All translations and adaptations of Professor Clare Bradley’s questionnaires for use in a target country are subject to a rigorous Linguistic Validation (LV) process to ensure that they are understood in the same way across languages and countries. This means data collected from respondents in different countries can be combined or compared. The aim is to make these other language versions read as if they had been designed from the beginning in the target language rather than translated from another language.

All translations are linguistically validated for use in a particular country and will need to be adapted for use in any other country (or with any other community) where the language is spoken. This applies to English as well as other languages. Examples include:

• Arabic (for Israel, Lebanon, Saudi Arabia and other countries)
• French (for Switzerland, Canada) 
• German (for Austria and Switzerland)
• Italian (for Switzerland) 
• Portuguese (for Brazil)
• Spanish (for USA, Mexico, Peru and other countries)

When a questionnaire is translated into a new language, the full LV process is required. Where full LV has already been applied for a language in one country and the same language is now needed for another country the shorter linguistic adaptation process may be more appropriate. Some language versions, however, are better done with a full LV process, using other same-language versions just as reference translations.

Linguistic validation certificates are available for licensees. These may be needed to support conclusions arising from use of other language versions of questionnaires licensed by Health Psychology Research. 

When funding is available, a new language or adaptation of an existing language can be done by a specialist translation company. Otherwise, researchers may have the option to produce translations for their own use if they have the resources to follow the LV process we require. Such translation will have to be done in close collaboration with the LV team at HPR to ensure that other language versions being produced maintain their equivalence to the original English version. You can read more about the LV process and contact us to discuss potential LV projects.

If a new language or adaptation of an existing language is needed for a study, the Linguistic Validation (LV) work can be done commercially by a specialist translation company and usually takes approximately 4 months. If funding is not available for this, researchers may be permitted to produce translations for their own local use in non-commercial projects, if they have the resources to follow the LV process we require.

You must have a licence from Health Psychology Research to translate and to conduct LV of one of Prof. Bradley’s questionnaires. Prof. Bradley retains full ownership of translations. Both commercial and non-commercial translations and adaptations are done in close collaboration with the LV team at Health Psychology Research, who review the outcome of each step of the LV process. The process of LV, without funding to pay a specialist translation company, can take 8 months or more, depending on the language, the questionnaire and the time available to do the work. Adaptations to the same language for a different country take less time but require parts of the same procedure to be followed. 

The LV of a questionnaire is a major undertaking. If doing the work on a non-commercial basis, you need to put together a very competent team of people and make sure you have enough time in which to complete the project satisfactorily before you need to use the questionnaire in your study. We would advise you to allow a minimum of 8 months.  

If you do not have the funds for commercial LV work and you wish to translate or adapt a questionnaire using your own resources, in collaboration with Health Psychology Research, we would first need to check the suitability of your LV team and, upon approval, sign an agreement which would grant you a licence to translate/adapt the questionnaire and use it in your study. We will be happy to provide a licence for you if we are confident that your team will be able to produce a translation of the standard that we require. We will discuss with you which route (linguistic adaptation or full LV) would be best for the language concerned and will provide support with the LV process where possible. 

For new translations the Linguistic Validation (LV) team needs to include: 

• Co-ordinator with an appropriate background (e.g. medical, nursing, psychological or similar academic background)
• 2 forward translators and 1 person reconciling the forward translations 
• 1 back translator (we will provide the second)
• Psychologist and/or clinician in relevant speciality
• Interviewer for Cognitive Debriefing, usually with 5 patients with the relevant condition
• Proof-reader

Two key people in the team are (1) the person co-ordinating the project and (2) the person reconciling the two forward translations. Both must have the target language as their first / native language (for the target country) and be able to show evidence of fluency in English (e.g. educated/trained/worked at least partly in English). If the LV work is being carried out on a non-commercial basis, at least one of the two forward translators should ideally be a professional translator. The back translator should have English as their first/native language and be fluent in the target language.

For non-commercial projects, a team member may take on more than one role. For example, the co-ordinator may also review the questionnaire as a clinician or psychologist, if they have the relevant expertise and linguistic skills. We will check the suitability of non-commercial LV teams before every non-commercial project begins and, if approved, we will prepare a licence agreement which would grant the licensee permission to translate and LV the required questionnaire.

Please note that for languages which are written other than from left to right, LV teams must include a member who can save the questionnaires in a file format that is fully readable by Microsoft Word and follow other requirements (e.g. questionnaire layout). Target language versions of the questionnaires are required from the FT stage until formatting of the final versions.

If adapting an existing language version for use in another country (e.g. Spanish for USA, Chile, Argentina or another), the forward and back translation steps are usually omitted, and instead an adaptation review is done by someone for whom the target language is their first / native language. After the adaptation review, the usual LV process is followed: clinician and/or psychologist review(s), cognitive debriefing interviews with five patients with the relevant condition and proofreading. The proof-reader will need to have the target language as their first/native language (for the target country). Read more about the LV process here.

The Linguistic Validation (LV) process is divided into the following parts:  

• Forward and back-translation

Two parallel forward translations (from English to the target language) are prepared by two independent translators. A third person reviews, notes down any discrepancies and reconciles the two forward translations to prepare the 1^st intermediate forward translation. Two parallel back-translators then, independently of each other, translate the intermediate forward translation back into English. A member of Health Psychology Research (HPR) reviews and highlights any discrepancies and concerns, which are discussed with the LV team’s co-ordinator and revisions are made, if necessary.

• Clinician and/or psychologist reviews

A member of HPR reviews the suggestions and decisions resulting from the psychologist’s and clinician’s reviews and these are discussed before proceeding to interviews with patients. 

• Cognitive debriefing with patients

The person conducting the interviews prepares a detailed report which is reviewed by the co-ordinator and HPR and any proposed revisions are discussed. Where necessary, changes to the translations are made and these are re-tested with patients.

• Proofreading and finalisation

Formatting improvements are made using the original English questionnaire as a template and the licensee’s LV team must be able to reformat the questionnaires in the target language to the required standard of HPR. Finally, all new translations/adaptations are proofread by at least one person with the target language as their native language. HPR then prepares the final PDF of the questionnaire in the target language.

For adaptations, i.e. when adapting a language for use in another country or community, the first forward and back-translation step is not usually needed. 

Please see our LV process document or LV flowchart for more information.