Keywords

Cultural disparities must be considered not only when multiple languages are spoken in different countries, but also when one language is spoken in more than one country or in different regions within a country (Kuliś et al., 2011). As such, cultural factors need to be appropriately dealt with in the translation of instruments developed in the source languages and cultures into the target languages and cultures. To solicit valid data, translated and adapted mental health scales must be culturally acceptable to the target readers. Cultural acceptability is closely associated with technical equivalence. When displaying semantic equivalence, which means that “the method and impact of evaluation remain consistent,” an instrument item is acceptable (van Ommeren et al., 1999, p. 534).

The cultural acceptability of translated mental health scales can be easily undermined by cultural-dependent issues. Such issues can be divided into two types: specific cultural issues and topical cultural issues. Specific cultural issues involve any specific concepts that may not be known to other cultures; topical cultural issues are related to questionnaire items that are associated with sensitive or offensive topics in particular cultures (Kuliś et al., 2011). These two categories of cultural issues need to be prioritized in the translation and adaptation of mental health scales to enhance cultural acceptability.

Concepts specific to certain cultures must be adapted to the target culture. This is because particular concepts that are obvious to one group of people may be completely obscure to another (Kuliś et al., 2011). Item 7 on the Psychiatric Scepticism Scale (Swami & Furnham, 2011) can serve as a good example of such a potentially obscure concept in an adapted Chinese scale. This item reads: “Psychiatry inappropriately excludes other approaches (e.g. alternative medicine) to mental distress.” For western readers, like Australians or Americans, “alternative medicine” is clearly defined and stands in stark contrast to mainstream, evidence-based western medicine. When being forcefully translated literally into “替代医学,” Chinese readers would be most likely to be confused in terms of what this translation drives at, for such a Chinese version does not make any sense in the context of Chinese language and culture due to the lack of such a concept or construct in Chinese language and cultural settings. Considering the unacceptability of this Chinese version to Chinese readers, we rendered “alternative medicine” into “非西医的各种传统医学” (various traditional medicines other than western medicine) and provided specific instances, “针灸” (acupuncture) and “草药” (herbal medicine), for this relatively abstract translation to enhance acceptability. A similar good case in point is “the clergy” in Choice E of Item B5a “Most people in treatment for depression are treated by which of the following?” on the 33-item Version of the Multiple-Choice Knowledge of Mental Illnesses Test (MC-KOMIT) (Compton et al., 2011). In western countries, like Australia and America, “the clergy” is a household name, but this concept is entirely new or strange to the Chinese culture. The forced, literal translation of “神职人员” would thus be unacceptable to Chinese readers who never engage in a relevant lived experience with a clergy. Considering this, we deleted this choice from the translated Chinese item. Choice C “Primary care physicians” in the same item could also be misleading to Chinese readers if being translated into “初级保健医生” literally or into “社区医生” using a foreignization translation approach. There is no “初级保健医生” or “社区医生” in mainland China, where people usually go to hospital to visit and consult a doctor when they are out of condition physically or mentally. Such a practice is different from that in Europe, America, and Hong Kong, where individuals first visit and consult their “primary care physician” before it is necessary to go to hospital with a referral from the latter. This is true for Choice B “Family therapist” in the same item. Since there is no “family therapist” in mainland China, the Chinese translation of “家庭治疗师” is, therefore, equally unacceptable to Chinese readers. Considering the unacceptability of the Chinese translation of these choices of Item B5a on MC-KOMIT (Compton et al., 2011), we deleted this item from the translated Chinese scale.

Sensitive or offensive topics or terms in particular cultures pose great obstacles to the translation of mental health scales. While sexuality can be a topic open to discussion in some western cultures, it is a taboo topic in the majority of eastern societies. Kalra et al. (2015) discussed the relationship between sexuality and mental health. Although we acknowledge that sexuality can positively contribute to mental health, we need to pay close attention to rewording when translating sex-related items on mental health scales. The solution to translating such items is to retain these problematic items but to thoroughly scrutinize each possible option of rewording through pilot tests among people (Kalra et al., 2015). The terms and constructions suggested by pilot-testing respondents can be relatively more acceptable to the target readers. Each suggestion should be subjected to analysis by an expert panel consisting of bilingual translators, mental health professionals, content experts, and scale developers in terms of acceptability from the perspectives of the source and target cultures. In this way, the best rewording can prove to be the preferable solution to the problematic items and is finally confirmed by respondents through additional interviews.