18. Guidelines for the Translation of Questionnaires

The following Steps are recommended for the translations of questionnaires

1. The questionnaires are translated by one or more persons who are bilingual and familiar with the area in which the questionnaire will be used.
2. In order to find the most appropriate translation for difficult terms, e.g.: “wheezing” or “whistling in the chest”,it is proposed to:
   1. Ask local doctors about local words to describe these terms.
   2. Ask children with asthma and parents of children with asthma how they would describe the breathing during an asthma episode.
   3. Show the video and ask children with asthma and parents of children with asthma how they would describe the breathing of the children and adolescents in the video.
   4. Submit a list of possible descriptors to children with asthma and parents of children with asthma and ask them to indicate, e.g. using a rating system, which description(s) they favour best.
3. The most appropriate translation should be agreed upon among a group of national experts on the basis of 2(a) – 2(d). The national questionnaires should allow for differences in the wording of questions according to the local use of language.
4. The questionnaires are required to be translated back into English by an independent translator. Modifications should be made if necessary.
5. The questionnaires should be tested in populations that are representative of the study population. Modifications should be made if necessary.
6. Steps 2 to 5 are repeated if necessary.

Comment
The translation of questionnaires is a key issue for the validity of comparisons involving non-English speaking countries. It is recognised however, that the Steps 2(c) and 2(d) may be too costly for some countries or centres and that those countries or centres may decide to leave them out. The translated questionnaires must have the same structure and logic as the original. In addition, we draw the attention to the need that the translations must be understood by the children and parents. Thus, the translations should apply the language which is used by the children and parents themselves and experience from Germany shows that it may well differ from the terminology of medical professionals¹³⁴.

NOTE
The language used, should be pre-coded onto the questionnaire prior to printing the questionnaires. Most languages have been listed in section 20.3 of this Manual and coded. Please use the codes provided. If your language is not listed, please contact the GAN Global Centre for a code number to be issued (contact details section 21).

An example of how these codes can be inserted into the questionnaire is shown in section 20 as well as more details on the use of the ‘office use only’ boxes.