Abstract

Aim: Cross-cultural use of quality-of-life measures have become more common when instruments developed in one country are translated to be used in other countries and cultures. This trend emphasizes the need to establish the cross-cultural equivalence between translated and original questionnaires (Willis 2015). The objective of this study is to explore validity of the Finnish and German translations of the Adult Social Care Outcomes Toolkit (ASCOT) for service users and carers. We translated and tested the interview schedules (INT service user, INT carer) and the self-completion tools (SCT service user, SCT carer). We are primarily interested in the cross-cultural validity and comprehensibility of the translated ASCOT instruments, but our findings from cognitive interviews also contribute to a more general discussion about the applicability of the cross-cultural cognitive interviewing techniques.

Methods: The instruments were translated from English into German and Finnish in summer and early autumn 2015 by a translation agency using forward and back translation methods. Cognitive interviews of the instruments were conducted in Austria and Finland in December 2015 and February 2016, respectively, on 10 service users (5 in Austria and 5 in Finland) and 10 carers (5 in Austria and 5 in Finland). Interviewers were natives of Austria and Finland. The think-aloud method with flexible probing techniques were applied in the interviews.

Findings and conclusions: According to our preliminary findings, cognitive interviews in Austria and Finland were useful and pointed to phrases and words in the translated instruments where translations were understood differently from the original ASCOT instruments. For example, although ASCOT is a subjective QoL-measure, several Finnish service users interpreted the Finnish translation of the word ‟adequate’ in objective terms. Secondly, some Finnish service users understood the description of the expected situation as the extreme situation with no help at all. Similarly to the Finnish findings, different terms and expressions turned out not to translate easily, such as ‘adequate’ or ‘control over daily life’. On the other hand, we found expressions that may reflect cross-cultural differences in how people talk about their perception of everyday life. Findings of the study will benefit future translations and cross-cultural validation of the ASCOT instruments but also more generally patient-reported outcome measures.