Forward and backward translations are necessary (preferably reviewed by the questionnaire author) to ensure that the translations have not introduced semantic discrepancies.
We found minor grammatical and semantic discrepancies in certain items (item 2, 4, 5, 6, 7, 11, 13, 15, 17) that were adapted to local dialect by consensus.
Only nonredundant nonalignments were stored and exported, as examining redundant nonalignments to assess whether there are true semantic discrepancies entails additional, unnecessary effort and biases statistics.
In Phase 3, five university lecturers at the authors' college (native English speakers) compared the original scale and the back-translation brought about by Phase 2, and checked for semantic discrepancies.
We then combined these two English translations into one by reaching a consensus with the two translators in the same way as in Step 1. Afterwards, two bilingual individuals, whose native language was English, checked for any semantic discrepancies between the Japanese translation in Step 1 and the backward translation in Step 2. All these backward translators were blinded to the original scale.
By sharing back translations of the initial and the modified Canadian versions of the ACT and by carrying out the subsequent analysis and dialogue, the Swedish researchers and the Canadian instrument developers were able to detect important linguistic and semantic discrepancies.
The translators discussed semantic and conceptual discrepancies and finally developed a consensus-based forward translation.
In the second and third stages, expert and focus group review, some minor semantic and idiomatic discrepancies were discussed at length.
Problems encountered in achieving cross-cultural equivalence included discrepancies in semantic equivalence (vocabulary and grammar), idiomatic equivalence (idioms and colloquialisms) and conceptual equivalence (disease-related).
5 Another consensus meeting was held, during which one native English speaker and two bilingual Thai researchers compared the translation with the original English version to check for conceptual discrepancies and semantic equivalence.
