Skip to main content

Table 1 Overview of the cross-cultural adaptation process, based on [27, 28]

From: Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland


Description of how each step was performed

Step 1. Preparation

The instrument developer (last author) permitted the process and agreed to be involved.

Step 2. Forward translations

Two separate forward translations were carried out individually by two native Icelandic speakers who were fluent in English, one a professional translator and the other a health professional; both also experienced researchers in their field. The focus was to avoid literal translation and capture the conceptual meaning of the items.

Step 3. Reconciliation

The first author, a native Icelandic speaker, met with the translators to synthesize the results of the translations. They compared and discussed the differences between the two translations. Ambiguities and discrepancies were examined to create a single forward version.

Step 4. Back translation

Back translation of the reconciled translation was performed by a native English speaker who was fluent in Icelandic. The back translator was an experienced researcher in the field of health sciences but had no prior knowledge of the instrument and had not seen the two forward translations.

Step 5. Back translation review

The first author reviewed the back translation against the source instrument to identify any discrepancies and ensure the conceptual equivalence of the translation. Clarification and recommendations were sought from the instrument developer (last author, a native English speaker and a skilled researcher).

Step 6. Expert committee review

A multidisciplinary committee reviewed all the versions of the instrument (steps 2, 3, and 4) and developed the pre-final version of the translation. The committee consisted of a methodologist and two health professionals (nurse and psychologist) experienced with working with survivors of violence. The committee’s role was to make recommendations to achieve semantic, idiomatic, experiential, and conceptual equivalence between the source and target instruments.

Step 7. Pretesting through cognitive interviews

Two rounds of cognitive interviews were conducted with participants drawn from the target population. The goal was to explore comprehensibility, interpretation, and cultural relevance of the pre-final version. The interview data were analyzed using qualitative content analysis.

Step 8. Review of pretest results

The results were reviewed, and desirable modifications identified. The pretesting, being of particular importance for cultural adaptation, is described in more detail in the sections below.

Step 9. Finalization and proofreading

Following agreement on adjustments, the translation was finalized. In this final quality control step, the translation was proofread by one of the forward translators, which checked for any remaining spelling or grammatical errors.

Step 10. Final report

Each step was thoroughly documented during the process, allowing tracking of all the decisions made. This article represents the final step of the process, where a report is written on the development of the Icelandic version of the scale.