Translation of established public health measurement instruments into Arabic and Dari (ENSURE) (English Version)

Findings for Multi-Item Scale Recommendations for Multi-Item Scale

Items 2 and 3 were systematically tested. For item 1, only spontaneous responses of the test persons were available.

Do test persons perceive item 2 and item 3 to be the same or different?

In each case, half of the test persons gave the same answer (SY04, SY05, SY06, IR02, IR03, DA02, DA04, DA05, DA06) or different answers (SY01, SY02, SY03, IR01, IR04, IR05, IR06, DA01, DA03) for items 2 and 3. Here, there were no systematic differences between countries of origin or language versions. Regardless of the equality or difference of the answers given, as well as of the countries of origin and language versions, the vast majority of test persons (n = 16) reported seeing a difference between the two items.

In the main, the difference was seen in the fact that item 2 asked whether one was ignored by others (SY02, SY03, SY05, IR02, IR03, DA01, DA03, DA04, DA05), whereas item 3 asked whether one isolated oneself from others (SY03, IR02, IR03, DA01, DA03, DA04, DA05). The key here is that "being on the outside" was understood as something that comes from others, i.e., others do to you, whereas "being socially isolated" was understood as your own doing. In addition, test person DA04 saw in item 3 the automatic consequence of item 2, that if one has the feeling of not being noticed, one automatically feels isolated and therefore withdraws. Two test persons (SY02, SY05), on the other hand, saw the difference in the fact that item 2 was about being generally ignored by others, i.e., not being paid attention to, whereas item 3 was about active isolation, i.e., actively showing with looks or words that one was not wanted. Both are therefore initiated by others.

In the case of the two test persons who stated that they perceived both items as the same (IR05, DA02), it turned out upon closer examination that they did see a difference between the two. IR05 had made different statements for the items ("rarely" vs. "very rarely") and indicated that item 3 had more emphasis than item 2 (being isolated [item 3] vs. being ignored [item 2]). DA02 had given the same answer for both items ("often") and indicated seeing a connection of one item with the other and yet a difference, which she could not explain further.

During an interview with an Arabic-speaking test person, the interpreter noted that "to be left out" posed a problem in the translation because it was not entirely clear what it referred to. It would be better to translate it as "to be ignored", since this formulation always refers to the fact that it comes from others. "To be socially isolated", on the other hand, in the Arabic context always refers to oneself and is understood to mean that one isolates oneself or is shy of people. Accordingly, this formulation does not mean in Arabic that others isolate one socially. Since the same was also found in the Dari-speaking test persons, there seems to be a problem here that should be examined again.

Other findings

For item 1, three respondents stated that they did not really understand what was meant by the question (SY03, DA01, DA05). One test person, who spoke fluent German, said when she was shown the German translation that it had nothing to do with the version in Dari and that the latter was worded strangely. She did not know whether it was about feeling uncomfortable when you are in a group of people or about not having enough of something that the others have, e.g., in a conversation topic, when you do not know as much about it as the others and then you cannot have as much of a say.

Three test persons would also have liked the answer category "never" (SY05, DA04, DA05).

Introduction: No changes recommended.
Item 1: We recommend that you consult translation experts once again, especially for the Dari-language wording, to ensure that the translation corresponds to the German original.
Response format: We recommend adding "never" as an additional response category.