title: A systematic survey instrument translation process for multi-country, comparative health workforce studies.
abstract: BACKGROUND
  As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems.
  
  
  OBJECTIVE
  To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey.
  
  
  METHODS
  We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe.
  
  
  METHODS
  Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field.
  
  
  METHODS
  The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context.
  
  
  RESULTS
  The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation.
  
  
  CONCLUSIONS
  The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation.
authors.affiliation: New York University College of Nursing-Global Health Division, New York, NY 10003, USA. aps6@nyu.edu
authors.forename: Allison
authors.initials: A
authors.lastname: Squires
authors.forename: Linda H
authors.initials: LH
authors.lastname: Aiken
authors.forename: Koen
authors.initials: K
authors.lastname: van den Heede
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
authors.forename: Luk
authors.initials: L
authors.lastname: Bruyneel
authors.forename: Rikard
authors.initials: R
authors.lastname: Lindqvist
authors.forename: Lisette
authors.initials: L
authors.lastname: Schoonhoven
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Stromseng
authors.forename: Reinhard
authors.initials: R
authors.lastname: Busse
authors.forename: Tomasz
authors.initials: T
authors.lastname: Brzostek
authors.forename: Anneli
authors.initials: A
authors.lastname: Ensio
authors.forename: Mayte
authors.initials: M
authors.lastname: Moreno-Casbas
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Rafferty
authors.forename: Maria
authors.initials: M
authors.lastname: Schubert
authors.forename: Dimitris
authors.initials: D
authors.lastname: Zikos
authors.forename: Anne
authors.initials: A
authors.lastname: Matthews
mesh_terms: D003625:Data Collection; D038622:Internationality; D009740:Nursing Staff / Q000600:supply & distribution*; D014175:Translating