Table 6 Translation Issue and Revision

English source language term did not incite further elaboration in probing as did the translated term

Scale Item (Self-efficacy): “I am confident that testing three separate bowel movements would not be inconvenient.” The word “inconvenient” was translated as “hard to do” in the Urdu language version during translation. “Inconvenient” is an English term to convey problematic or difficulty with a task. This was comprehensible in Urdu and resulted in participants using other meaningful responses during verbal probes such as: “difficult for me”, “not easy to take test on different time because I am very busy and have day care”, “a problem”, “not easy, takes time”, and “takes me out of my way to get it”. In English, the word “inconvenient” did not provide as meaningful responses to verbal probing, for example: “too much trouble”, and “uncomfortable” were terms used. Upon further discussion at the joint collaborative analysis meeting, the cognitive interviewer indicated that “uncomfortable” related to the stool collection process and the impact on the individual to do this in a given day.

No modification was made to the English version of the item. As this was a minor issue, it was decided that providing additional training to interviewers on non-leading probing was satisfactory. Therefore, interviewer instructions were added to stimulate more meaningful responses, particularly for English language participants. We used Urdu language participants’ responses to refer to in terms of the appropriate probing descriptors that should emerge.

English language