The cultural relevance of research instruments
The selection of instruments is an always daunting and frequently time consuming task that researchers undertake as they plan their studies. All researchers know that the instruments they select must be reliable and valid for the concepts they plan to measure. However, as nursing research becomes increasingly global, the need for instruments that are relevant for the culture of interest to the researchers has become increasingly acute.
All researchers understand that instruments must be translated for use in studies of populations who do not speak the language in which the instrument was originally written. Yet all researchers may not be fully aware of what else is needed to establish the cultural relevance of an instrument. Indeed, many concepts do not have exactly the same meaning in all cultures and some concepts may not even be translatable in some cultures. For example, Simões et al. (2011) reported that they not only translated the Coma Recovery Scale into European Portuguese but also had to adapt the instrument for the Portuguese situation.
King et al.’s (2011) study of techniques used to establish cultural equivalence of instruments, published in this issue of JAN (pp. 2267–2274), is an especially informative paper that goes beyond an explanation of standard translation and back translation techniques. The researchers explained that they examined the content, semantic, technical and conceptual equivalence of self-report instruments they intended to use for a multi-site, multi-language study of the differences in the prevalence of presentation of acute coronary syndrome symptoms and diverse pathways to care. More specifically, King et al. described how they assessed the clinical meaning of the words used in the instruments, the conceptual equivalence of the instrument items, readability, interpretation of graphics used in the instruments and order of presentation of demographic information. One noteworthy aspect of the King et al. study is that the researchers translated and examined the cultural equivalence of each instrument in not just one language but several—English, Cantonese/Mandarin, Punjabi, Hindi, Urdu, Gujarati and Tamil. Another noteworthy aspect of the study is that they invited both healthcare professionals and lay persons who spoke and read English and the language of interest to review the instruments. Still another noteworthy aspect of the study is the finding that the typical forward and backward translation of the instruments by a translation service was not sufficient.
The King et al. work is one of several reports of instrument development and psychometric testing that are published each year in JAN. Each one of those publications provides researchers with solid information that enhances selection of the best instruments to measure the concepts of the middle-range theories they are generating or testing. The reports that focus on the cultural relevance of instruments provide researchers in various countries with information that greatly facilitates selection of instruments that are not only reliable and valid but also culturally relevant for the population of interest (see, for example, Tanglakmankhong et al. 2011).
The techniques used by King et al. may be applied to many different instruments developed in various languages. For example, although JAN is published in English, some instrument development papers are reports of work carried out in non-English speaking countries (see, for example, Chen et al. 2011). Although JAN typically publishes the instrument items in English, the work to establish the cultural relevance of the instrument for use with particular English-speaking populations remains to be done. As King et al. point out, ‘It is particularly salient in healthcare research to recognize that language and cultural nuances might affect people’s capacity to communicate regarding their health, illness or symptoms and fully understand questions posed of them’ (p. 2272). Any such nuances most likely will compromise the reliability and validity of an instrument and render the data essentially meaningless, a situation every researcher wants to avoid.