Thank you for your interest in translating and/or culturally adapting these instruments.

Before submitting a translation request, please take a moment to check the Feeding Flock Tools page to see if the tool has already been translated. We appreciate your cooperation—thank you!

We have taken great care to develop these instruments in a psychometrically-sound way. To maintain the integrity of the tool, we ask that you translate the first two introductory pages as well as the tool itself, including directions and scoring options, following the appropriate process for translation and cultural adaptation of health-related instruments. These steps have been adapted from various sources as listed in the reference section (Acquadro et al., 2008; Beaton, Bombardier, Guillemin, & Ferraz, 2000; Carter et al., 2005; Gjersing, Caplehorn, & Clausen, 2010; Maneesriwongul & Dixon, 2004; Perneger, Leplege, & Etter, 1999; Sousa & Rojjanasrirat, 2011; Wang, Lee, & Fetzer, 2006; Wild et al., 2005). You can also refer to the PROMIS guidelines for translation and cultural adaptation (available at: link)

Please Note: All steps and revisions must be carefully documented and may be requested by the original authors for review. Steps 1 – 4 are required before the instrument can be used in clinical practice, and Steps 5 and 6 are additionally required for research use.

Step 1

• Simultaneous forward-translation (i.e., translation from English to the new language) by two native speakers of the new language. These two translations are to be done independent from each other.

Step 2

• A third native speaker then looks at the two forward-translations created in step 1, reconciles the differences, and decides on the ideal forward translation. This may be done as a team.

Step 3

• A fourth native speaker (who has not been involved previously and who has not seen the original instrument) then back translates the version of the instrument created in step 2 into English (i.e., translates from the new language to English).

Step 4

• A team of people then needs to review and reconcile issues with the back-translated English version created in step 3 to compare it to the original instrument. This team should include at least one of the original tool authors, as many of the translators that have been involved as possible, at least one professional with experience caring for children with feeding problems who is a fluent speaker of the new language, and for all tools except the EFS, at least one lay person who is a parent of a young child. If a lay person/professional was a translator, they may fill both of these roles. The EFS has an exception because it is not intended to be completed by a parent.

Step 5

• If possible, cognitive interviews in the new language should be conducted with 5-10 parents of children with feeding difficulty to ensure that that the language used in the translated version is understandable to parents. For the EFS, instead of parents, the cognitive interviews would be conducted with nurses or therapists familiar with preterm infant feeding. Please see tool publications on the development of the instruments for details on the process of cognitive interviews (e.g., Pados, Estrem, Thoyre, Park, & McComish, 2017; Thoyre et al., 2014). The cognitive interviews will ensure content validity in the new language.

Step 6

• Psychometric testing of the instrument in the new language will need to be conducted before it can be considered a valid and reliable measure, including internal consistency reliability, test-retest reliability, and construct validity with another related measure available in the new language that has strong psychometric properties. Please see the tool developer’s publications on the process of psychometric testing for guidance on this process (Thoyre et al., 2017).

Should a factor analysis of the translated tool be conducted?

• Factor analysis – confirmatory or exploratory – is not needed. Negative consequences of conducting a factor analysis should be carefully considered before deciding to conduct this type of study. A factor analysis of a newly translated tool will likely derive different results than the original factor analysis. No sample is exactly like a prior one so a new factor analysis is likely to result in the addition or loss of a subscale, the loss of an item or items, and/or the movement of items from one subscale to another. If the number of items or subscales or location of items of the original tool are altered, the integrity of the tool will have been altered. The altered tool will no longer be able to be scored using the original tool’s scoring system and study findings using the altered tool will not be comparable to studies using the original tool. Protecting the scoring system is especially important. Original research used age norming studies that were conducted with 1000s of children; the age- normed reference values are invaluable in determining when children need to be seen by experts and in tracking progress of feeding treatments. It would be a loss for you not to be able to use them. We therefore, advise against conducting a new factor analysis.
• Should you decide to conduct a factor analysis despite these cautions, please understand this is optional and not necessary. We recommend confirmatory factor analysis with careful attention to the sample size and the characteristics of the sample. A minimum of 5 participants per item are recommended for an acceptable factor analysis (DeVellis, 2012; Pett, Lackey, & Sullivan, 2003). For example, the PediEAT has 78 items so a minimum sample size of 390 participants will be required. In addition, a sufficient number of participants caring for children with feeding problems is required and needs to be similar to the sample used in the original factor analysis. For example, 54% of the PediEAT’s factor analysis sample were caring for children with a diagnosed feeding problem or a child with feeding concerns. It is also important to conduct a factor analysis with a sample that fully represents the age groups the tool is meant for. For example, the PediEAT is for children aged 6 months to 7 years so the sample needs to fully represent all of these ages. Violations of the sample size or characteristics of the sample will invalidate the translated tool’s factor analysis findings.

Publishing

After steps 1-6 have been completed, we encourage you to publish your findings in a peer-reviewed, relevant journal. Please be aware that there are predatory publishers who will publish articles for a monetary fee, but do not follow the widely-accepted ethical standards for publishing practice. Feel free to consult with one of the original authors if you are unsure about the selection of a journal for publication. It is important to us that any publication that comes from our work meet standards for ethical and high-quality research. At least one developer of the tools needs to be a co-author on any publication that results from the translation and cultural adaptation of our tools. This co-author should be identified early in the process (at the time of signing this document) and it is required that this co-author approve the final version of the manuscript before it is submitted for publication. This co-author may also provide English-language editing, as needed.

Translation Request

References

• Acquadro, C., Conway, K., Hareendran, A., Aaronson, N., European Regulatory, I., & Quality of Life Assessment, G. (2008). Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health, 11(3), 509-521. doi:10.1111/j.1524-4733.2007.00292.x
• Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976), 25(24), 3186-3191. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11124735
• Carter, J. A., Lees, J. A., Murira, G. M., Gona, J., Neville, B. G., & Newton, C. R. (2005). Issues in the development of cross-cultural assessments of speech and language for children. Int J Lang Commun Disord, 40(4), 385-401. doi:10.1080/13682820500057301
• DeVellis, R. F. (2012). Scale development: Theory and applications (3rd ed.). Thousand Oaks, CA: SAGE Publications, Incorporated.
• Gjersing, L., Caplehorn, J. R., & Clausen, T. (2010). Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol, 10, 13. doi:10.1186/1471-2288-10-13
• Maneesriwongul, W., & Dixon, J. K. (2004). Instrument translation process: a methods review. J Adv Nurs, 48(2), 175-186. doi:10.1111/j.1365-2648.2004.03185.x
• Pados, B. F., Estrem, H. H., Thoyre, S. M., Park, J., & McComish, C. (2017). The Neonatal Eating Assessment Tool (NeoEAT): Development and content validation. Neonatal Network: The Journal of Neonatal Nursing, 36(6). 
• Perneger, T. V., Leplege, A., & Etter, J. F. (1999). Cross-cultural adaptation of a psychometric instrument: two methods compared. J Clin Epidemiol, 52(11), 1037-1046. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10526997
• Pett, M. A., Lackey, N. R., & Sullivan, J. J. (2003). Making sense of factor analysis: The use of factor analysis for instrument development in health care research. Thousand Oaks, CA: Sage Publications, Inc.
• Sousa, V. D., & Rojjanasrirat, W. (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract, 17(2), 268-274. doi:10.1111/j.1365-2753.2010.01434.x
• Thoyre, S. M., Pados, B. F., Park, J., Estrem, H., Hodges, E. A., McComish, C., . . . Murdoch, K. (2014). Development and content validation of the Pediatric Eating Assessment Tool (Pedi-EAT). American Journal of Speech Language Pathology, 23(1), 46-59. doi:10.1044/1058-0360(2013/12-0069)
• Thoyre, S. M., Pados, B. F., Park, J., Estrem, H., McComish, C., & Hodges, E. A. (2017). The Pediatric Eating Assessment Tool (PediEAT): Factor structure and psychometric properties. J Pediatr Gastroenterol Nutr. doi:10.1097/MPG.0000000000001765
• Wang, W. L., Lee, H. L., & Fetzer, S. J. (2006). Challenges and strategies of instrument translation. West J Nurs Res, 28(3), 310-321. doi:10.1177/0193945905284712
• Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., . . . Cultural, A. (2005). Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health, 8(2), 94-104. doi:10.1111/j.1524-4733.2005.04054.x

If you do not have access to any of these publications and would like to read them, please contact a member of the Feeding Flock Team.