Cultural adaptation commonly involves forward and back translation and committee review [9, 10, 14, 15]. Discrepancies exist around (a) the number of translators used and their qualifications, (b) whether to perform back translation processes on each forward translation or a synthesized version, (c) recruiting additional personnel for synthesis processes needed to produce a single translated version, (d) committee review composition and size, and (e) sample size recommendations for pilot testing [9, 10, 14, 15]. These discrepancies may be related to feasibility, such as the lack of available qualified translators and cost.
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To identify revisions required to achieve semantic and idiomatic equivalencies when developing culturally adapted versions of the YC-PEM. We hypothesize that a greater number of changes are required to achieve semantic and idiomatic equivalencies of the culturally adapted and translated version of the YC-PEM than the non-translated version.
There are several ways to interpret the differences in results. One possible explanation is that Lim and colleagues [23] pursued a transnational cultural adaptation without translation (i.e., from North America to Singapore), whereas this study focused on cultural adaptation without translation for use within the same country in which the instrument was originally developed. It is possible that a transnational context resulted in a greater number of revisions required to achieve semantic equivalence without translation. Alternatively, differences in results may be attributed to use of questionnaire versus caregiver interview for cognitive testing, as was used by Lim and colleagues [23]. Questionnaires afforded feasible data collection but may have limited opportunities to ask clarifying and probing questions. Thus, results of this study may underestimate the revisions required in order to achieve semantic and idiomatic equivalencies for the non-translated (English) version.
Audio recordings were transcribed verbatim. Spanish transcripts were transcribed and analyzed in Spanish. (Research assistants translated selected quotes chosen for inclusion in an English language journal at the end of the analysis process.) The initial coding book was built from the interview/focus group guides and inputted into ATLAS.ti 7.5.16 Qualitative Data Analysis software (ATLAS.ti Scientific Software Development GmbH, Berlin, Germany). Two research assistants independently coded the first transcript. The original codebook was then modified to include new codes that emerged. Data was recoded and compared to verify concordance. Discrepancies were discussed, and another three transcripts were then double coded and compared. At this point, concordance was near 100%, and subsequent transcripts were single coded with close supervision. The second phase of grounded theory-based analysis consisted of conceptual coding [24]. For this phase, we used the query tool in ATLAS.ti to merge all the text associated with one particular code across all the transcripts. A team including the principal investigator, project manager, research assistants, and a co-investigator met to create conceptual categories. First, the key informant-coded data were reviewed. Data associated using the query tool were read together line by line by the team and then assigned to corresponding preliminary domains by group consensus. After reviewing all the data once, the team again reviewed and modified the preliminary domains to further distill the primary domains. The same process was done with focus group data. Then focus group and key informant primary domains were combined into the final domains by the team. During this process, areas of concordance and discordance were identified and emphasized. Lastly, the data from the site observations were reviewed by the team to identify areas where key informant and caregiver data could be verified, expanded, or contradicted. We looked at the notes, maps, and photos to identify spaces where recruitment, data collection, and intervention delivery could occur; we were assessing for visibility for recruitment and intervention delivery but also privacy for data collection. We examined the educational and client support materials on walls and shelves to determine interest in oral health and the target age group. These observations were incorporated to complete the final domain data.
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