Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Introduction
Marketers must become more attuned to social and cultural backgrounds in order to better address global consumers' needs. Although survey research is a popular tool for measurement with culturally-diverse populations, little detail is usually provided regarding the development of the instrument in research results. This is critical to the qualitative research effort, especially in a cross-cultural environment, as inaccurate measurement tools will provide inaccurate conclusions. Marketing research firms today are beginning to investigate in more detail methods for addressing cross-cultural research (Saxton, 1998). This study focuses on the issue of survey translation and the critical need to accurately prepare the survey for cross-cultural research. Too often, studies employing survey research methods in a cross-cultural environment do not provide much detail regarding the development of the survey, describe only one method of survey translation, or completely omit any description of survey development. This study details the development of a survey for measurement of Hispanics' satisfaction with medical services. Survey translation alternatives are presented and some empirical evidence provided as to the effectiveness of combining these methods.

The author Susan Y. McGorry is Assistant Professor in the Department of Business, Allentown College of St Francis de Sales, Center Valley, Pennsylvania, USA. Keywords Marketing research, Global marketing, National cultures, Foreign languages Abstract Focuses on the issue of survey translation and different translation alternatives available to researchers. As marketers attempt to better understand and serve the needs of the global consumer, they face a culturally diverse population. When conducting research with different cultural groups, it is necessary to utilize culturally and linguistically appropriate instruments to measure various concepts. Frequently, details of instrument development are very limited, or omitted from presentation of research results. An instrument that is not properly adapted can have serious ramifications for study conclusions. This study attempts to identify alternatives for survey translation (specifically with a Hispanic subgroup), and provides some empirical evidence as to the effectiveness of a combination of these methods. Electronic access The current issue and full text archive of this journal is available at http://www.emerald-library.com

Survey translation
As companies extend their global reach with the advent of the Internet, and marketers attempt to develop and maintain long-term relationships with customers, there is an increasing need for marketing research that spans numerous cultures. Often, surveys and scales are adapted to various languages without consideration of culture. Scales or constructs created in one culture may not describe the experience of individuals in another culture. Although cultural and linguistic diversity within health care presents particular challenges to both health care consumers and their health care providers (Easthope, 1995; Hartley, 1995; Meleis, 1992), many other organizations are interested in issues of linguistic and cultural translation, not only for research purposes, but communication in general. 74

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . pp. 7481 # MCB University Press . ISSN 1352-2752

Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . 7481

For example, organizations developing global Web strategies translate versions of their sites into local languages and/or offer localized content. Translation can sometimes be politically challenging, especially because some countries use the same language with different conventions. Using the traditional Chinese character set, for instance, is necessary to reach the Taiwanese, but mainland Chinese prefer the simplified set of characters. Cisco Systems found that the meaning of the word ``router'' in Spain was different to that used in Latin America. Jorden Woods, CEO of Global Sight, the software company in San Jose, California, that worked with Cisco on its globalization project, said the language issue was critical: ``Spain wanted the Spanish word for router; Latin Americans didn't even know the Spanish word'' (Radosevich, 1999). In a recent Marketing News article, Jennifer Mitchell, director of the International Division of Hispanic and Asian Marketing Communication Research Inc., Belmont, California, notes that when collecting customers' opinions globally, marketers must ensure comparability across regions, markets and cultures. Often, even careful translations and market adaptations are not enough. If measurements of repurchase intent and overall satisfaction are recorded on, for example, a ``1-to-10'' rating scale, you must understand how each respondent will use that scale. Latin Americans tend to use the high end of the scale. A less-than-ecstatic customer still may rate your company a ``7'' or an ``8''. Comparatively speaking, a person from the UK wanting to rate the company in exactly the same way may qualify the company with a ``5'' or a ``6''. Asian respondents tend to prefer the middle of the scale (Mitchell, 1999). In the aforementioned articles, as well as in many others, the issue of survey translation is not discussed in detail, or the authors mention back translation as the translation method of choice (Homburg et al., 1999; Unger and Molina, 1999; Hofstede et al., 1999). There are, however, several approaches to ensuring a culturally appropriate tool. Marsula (1978) and Rogler (1989) suggest that researchers immerse themselves in the culture of the ethnic group that they are studying. This means the researcher actually lives in the community group under observation to 75

learn how the group perceives the environment and other individuals around them. It is suggested that the researcher also studies the culture of the group and participates, when possible, in cultural events. Others such as Brislin et al. (1973) and Wesley and Karr (1966) have suggested that key informants and/or researchers be identified who are knowledgeable about the culture and can assist the researcher in learning about the culture and provide assistance in developing a culturally appropriate instrument. Although it is imperative to be familiar with the cultural group and its norms, it is not always possible for the researcher to reside in the community under observation. However, specific steps can be taken to ensure that the instrument to be used for measuring is culturally appropriate. A number of different methods have been developed to address this issue. Berry (1980) suggested that the goal of translation is to obtain instruments that elicit responses which convey similar meanings to members of various groups (i.e. ``conceptual equivalence''). This means that a literal translation of an instrument is not sufficient for conveying the equivalent of an instrument in ethnic group research. Not only is proper linguistic translation of an instrument important, so is cultural translation. A researcher must consider the cultural applicability of the constructs being measured or purported to be measured by an instrument. In a study with ethnic groups, the researcher must be sure that plausible rival hypothesis of differential instrumentation has been ruled out (Brislin, 1970). In other words, the subjects are responding to a culturally equivalent version of an instrument and the results are not due to some function of translation of the instrument. A central concern of every translation is to produce the cultural equivalent of an instrument (Werner and Campbell, 1970), or an instrument that has the same connotative meaning as the original instrument. There are four procedures recommended for translation of an instrument: (1) one way translation; (2) double translation; (3) translation by committee; and (4) decentering.

Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . 7481

One-way translation This is the simplest of translation methods used by researchers in the field. In this case, a translator is asked to review the instrument in its original language and translate the instrument into the target language. No backtranslation is involved. Some researchers may choose to have a few translators conduct oneway translation of the instrument. Although this may be less expensive and less time consuming than other methods, there is no comparison of the final survey version, and there may be loss of information through literal translation. Double translation In this form of translation, which is also called back-translation, there are at least two bilingual individuals who participate independently in the translation process. This process is effective because the instrument goes through a number of filters produced independently by researchers. The steps to this translation process include: . The version in the original language is translated by a first translator into the target language. . A second independent translator takes the results from the previous step and independently translates the instrument back to the original language. The researcher now has two versions of the instrument in the original language and can compare them for any inconsistencies, mistranslations, meaning, cultural gaps and/or lost words or phrases. If any differences are found the researcher can consult with the translators to find out why this occurred and/or how the instrument can be revised. . The investigator compares both versions in the original language and checks with the translators for inconsistencies. This process has been described as one of the most adequate translation processes (Marin and Marin, 1991), even though issues of literal translation and missing information may arise. A researcher can use a few iterations of this process to ensure proper translation. This may lead to a more costly translation process. Translation by committee This type of translation process is completed by asking each of two or more individuals who 76

are familiar with both languages in the study to translate the text instrument from the original language to the target language (Marin and Marin, 1991). Then, the researcher can ask the two independent translators to arrive at consensus on a final format, or request that a third independent party choose a version that most closely captures the meaning of the original language version. Although this translation method is more effective than one-way translation and may use less resources than other methods discussed, translators may be reluctant to criticize one another and/or may miss information relevant to the target group due to similar cultural backgrounds and education. Decentering Werner and Campbell (1970) proposed decentering as a way to develop instruments that would be culturally appropriate when cross-cultural research is conducted. In this process, the original language instrument is not considered finalized until the entire translation process is completed. Therefore, if a translator believes that a grammatical structure or word or tense must be changed to appropriately fit the cultural group under study, the original instrument should also be changed to reflect these linguistic and cultural characteristics. There is a constant comparison of the two instruments, and modifications are made to the first to account for limitations of the target language. Double translation only considers the original language the most important in the translation process it is the guide the researcher follows. Decentering, however, allows for a ``culturally and linguistically equivalent'' translation to evolve during the course of the interviewing/surveying period. Several guidelines for employing decentering are: . use short, simple phrases; . employ active rather than passive voice; . avoid metaphors and colloquialisms. This method involves actual revision of the original instrument to fit the new research situation. Although the instrument may be more accurate culturally and linguistically, this may also be more costly in terms of time and resources, and the length of the instrument may be increased.

Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . 7481

Regional variations Another factor critical in survey translation is regional variation. There are regional variations, not only of Spanish, but many other languages as well. Haffner (1992) noted the seriousness of a regional difference in language in her study of a California medical center. A patient in pain yelling, mi espinilla is having his leg X-rayed. Espinilla usually means shinbone in most Spanish-speaking countries, however, in some parts of Mexico, it means wrist. This patient had a broken wrist, yet someone had improperly translated espinilla due to regional language differences. Although some researchers (Fishman, 1987) estimate that the usage of regional variations is decreasing, the researcher must be prepared to address this issue. There are a few recommendations for addressing regional variations (Marin and Marin, 1991): (1) Use all appropriate variations of a word. If a researcher thinks/believes that a few subgroups may be represented in a particular sample, he/she should include all regional variations of a word. For example, in the Hispanic Health and Nutrition Exam Survey (HHANES) where particular subgroups were targeted, researchers included variations: the subgroups used different words to identify a cigar. In the interviews, the researcher would present the different variations of the word cigar (US Department of Health and Human Services, 1984). (2) Avoid colloquialisms. In some cases words that are preferred or used commonly by one subgroup may cause confusion among members of other groups. For example, guagua is a common word for bus to Puerto Ricans; but this word means child in Chile and wolf in Columbia. (3) Use descriptive phrases. If a particular word may cause unknown confusion, the researcher can simply use a phrase that describes the word. For example, in this study, ``physical facilities'' was described by additional words (the reception room, the examination rooms, the bathrooms and the doctor's office). The translators had expressed concern that this word may be interpreted differently by respondents, and therefore the word was described more completely. 77

(4) Researchers must also be prepared for ``Angloisms'' creeping into their instrument and the responses of subjects. For example, in the current study, ``staff'' was used in the Spanish version of the instrument (which is really an English word). One translator thought it might cause problems, while another thought it was a very common term and would be recognized easily. Therefore, a brief Spanish description of the word staff was provided at the beginning of the survey.

Pilot study translation method

Prior to using an original English survey in a study with Spanish speaking respondents, a pilot study was planned to ensure proper translation of the survey. The survey was first adjusted for a medical services environment, as noted previously. The instrument was further refined with a third grade English level translation in order to avoid confusion or misinterpretation (Brislin et al., 1973; Campbell, 1994). For the pilot study, two translators were asked to assist in a double, or back-translation process (the more commonly used translation process). Both translators were born in Puerto Rico and had lived in the mainland USA for approximately 15 years. Additionally, one translator held a master's degree in education. Once the translation was completed, the primary researcher delivered the survey to a pilot group of approximately 35 respondents. A translator accompanied the primary researcher in order to address questions and to collect verbal feedback regarding the survey. Once the data were collected, reverse scoring was performed for the negatively worded items, data were analysed, and the respondents' feedback summarized. Feedback included: . Respondents confused by the double negatives and wording. . Respondents confused by verb tense (said the second question set was similar to the first). . Some of the terms used (e.g. staff, equipment) had to be explained to respondents. . Some respondents were unclear about the labels used on the numeric choices

Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . 7481

An item analysis was conducted and item distributions investigated in order to determine the structure of the instrument. The item analysis resulted in a negative reliability coefficient: 1.6 for expectations, and 0.80 for perceptions. This indicated that some of the items were behaving strangely. A correlation matrix of the items also was explored, revealing strong negative correlations between several items that should have been positively related, and strong positive associations between some items that should have been negatively related. Additionally, several of the items demonstrated bi-modal distributions. Either some respondents highly disagreed with their fellow respondents or they responded incorrectly due to misinterpretation, confusion or some other cause.

Revision
Although the survey had been revised to a simplified version of English, adapted to a medical services situation, and translated with the back-translation process, the feedback and data analysis indicated that perhaps there may have been some problem with the original survey. At this point, steps were taken to revise the survey to determine the origin of the data problems. Three people born in Puerto Rico, with at least a high school education and some university schooling, and two Anglos, one with a masters and one with a doctorate in Spanish, participated in the revision process. Although most documented studies are completed with only one translation process (which may be due to funding and/or planning), a combination of the recommended translation methods was completed for this revision. Translation by committee was employed for this study; two Puerto Rican translators first independently translated the instrument, while a third, independent, party selected that version which most closely represented the original language version. The double translation process was also utilized in the current study. Once the committee translation was complete, the instrument was translated back into the original language, English, by a third independent party. All parties exercised caution in translating the instrument so as to keep the 78

``general'' concept addressed in the item the same. However, if the item did not read well literally in the target language, it was changed. An adaptation of decentering was employed, as changes were made as necessary to the original English version if translators believed that certain words or grammatical structures were not appropriate for the Puerto Rican population. This did not occur in a sequential process. Once those of Puerto Rican cultural and linguistic background began to translate the instrument, certain grammatical structures and words would seem inappropriate, and therefore, the translation process would be suspended until the English version of the survey was changed. For example, in item 11, the English version reads ``Patients cannot always expect the staff to provide prompt services''. Translators recommended that this be changed to read more easily in Spanish ``Patients cannot expect that the staff will provide services immediately''. They also expressed concern that the word ``prompt'' would not be common to Latinos. Additionally, all negatively-worded statements were changed to reflect positive statements. A copy of the English revised survey is provided in the Appendix.

Redistribution of survey
A medical services clinic with a large Puerto Rican patient base in an urban area of the northeastern USA participated in this study. Patients were identified as Puerto Rican by their records, by their surnames and by their ability to speak or read Spanish. Patients who could speak and/or read Spanish were asked to complete the questionnaire while they waited for their appointment. A translator was present in order to answer questions. Of the 106 patients asked to participate, only one refused, for a total of 105 respondents and a response rate of 99 percent. Patients were randomly asked to complete questionnaires when they arrived at the clinic for an appointment. No names were used, to maintain patient anonymity.

Revision results
Although some respondents still did not understand why they had to complete two sets

Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . 7481

of questions which appeared very similar, complaints regarding confusion with the statements were significantly reduced. Similar data analyses were conducted to reveal much improved alpha coefficients (0.90 for expectations, 0.88 for perceptions). Item distributions, although somewhat negatively skewed, were moving in the same direction for similar items.

the back translation and the quantitative analyses were pursued). Investigate a few randomly selected surveys after data are collected (for misinterpretations, missing data, etc.). Run preliminary basic statistical analyses (distributions, item analyses) to investigate data before proceeding with any advanced data analyses.

Conclusions and implications for qualitative research

The most interesting finding from this study is the fact that one of the most commonlyused translation methods did not result in an accurate instrument. Feedback from respondents and the investigation of the data from the pilot study indicated trouble with the survey. Had there been no feedback, and had data results been less inflated, the analyst may have proceeded with the data from the first survey and had very inaccurate study conclusions. Although the scale was adapted to a medical services situation, the language simplified, and a back-translation conducted, the survey was not culturally and linguistically adapted. The verbal feedback from the respondents during the pilot study, as well as the implementation of multiple translation methods, created a more accurate final survey. As marketers attempt to reach global consumers, more attention must be dedicated to cross-cultural research efforts, and thus, qualitative research methods to ensure proper measurement in various cultural environments. Based on the observations from this study, the following steps are recommended for accurate cultural and linguistic revision of a survey: . Employ a combination of survey translation methods (at least more than one), specifically including decentering. . Employ at least two independent translators to be included in the translation process. . Have a translator present (if the researcher is not fluent in the target language) during data collection. . Obtain verbal feedback from respondents during/immediately after data collection (this indicated to the primary researcher that there may have been problems with 79

For many organizations, these recommendations may be difficult to implement due to funding, time or other resources (and/or a combination of these factors). For example, some researchers will employ friends and/or colleagues to conduct the translation process because a professional translator may be very expensive. Additionally, the time involved in the translation process may prolong the research effort (e.g. in this study the total time from first translation to pilot to second translation to revision to pilot was nearly four months). However, had the pilot not been conducted, verbal feedback obtained, and additional translation processes employed, invalid data would have been collected, wasting more valuable resources. In some cases, it may be more appropriate to simply construct an entirely new scale in the target language. This study provides some investigation of the translation process and recommendations for accurate translation. Future research should focus on additional investigation of these translation procedures in a variety of cultural environments.

References
Berry, J.W. (1980), ``On cross-cultural comparability'', International Journal of Psychology, Vol 4, pp. 207-29. Brislin, R.W. (1970), ``Back translation for cross-cultural research'', Journal of Cross Cultural Psychology, Vol. 1, pp. 185-216. Brislin, R.W., Lonner, W.J. and Thorndike, R.M. (1973), Cross Cultural Research Methods, John Wiley & Sons, New York, NY. Campbell, D.T. (1994), personal Interview. Easthope, G. (1995), ``Ethnicity and health'', in Lupton, G. and Najman, J. (Eds), Sociology of Health and Illness: Australian Readings, 2nd ed., Macmillan, New York, NY, pp. 143-61. Fishman, J.A. (1987), ``What is happening to Spanish on the US mainland?'', Ethnic Affair, Vol. 1, pp. 12-23. Haffner, L.. (1992), ``Cross-cultural medicine: translation is not enough'', Western Journal of Medicine, Vol. 157, pp. 255-9.

Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . 7481

Hartley, R. (1995), ``Families, values and change: setting the scene'', in Hartley, R. (Ed.), Families and Cultural Diversities in Australia, Allen and Unwin, with Australian Institute of Family Studies, Sydney, Australia, pp. 1-20. Hofstede, F., Steenkamp, J.B.E.M. and Wedel, M. (1999), ``International market segmentation based on consumer-product relations'', Journal of Marketing Research, February, Vol. 36 No.1, pp. 1-17. Homburg , C., Workman, J.P. Jr and Krohmer, H. (1999), ``Marketing's influence within the firm'', Journal of Marketing, April, Vol. 63 No. 2, pp. 1-17. Marin, G. and Marin, B.V.O. (1991), Research with Hispanic Populations: Applied Social Research Series, Vol. 23, Sage Publications, Beverly Hills, CA. Marsula, A.J. (1978), ``Thoughts on cross-cultural studies on the epidemiology of depression'', Cultural and Medical Psychiatry, Vol. 2, pp. 343-57. Meleis, A.I. (1992), ``Cultural diversity research'', Communicating Nursing Research, Vol. 25, pp. 151-73. Mitchell J. (1999), ``Reaching across borders'', Marketing News, Vol. 33, 10 May, American Marketing Association, Chicago, IL. Radosevich, L. (1999), ``Going global overnight'', InfoWorld, April, Vol 21, p. 1 Rogler, L.H. (1989), ``The meaning of culturally sensitive research in mental health'', American Journal of Psychiatry, Vol. 146, pp. 296-303. Saxton, K.M. (1998), presentation: ``Customer satisfaction and measurement modeling'', AMA Winter Educators Conference, February, Austin, TX. Unger, J. and Molina, G. (1999), ``The UCLA multidimensional condom attitudes scales: validity in a sample of low-acculturated Hispanic women'', Hispanic Journal of Behavioral Sciences, Vol. 21 No. 2, pp. 199-211. US Department of Health and Human Services (1984), Field Staff Operations Manual for the Hispanic Health and Nutrition Examination Survey, National Center for Health Statistics, Public Health Service, Hyattsville, MD. Werner. O. and Campbell, D.T. (1970), ``Translating, working through interpreters and the problem of decentering'', in Cohen, R.N. (Ed.), A Handbook of Methods in Cultural Anthropology, American Museum of Natural History, New York, NY. Wesley, F. and Karr, C. (1966), ``Problems in establishing norms for cross-cultural comparisons'', International Journal of Psychology, Vol. 1, pp. 257-62.

Appendix
General medical patient survey This survey deals with your opinions of the clinic's services. Please show the extent to which you think the clinic should possess the features described by each statement. Do this by selecting one of the five numbers below each statement. 1. The office should have up-to-date equipment. 1 2 3 4 5 never always 2. The physical facilities should be visually appealing. 3. The staff members should be welldressed and neat. 4. The appearance of the physical facilities of the office should be in keeping with the type of services provided. 5. When the office promises to do something by a certain time, it should do so. 6. When patients have problems, the physician and staff should be sympathetic and reassuring. 7. The physician and staff should be dependable. 8. The office should provide its services at the time it promises to do so. 9. The office should keep patient records accurately. 10. The office should be expected to tell patients exactly when services will be performed. 11. Patients should expect prompt service from the staff in the physician's office. 12. The staff members in the physician's office should be willing to help patients. 13. The office should respond to patients' requests promptly. 14. Patients should be able to trust the staff in the physician's office. 15. Patients should be able to feel safe in their transactions with the staff in the physician's office. 16. The staff members should be polite. 17. The staff members should get adequate support from these offices to do their jobs well. 18. The office should not be expected to give patients individualized attention. 19. The office should not be expected to give patients personal attention.

Further reading
Gale Research (1995), ``Origins of US Hispanics'', Hispanic Market Handbook. US Bureau of the Census (1990), Current Population Survey, Washington, DC. US Bureau of the Census (1990), Statistical Abstract of the United States, Washington, DC.

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Measurement in a cross-cultural environment: survey translation issues

Susan Y. McGorry

Qualitative Market Research: An International Journal Volume 3 . Number 2 . 2000 . 7481

20. Staff members should know what the needs of patients are. 21. The office should have all of its patients' best interests at heart. 22. The office should have office hours convenient for all patients. This part of the survey deals with your opinions of the clinic's services. Please show the extent to which you think the clinic has the feature described by each statement. Do this by selecting one of the five numbers below each statement. 1. The office has up-to-date equipment. 1 2 3 4 5 never always 2. The physical facilities are visually appealing. 3. The staff members are well-dressed and neat. 4. The appearance of the physical facilities of the office is in keeping with the type of services provided. 5. When the office promise to do something by a certain time, it does so. 6. When patients have problems, the physician and staff are sympathetic and reassuring. 7. The physician and staff are dependable. 9. The office provides its services at the time it promises to do so.

9. The office keeps patient records accurately. 10. The office tells patients exactly when services will be performed. 11. Patients receive prompt service from the staff in the physician's office. 12. The staff members in the physician's office are willing to help patients. 13. The office responds to patients' requests promptly. 14. Patients trust the staff in the physician's office. 15. Patients feel safe in their transactions with the staff in the physician's office. 16. The staff members are polite. 17. The staff members receive adequate support from these offices to do their jobs well. 18. The office gives patients individualized attention. 19. The office gives patients personal attention. 20. Staff members know what the needs of patients are. 21. The office has the patients' best interests at heart. 22. The office has office hours convenient for all patients.

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