We retained the questions as written in the original Trust and Teambuilding Scale, but found it necessary to ensure conceptual equivalence of translated items, not literal translation [ 41].
As the emphasis was on conceptual rather than linguistic translations, some of the translated items took a different form from the UK original.
Subsequently, local experts reviewed disagreements between the original and the translated items and discussed them with a team of translators and local counselors to optimize conceptual and semantic equivalence as well as acceptability and relevance to the local culture.
They discussed the original and translated items until a consensus was reached about the correct translation.
The judges, blinded to the translators and to each other's ratings, they rated the translated items for three factors: applicability (can these items be used by researchers in Lebanese NHs?), adaptability (are caregivers or the elderly able to answer or perform a task described in the items?), and suitability (are the items appropriate for the elderly in Lebanon?
Individual cognitive interviews were then conducted with six cancer patients to evaluate the wording and understanding of the translated items.
In total, 123 translated items were divided into two questionnaires (A and B) per symptom, to reduce participant burden.
In addition, translating items creates the potential to lose integrity in the equivalency of what is being asked from one country to other country (Ram 2007).
The working group and particularly the patient representative paid specific attention to whether the translated items and topics made sense the context of measuring quality of life for patients with OSA, to ascertain that the translators had not made misinterpretations.
The final translated items used for data collection were generated through consensus on the wording, clarity and cultural equivalence of items (refer to supporting file, File S1, for the translated scale).
