Theme 7 part 2
Cultural adaption of mental health measures: improving the quality of clinical practice
and research (Bhui K.)
This article summaries the main challenges in the cultural adaption of such measures
in the work with adults and adolescents of South Asian, African and Caribbean origin.
Conceptual issues
The preliminary selection of instruments must address the ease of translating the
conceptual targets.
This is a function of the conceptual proximity between the source and target
languages.
o How similar language can be (French and English is easier to translate vs
English and Somalian)
Even where the core experience and expressions of distress are experience and
expressions of distress are similar in two or more cultures, judgements about what
constitutes a symptom of ill- about what constitutes a symptom of illness, and the
threshold for diagnosis of psychopathology at different symptom levels, are not
always identical across cultures.
This may be tackled by employing interview-based measures administered by local
clinicians who are, perhaps, best placed to come to judgements about
psychopathological illness.
MINI it could be easier to use because it is filled with yes or no questions
Flaherty et al (1998) classified questionnaires according to their track record in cross
cultural settings. Three typologies emerged:
o Instruments with a proven cross-cultural equivalence.
o Instruments with established validity and reliability in the original culture but
not tested in other cultures
o Instruments with high face validity but untested in the country of origin.
Sartorius and Kuyken (1994) proposed a useful schema:
o The ethnocentric approach assumes total conceptual and psychometric
equivalence, so instruments are freely used across culture
o The pragmatic approach is advocated if there is a 60-75% overlap: this
involved limited adaptation, on the assumption that psychometric properties
are not significantly altered, and that conceptual limitations exist but are not
marked.
o If there is no conceptual overlap, then translation and validation are
impossible.
Translation issues
A major challenge is to ensure literal and conceptual equivalence and comparability at
multiple levels of meaning. So, translators must have sufficient experience. It is
crucial that they understand both languages and know about the cultural
understanding of mental distress and disorder.
It is recommended by Edwards (1994) to choose translators who have learn the
language of the original version as a second language, in preference to those who use
the source language as their dominant language. Another approach is translation by an
expert committee alternatively the committee may choose the most appropriate
, version produced by the translators and recommend modifications to maximize face
and content validity.
Validation measures
Face and content validity are ensured during the translation process, but can be further
strengthened by focus group, pilot studies and consultation with community
agencies.
Ensuring criterion validity requires a golden standard. This may be a psychiatric gold
standard with little or no cultural adaption to recommend it.
Relativistic ideologies argue for incomparability across cultures owing to an emphasis
on context, behavior, and indigenous concepts of distress rather than indigenous
concepts of distress rather than psychiatric constructs. In the future, more authentic
interpretations of data must acknowledge the methodological trade-offs and the
limitations.
Using imported measurement would be not that smart because people who are
imported probably will become westernized. So it would only work if they are just
migrated.
Clinical practice
Interpreters can help where there are language difficulties, but in a clinical situation,
triangulation with information from families about social functions, unusual
thinking and beliefs should be supplemented by a bilingual clinician’s
assessment.
Bias and equivalence in cross-cultural research (Jia He and Fons van de Vijver)
Introduction
This paper focuses on the methodological aspects of cross-cultural research, focusing
on two key concepts: bias and equivalence.
o Bias: nuisance factors that jeopardize the validity of instruments applied in
different culture. Bias does not refer to random errors but to systematic
measurement anomalies that are expected to be replicable if a study were to be
repeated.
o Equivalence: level of comparability of scores across culture. This is a
characteristic of cross-cultural comparisons and not an intrinsic property of
instruments.
Instruments choice in cross-cultural studies
Adoption: amounts to a close translation of an instrument in a target language. This
option is simple to implement, cheap, has high face validity, and retains the
opportunity to compare scores obtained with the instrument across all translations.
o This approach has an important limitation, it can only be used when items in
the source and target language have an adequate coverage of the construct
measured.
o This option is only available if the construct and instrument are taken to be
adequate in all cultural groups involved.
Cultural adaption of mental health measures: improving the quality of clinical practice
and research (Bhui K.)
This article summaries the main challenges in the cultural adaption of such measures
in the work with adults and adolescents of South Asian, African and Caribbean origin.
Conceptual issues
The preliminary selection of instruments must address the ease of translating the
conceptual targets.
This is a function of the conceptual proximity between the source and target
languages.
o How similar language can be (French and English is easier to translate vs
English and Somalian)
Even where the core experience and expressions of distress are experience and
expressions of distress are similar in two or more cultures, judgements about what
constitutes a symptom of ill- about what constitutes a symptom of illness, and the
threshold for diagnosis of psychopathology at different symptom levels, are not
always identical across cultures.
This may be tackled by employing interview-based measures administered by local
clinicians who are, perhaps, best placed to come to judgements about
psychopathological illness.
MINI it could be easier to use because it is filled with yes or no questions
Flaherty et al (1998) classified questionnaires according to their track record in cross
cultural settings. Three typologies emerged:
o Instruments with a proven cross-cultural equivalence.
o Instruments with established validity and reliability in the original culture but
not tested in other cultures
o Instruments with high face validity but untested in the country of origin.
Sartorius and Kuyken (1994) proposed a useful schema:
o The ethnocentric approach assumes total conceptual and psychometric
equivalence, so instruments are freely used across culture
o The pragmatic approach is advocated if there is a 60-75% overlap: this
involved limited adaptation, on the assumption that psychometric properties
are not significantly altered, and that conceptual limitations exist but are not
marked.
o If there is no conceptual overlap, then translation and validation are
impossible.
Translation issues
A major challenge is to ensure literal and conceptual equivalence and comparability at
multiple levels of meaning. So, translators must have sufficient experience. It is
crucial that they understand both languages and know about the cultural
understanding of mental distress and disorder.
It is recommended by Edwards (1994) to choose translators who have learn the
language of the original version as a second language, in preference to those who use
the source language as their dominant language. Another approach is translation by an
expert committee alternatively the committee may choose the most appropriate
, version produced by the translators and recommend modifications to maximize face
and content validity.
Validation measures
Face and content validity are ensured during the translation process, but can be further
strengthened by focus group, pilot studies and consultation with community
agencies.
Ensuring criterion validity requires a golden standard. This may be a psychiatric gold
standard with little or no cultural adaption to recommend it.
Relativistic ideologies argue for incomparability across cultures owing to an emphasis
on context, behavior, and indigenous concepts of distress rather than indigenous
concepts of distress rather than psychiatric constructs. In the future, more authentic
interpretations of data must acknowledge the methodological trade-offs and the
limitations.
Using imported measurement would be not that smart because people who are
imported probably will become westernized. So it would only work if they are just
migrated.
Clinical practice
Interpreters can help where there are language difficulties, but in a clinical situation,
triangulation with information from families about social functions, unusual
thinking and beliefs should be supplemented by a bilingual clinician’s
assessment.
Bias and equivalence in cross-cultural research (Jia He and Fons van de Vijver)
Introduction
This paper focuses on the methodological aspects of cross-cultural research, focusing
on two key concepts: bias and equivalence.
o Bias: nuisance factors that jeopardize the validity of instruments applied in
different culture. Bias does not refer to random errors but to systematic
measurement anomalies that are expected to be replicable if a study were to be
repeated.
o Equivalence: level of comparability of scores across culture. This is a
characteristic of cross-cultural comparisons and not an intrinsic property of
instruments.
Instruments choice in cross-cultural studies
Adoption: amounts to a close translation of an instrument in a target language. This
option is simple to implement, cheap, has high face validity, and retains the
opportunity to compare scores obtained with the instrument across all translations.
o This approach has an important limitation, it can only be used when items in
the source and target language have an adequate coverage of the construct
measured.
o This option is only available if the construct and instrument are taken to be
adequate in all cultural groups involved.
