Translation of the PROFILE of Adaptation to LIFE-MEDICAL Psychosocial Screening Instrument Into SPANISH

Background and Purpose: This paper will describe the process of translating the Profile of Adaptation to Life-Medical (PAL-M)—a rapid psychosocial screening instrument—into Spanish for use with cancer patients and other medically ill patients at the NIH Clinical Center. The PAL-M has been demonstrated to be a reliable and valid instrument for identifying patients in need of social work assessment and intervention (BrintzenhofeSzoc, Aron, Jacobsen, Koziol, & Callahan, 2007). It is a 31-item Likert-type multi-dimensional instrument that queries multiple dimensions of a patient's life, including psychological, interpersonal, financial, employment, somatic and substance use/abuse domains. It is beneficial for clinicians to be able to use the PAL-M with their Spanish-speaking patients, yet imperative to produce the most relevant translation possible that goes beyond mere back translation (often fraught with error and unintended meanings). The paper will explain how the researchers undertook the process of cognitive interviewing at the NIH with patients and family members who served as language experts to ensure that the instrument's translation was culturally and linguistically germane. The study objective was to produce a Spanish translation of the PAL-M that could be used with patients from different Spanish-speaking countries with language that was widely applicable, as the NIH Clinical Center has a large Spanish-speaking patient population not only from the U.S. but also from around the world. This hospital has a growing transplant program in which early psychosocial screening and identification of risk factors as part of the intake process are critical.

Methods: The researchers employed a qualitative strategy of cognitive interviewing (Willis, 2005) that encompassed think-aloud and retrospective questioning with patients who examined the PAL-M's questions. Researchers asked participants about their perceptions of the questions, thoughts about unclear wording, suggested changes, and feelings evoked by sensitive questions (e.g., depression and alcohol and drug use). The researchers used a convenience sample of ten participants—conducting the interviews one at a time—ensuring diversity in gender, education, age, and country of residence. All cognitive interviews were transcribed, and responses were collated and analyzed item by item for determination of the best possible wording for a final version of the instrument in Spanish.

Results: Participants offered suggestions regarding culturally-appropriate and relevant wording changes, phrasing, and use of colloquialisms, especially for questions regarding use of alcohol and drugs and their effect on relationships. Participations suggested changes in wording to correct their misperceptions due to unclear wording and to make items clear and comprehensible in Spanish. The investigators noted how translation involved variation and subtlety as different words connoted variability in describing mood, quality of interpersonal relationships, and psychosocial and financial stress. Based on participant feedback, the researchers selected the most relevant wording to test in the final version.

Conclusions and Implications: Cognitive interviewing is a critical yet rarely reported aspect of instrument translation and development for use in other languages. Given that many hospitals and clinics are serving cancer patients from a variety of cultures and nationalities, psychosocial screening instruments that identify their distress must “speak their language.”