASH questionnaire. Both these practices could have relevance in the translation and cross-cultural adaptation of PROMs where the translation is intended for persons from low socio-economic backgrounds and low levels of education. Electronic supplementary material The online version of this article (10.1186/s41687-019-0144-z) contains supplementary material, which is available to authorized users.

Patient Follow‐up After Orthopaedic Outreach Trips – Do We Know Whether Patients are Improving?

“…Cultural differences were noted as a barrier to follow-up within this review [26,35], mirrored in other studies showing how a lack of cultural adaptation results in higher attrition rates [57]. Additionally, tailoring tools to the patient population promotes shared decisionmaking and patient-centred care by building trust and incorporating patients' values [42,[58][59][60].…”

Structural and cross-cultural validity of the Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire

“…No explanation can be provided for item 2 as in both language versions item 2 is one word (Afrikaans for the Western Cape: skryf and South African English: write ), skryf being a direct translation, with no synonyms. In considering the other items it could be that during the process of translation and cross-cultural adaptation [ 10 , 11 ], despite our best efforts, the meaning across language versions changed. However, when considering that the items still load on the same factors (with factor loadings of 0.597 and above), appropriately fitting M1: configural invariance, just not sufficient to support metric invariance, it may not be necessary to investigate further.…”

“…The total score is calculated as follows: (sum of responses/number of responses) − 1 × 25 with scores closer to 100 indicating greater disability. The Afrikaans for the Western Cape DASH (for which the translation and cross-cultural adaptation and content validity is described elsewhere [ 10 , 11 ]) and the South African English DASH (available from the IWH website: https://dash.iwh.on.ca/available-translations ; with evidence of construct validity available in Additional file 1 ) were used during data collection. Patients were requested to complete both language versions.…”

“…English (20.3%), Afrikaans (49.7%) and isiXhosa (24.7%) are the three most predominantly spoken languages in the Western Cape of South Africa. The variation that exists within the Afrikaans language (previously described [ 9 ]) served as motivation to translate and cross-culturally adapt the DASH questionnaire into Afrikaans for the Western Cape, within the public health context of the Western Cape of South Africa and is reported on elsewhere [ 10 , 11 ]. Validity of this new language version and equivalence between language versions within this context would allow for accurate self-report and for comparisons between patient scores (from different languages and cultural backgrounds) within the same clinical setting, addressing the call to demonstrate outcomes of intervention [ 12 ].…”

Investigating the Effects of a (Non-) Professional Interpreting Service in Healthcare

“…The level of competency can be established by asking patients probing questions and inviting them to repeat the information they have received. Another way of addressing the issue at hand is to undertake a retranslation of the source texts into Afrikaans and into isiXhosa using the functionalist approach or a genre-specific community translation approach (De Klerk, et al, 2019;Lesch, 2018;Taibi and Ozolins, 2016:1-6). The interpreters could then be retested to see whether they then understand the target texts better and whether they would then be able to paraphrase and explain the content better to the patient.…”