Sustainable Development Goal 3: Ensure healthy lives and promote well-being for all at all ages.
Belize population and housing census country report 2010.
- Escure G.
Transcultural translation and adaptation (TTA) process
- Step 1 -Translation and adaptation by bilingual experts.
- Items from the original RCADS tool in English were reviewed by two bilingual experts in Belize. An initial Kriol version of the tool was produced by them to be used in the subsequent steps.
- Step 2 – Mental health expert review.
- Belizean counselors who work with adolescents next reviewed the tool. A structural suggestion that came from this step was to frame declarative statements in the original tool as questions to enhance comprehensibility by adolescents. This change was corroborated as an improvement by adolescents during steps 3 and 4 of the process.
- Step 3 - Focus Group Discussions.
- Six FGD were conducted in June 2019, four with adolescents and two with parents of younger adolescents. The purpose of the FGDs was to systematically explore the most appropriate use of language and full equivalence of meaning for each item with participants. Discussions also included the confirmation of the suggested item wording in Belizean English and Kriol.
- The FGDs were organized using the transcultural translation elements in the TTA monitoring form []. Discussions were conducted in English and Kriol by trained bilingual facilitators, who were experienced child psychologists, teachers, nurses, or school counsellors. Facilitators began with age-appropriate techniques for adolescents that included an adapted body mapping group activity and free-listing exercises to elicit common words and expressions to describe aspects of mental health, based on previous methods used with adolescents in Nepal and Nigeria [,].
- A total of 28 adolescents participated in FGDs. FGDs were held separately for younger (ages 10–14) and older adolescents (ages 15–19), with an FGD for boys and an FGD for girls for each age group. FGD sessions took place in hotel conference rooms in Belize City. Two additional FGDs were conducted with a total of six parents of adolescents aged 10–14.
- Step 4 - Cognitive Interviews.
- CIs were conducted in July-August 2019. The purpose of the CIs was to discuss with individual participants how the items in the questionnaire were understood, assess suitability and interpretation of the response options, and to understand the process whereby responses were chosen. A total of 12 adolescents 10–19 years old and six parents of younger adolescents participated in individual cognitive interviews. Interviews lasted an average of 60 minutes.
- Step 5 – Data analysis: Triangulation and integration of qualitative findings.
- FGDs and CIs were audio recorded and data was transcribed verbatim for subsequent analysis. All data from transcripts were analyzed using NVivo software (12 version). Initial coding was conducted by three of the authors for the a priori TTA domains indicated above. Once an inter-rater reliability score of higher than 0.7 was met among the three researchers, a single researcher completed the remaining coding. Code queries were generated for each RCAD item along each equivalence domain, from which data were synthesized into code summaries to reflect these key dimensions of transcultural adaptation.
- Step 6 – Final Back-translation.
- Informal back-translation was used throughout the proceeding steps to discuss potential modifications. After all the Belizean English and Kriol version adaptations based on the prior steps were completed, a final English back translation was done and differences between the original English and the Belizean version were documented.
- Spence S.H.
Informed consent and ethical approval
Response set issues
Working in two languages simultaneously
Strengths and limitations
- Supplement 1
- Supplemental Annex S2
- Supplemental Table S3
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Conflicts of interest: The authors have no conflicts of interest to disclose.
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