Translation of questions: the international study of asthma and allergies in childhood (ISAAC) experience

Abstract

OBJECTIVE: To explore the consequences of translating the International Study of Asthma and Allergies in Childhood (ISAAC) English core questionnaires on asthma, rhinitis and eczema symptoms into other languages. DESIGN: ISAAC Phase III developed 49 language translations for adolescents and 42 for children following standardised guidelines, which included back-translating the questionnaires into English to check their accuracy and meaning. Language deviations were categorised and analysed with regard to influences on the reported symptom prevalence. RESULTS: Category 1 deviations for one or more questions were found in seven translations (14%) for adolescents and in three translations (7%) for children. Data for these questions were excluded from the worldwide analyses. Category 2 deviations were identified in the publications, and Category 3 deviations were ignored. CONCLUSIONS: Translations of questionnaires should follow a consistent protocol in global epidemiological research. Cultural norms need to be considered when evaluating back-translations into English, as disease labels are not available in every language, nor are they understood in the same way. Deviations from literal translations of English should be permitted if the intent of the original meaning is retained. A web-based tool of medical terminology would be useful for international research requiring the use of translations.