title: Challenges in language, culture, and modality: translating English measures into American sign language.
abstract: BACKGROUND
  Few health-related questionnaires have been translated into American Sign Language (ASL), precluding Deaf adults from full participation in health-related research.
  
  
  OBJECTIVE
  To translate self-report measures (written English) into sign language and to evaluate the equivalence of the ASL versions to the original English versions of the measures.
  
  
  METHODS
  A descriptive-comparative design with a derived etic (outsider) perspective was used to evaluate equivalency between the English version of the Self-Rated Abilities for Health Practices (SRAHP) and an ASL version. Both versions were administered to 24 bilingual (English and ASL) adults. Analysis included correlation between total scores and comparison of internal consistency of both versions; psychometric properties of the signed SRAHP were computed for 105 Deaf adults who participated in a study of the Deaf Heart Health Intervention (DHHI).
  
  
  RESULTS
  The correlation between total scores on ASL and English versions was .92, item-to-total correlations ranged from .08 to .80 on the English version and from .33 to .80 on the ASL version. Cronbach's alpha was .91 for the English version and .90 for the ASL version. Mean scores on the ASL version were significantly lower for the all-Deaf DHHI sample (n = 105) than for the bilingual subjects (n = 24) although internal consistency remained high (Cronbach's alpha of .93 and item-to-total correlation of .38-.74) for the new ASL version.
  
  
  CONCLUSIONS
  The use of an adapted translation model resulted in a sound ASL version of a health-related measure. Results support use of the derived etic strategy for translating measures from their original language into new languages. The approach is also appropriate for changing modalities from written form to other modalities, such as the visual-manual modality of ASL.
authors.affiliation: College of Nursing, University of Arizona, Tucson 85721-0203, USA. ejones@nursing.arizona.edu
authors.forename: Elaine G
authors.initials: EG
authors.lastname: Jones
authors.forename: R Kevin
authors.initials: RK
authors.lastname: Mallinson
authors.forename: Linda
authors.initials: L
authors.lastname: Phillips
authors.forename: Youngmi
authors.initials: Y
authors.lastname: Kang
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003431:Cross-Cultural Comparison; D003638:Deafness; D015438:Health Behavior; D006801:Humans; D008875:Middle Aged; D019303:Multilingualism; D010865:Pilot Projects; D011594:Psychometrics / Q000379:methods*; D015203:Reproducibility of Results; D012813:Sign Language; D011795:Surveys and Questionnaires; D014175:Translating