A systematic approach for accurate translation of instruments: Experience with translating the Connor–Davidson Resilience Scale into Arabic

When using instruments written originally in a different language, the accuracy of translation is a crucial issue. The language and cultural interpretations can be barriers to healthcare access. Despite the need for a robust translation process, the existing literature offers little information about best practices for translation. Therefore, the purpose of this qualitative research was to illustrate a systematic approach to developing an accurate translation. We describe the process of developing an accurate and culturally relevant translation of the Connor–Davidson Resilience Scale (CD-RISC) from English to Arabic. The CD-RISC is a healthcare instrument to measure resilience and comprises 25 items rated on a 5-point scale, with higher scores reflecting increased resilience. Resilience is an important healthcare construct that can be applied to research on mental illness and adaptation ability. For instance, increased resilience appears to protect against diminished mental health. The translation process began as two individuals independently translated the CD-RISC into Arabic. A third person combined the two translations to produce a reconciled version. A fourth individual then back-translated the reconciled Arabic version to English. To resolve difficult-to-translate segments, the research team consulted with the instrument developer and then conducted cognitive testing with six individuals. A cultural research methodologist participated throughout the process. Among the 28 text segments in the CD-RISC (the title, instructions, scoring, and 25 items), the best equivalency in Arabic came from eight segments of each forward-translation. The remaining 12 segments were similar. Each the back-translation and cognitive testing contributed to seven revisions. The robust translation procedures detailed can be used by researchers to develop best-quality translations.