Community Engagement in the Cultural Adaptation of Standardized Instruments Among Forcibly Displaced Populations: A Scoping Review

Background and Purpose: The efficacy of standardized instruments is often compromised due to a tendency to assume that an instrument’s validity extends to different times, places, and cultures. This limitation introduces biases and can affect sensitivity, specificity, and validity. The need for cultural adaptation of instruments is critical in the context of populations forcibly displaced into new cultural contexts. This scoping review aims to identify what is known from the literature about the methods of linguistically translating and culturally adapting standardized instruments among forcibly displaced populations. We developed review questions using the Joanna Briggs Institute (JBI) Population-Concept-Context framework to identify strategies used in translating standardized instruments and engaging participant communities in cross-cultural adaptation.

Methods: We used the JBI methodology for scoping reviews in developing our protocol (registered with Open Science Foundation) and utilized the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews framework and checklist. We followed the Arksey and O’Malley five-stage methodological framework to ensure rigor, transparency, and replicability. We conducted comprehensive searches across APA PsycArticles, APA PsycInfo, Academic Search Complete, MEDLINE, CINAHL Complete, Health Source: Nursing/Academic Edition, Global Health, and Google Scholar. Following the search, we utilized Covidence to facilitate the screening process. We analyzed studies that met our predefined inclusion criteria using deductive content analysis to systematically address our review questions, following Hsieh and Shannon’s method in analyzing, collating, summarizing, and reporting results. This structured method of reporting facilitated an in-depth understanding of the strategies employed in culturally adapting standardized instruments.

Results: Our initial search yielded 2,061 studies, from which Covidence removed 773 duplicates. We excluded 1,205 studies through title and abstract review, leaving 83 for full-text assessment. Seven studies met our predefined inclusion criteria, with an additional study included from a hand search. Included studies (N = 8), published between 2006 and 2024, represented communities from six countries of origin, currently situated in second-country asylum (n = 3) or third-country resettlement (n = 5). We addressed our review questions through deductive content analysis, identifying approaches to the linguistic translation of standardized instruments and strategies for community engagement in the cultural adaptation process. Translation strategies detailed steps such as initial qualitative research, community involvement across translation phases, divergent views on back-translation, semantic equivalence issues, and challenges with cross-cultural translation. Community engagement strategies were approached by initial engagement efforts, the integration of community insights, and harnessing community expertise.

Conclusions and Implications: Findings emphasize the critical role of community engagement in the cross-cultural adaptation of standardized instruments. Key challenges identified include the absence of established guidelines, the problematic centering of colonial languages in back translation, the use of potentially biased response scales, and issues in applying Western psychiatric constructs to diverse populations. The studies underscore the value of involving community members and ensuring their active participation throughout the translation and adaptation processes. Findings draw attention to time and resource constraints, underscoring the need for increased funding. Such research is vital for achieving measurement accuracy, which is crucial for developing and evaluating interventions.