Keywords

Cultural beliefs and values shape individuals’ understanding of health, interpretation of the changes of health status, and perception of the acceptability of health interventions (Givens et al., 2007; Killoran & Moyer, 2006). For instance, health measures are developed based on specific beliefs and values that represent those prevalent in the scientific community and the dominant culture. Therefore, language barriers and cultural beliefs impacts people’s ability to understand and respond to these tools (Warnecke et al., 1997), limiting the meaningfulness of data collected. It is imperative to enhance the cultural comprehensibility of translated and adapted mental health scales.

Cultural comprehensibility is closely associated with semantic equivalence. When displaying semantic equivalence, an instrument item is comprehensible (van Ommeren et al., 1999). An incomprehensible translation, on the contrary, lacks semantic equivalence (Flaherty et al., 1988). Assessing comprehensibility entails determining the extent to which the content of the items on the translated and adapted scale can be clearly understood by target-language readers (Sidani et al., 2010). Therefore, we must pay close attention to well-considered planning before translation and to meticulous operation during translation. Before translation, we need to clarify the definition and indicators of the concept captured by selected instrument items to gain a better understanding of the meaning involved, while sharing target-language words or expressions that best capture the content and response options of these items (Sidani et al., 2010). During translation, we need to attach great importance to rendering the meaning of the items rather than to translating the items word for word, and to choosing simple, clear wording that can be easily understood by a target audience with lower educational attainment (i.e., Year 6) (Banville et al., 2000; Eremenco et al., 2005).

Because of cultural disparities, particular concepts that are obvious to one cultural community might be entirely incomprehensible and obscure to another. To facilitate comprehensibility, some researchers, like Brislin et al. (1973) and McGorry (2000), advocated “decentering,” a strategy of rewording the source-language items in the simpler terms and sentence structures or examples to promote comprehension, which is referenced by much of the literature on translation currently cited in the domain of mental health (Brislin, 1980; Carlson, 1997; Cha et al., 2007). Rather than regarding the source text as static and unchangeable, decentering entails considering the source and target texts equal in importance and allows for modifications of the source text during translation to ensure equivalence between these two texts (Black, 2018). Take the translation and adaptation of “become romantically involved with someone” in the item “I would be less likely to become romantically involved with someone if I knew they were mentally ill” on the Prejudice towards People with Mental Scale (Kenny et al., 2018). We translated “become romantically involved with someone” into an easily understandable Chinese expression “谈恋爱” to help our target readers understand the translated item and thus the intended semantic meaning of the original item. In the same vein, “a close relationship” and “on an emotional roller coaster” in the item “A close relationship with someone with a mental illness would be like living on an emotional roller coaster” on Day’s Mental Illness Stigma Scale (Day et al., 2007) were translated and adapted into the Chinese expressions of “谈恋爱” and “情绪可能会不太稳定, 会经历情绪上的大起大落” respectively to enhance cultural comprehensibility. Based on our expert panel discussion, we reworded the Chinese literal translations of “a close relationship” that is obvious to readers of the source (English) language but entirely obscure to readers of the target (Chinese) language, and of the metaphorical expression of “on an emotional roller coaster” that is likely to be misleading or puzzling among the intended Chinese populations. The reworded Chinese versions of “谈恋爱” and “情绪可能会不太稳定, 会经历情绪上的大起大落” are the most appropriate translated versions, not only retaining the original meaning of the concept in the source instrument (Leplege & Verdier, 1995), but also using idiomatic cultural expressions of the target language that are expressed in simple, easily-comprehensible wording (Sidani et al., 2010). In this way, semantic equivalence is established between the source and target items, ensuring the cultural comprehensibility of the adapted item among Chinese populations.