SCIENCE, PRACTICE AND EDUCATION For Step 4, the committee focused on the technical- ity of the B-TL1 and B-TL2 versions of the survey and the precision of the terms and questions trans- lated. The following example illustrates this process. The committee had a long discussion about the item ‘dressing choices relating to skin tears’ as a topic that should be included in future educational programmes for Registered Nurses. The two experts involved in Step 1 translated this differently. One expert inter- preted this item as ‘what kind of wound dressing would be used on a skin tear’, and the other as ‘how should a person dress to avoid skin tears’. In Step 2, the co-supervisor and the author agreed on us- ing ‘what kind of wound dressing would be used on a skin tear’. After discussion about the meaning of the term in the original survey 4 , an agreement was reached to ask participants to identify if education would be useful concerning which ‘wound dressing/ pansement’ to use on a skin tear. At the end of Step 4, consensus was attained to generate a pre-final version of the instrument (P-FTL). way for a shared purpose’ or b) ‘the planning of an activity or event’. 10 The author used ‘organisation’ to refer to a group of people working together as an institution, or the hospital where the participant works. However, some participants (n=4) interpreted the word ‘organisation’ to refer to their own planning or way of working. Therefore, the translation was good, but the item was misinterpreted and had to be rephrased to refer to the ‘care setting/milieu de soins’ in French, to reflect the reality of the Swiss healthcare environment. Based on these findings, the author adapted the survey and proposed its final version. Finally, for Step 5, a sample of 27 postgraduate wound care nurses were recruited for the pilot test. They were asked to complete the survey to: a) de- Figure 2: Skin tear termine the time required to complete the question- naire and b) evaluate the clarity and intelligibility DISCUSSION of the different questions and answers in the survey. The aim of this study was to translate and cross- This step was very enlightening for the author. First, culturally adapt an original English survey into Swiss the time required to complete the questionnaire was French. This is essential for enhancing the valid- nearly identical for all participants. Second, regard- ity, generalisation and translation of cross-cultural ing clarity and intelligibility, 25 out of 36 questions health care research. 6 It is relatively easy to translate reached 100% agreement among the participants. a questionnaire literally, but some translators are not Even though participants declared nine questions to necessarily conscious of the rigorous requirements of be ‘unclear’, these questions reached more than 80% translation for cross-cultural research, therefore they agreement. Nonetheless, the author made some mod- may not pay enough attention to cultural nuances ifications or specifications to enhance the questions’ while maintaining the original meaning and intent. 11 comprehensibility. For example, three questions relat- Terwee et al. developed quality criteria for the design, ing to skin tears’ incidence and implications for the methods and outcomes of studies on the develop- management of these wounds reached 93% agree- ment and evaluation of health status questionnaires. ment: two participants declared they did not know Criteria were defined to yield a positive, negative or what a skin tear was. With this in mind, a picture of indeterminate rating. These criteria make a signifi- what a skin tear could look like was added to the sur- cant impact in defining the explicit quality standards vey’s introductory text (Figure 2). Some words used in for the measurement properties of health status ques- French have different meanings depending on their tionnaires. 12 All of the present questions’ ratings were context, which could lead to significant differences in well accepted during this translation process. In the the responses of future survey participants. Some par- French part of Switzerland, it is difficult to find bi- ticipants (15%, n=4) interpreted the original author’s lingual translators with a health sciences background. meaning differently and declared one question to be As demonstrated in this study, there are also potential ambiguous. For example, the word ‘organisation’ has cultural and literal differences in the interpretation two meanings in English, as it does in French: a) ‘a of many terms. This underscores the importance of group of people who work together in an organised achieving consensus among the research team and JOURNAL OF WOUND MANAGEMENT 49 OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATION
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