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Translation of Health Surveys Using Mixed Methods


University of California Davis—Betty Irene Moore School of Nursing, 4610 X Street Suite 4202, Sacramento, CA 95616. E-mail:


Purpose: The purpose of this study was to determine the effectiveness of a process-based translation method for a health survey instrument, Searching for Hardships and Obstacles to Shots (SHOTS), using a community-based participatory approach with the Hmong community.

Design: The study was based on a cross-sectional survey to assess the reliability and validity of the SHOTS immunization survey, an instrument used in the Hmong community, who are refugees originally from Laos living in the United States.

Method: Process-based universalistic health survey translation methods were used in a six-step procedure to translate the instrument. Mixed methods were used to analyze results, including cognitive interviewing, content validity indexing, Cronbach's α, t tests, and the Kolmogorov-Smirnov test.

Findings: Participants were able to accurately complete the SHOTS survey in either Hmong or English, depending on participant preference.

Conclusions: Universalistic, process-based, mixed methods used to analyze language translation, in combination with the principles of community-based participatory research, provide effective methods to translate health surveys. Involvement of the community strengthens the quality of translation and improves reliability and validity of survey results.

Clinical Relevance: Healthcare providers require accurate and reliable information from evidence-based health surveys to plan for culturally responsive care. Cross-cultural research often relies on language translation. Translation of a health survey instrument may be improved with universalistic, process-based methodology.