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Translating Questionnaires
For Use with Patients or Research Subjects

 Elaine G. Jones, PhD, R.N.
The University of Arizona

Nursing students working in clinical settings or conducting research often need to communicate with clients or subjects in their own language. In many cases, questionnaires are administered to gain essential information to guide nursing care. The original language of most questionnaires used in the United States is written English. If the English is not translated very carefully, the second-language questionnaire may be misunderstood by the patient or subject, and their answers may not be accurate at all. Planning care or reporting results based on misunderstanding and erroneous information can be very dangerous.  

Careful translations and pilot testing are key steps in order for the nursing student or researcher to be confident that the person really understands the second-language version of the questionnaire. The quick overview below gives you an idea of how much time it takes to carefully translate, pilot test, and evaluate the newly translated measure before you begin using it in actual practice or in the actual research. 

The translation process begins by discussing the questionnaire with someone who is skilled in both languages (bilingual expert). The bilingual expert then translates the English into the second language (Brislin, 1970). Next, a different bilingual expert reviews this first translation and changes it back into English (without seeing the original English). This step is called “back translation”. Next, compare the original English version with the back translated English version. Is the back-translated English similar to the original English?  Jones et al (2001) recommended that the translations be discussed in groups who are bilingual to consider differences in local terms, conceptual accuracies, and other difficulties identified with the translation. Based on the comparison, changes are made and the process is repeated until you are satisfied that the new version is conceptually equivalent to the original English, source language version. 

The next step is to pilot test the new-language version.  This is done by asking bilingual people to complete both the original English questionnaire and the new-language questionnaire. If the translation is sound, then their scores should be very similar on both the original and new-language questionnaire.  

This process is quite time-consuming, but essential for confidence in the equivalence of the questionnaires, and confidence in the information obtained from the translated questionnaire. Be sure to build in time for this process, and to always question how the non-English questionnaires you’re using were developed.


Brislin, R.W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology,  1,   p.185-216. 

Jones, P. S., Lee, J.W., Phillips, L.R., Zhang, X.E. & Jaciedo, K.B.  (2001). An adaptation of Brislin’s translation model for cross cultural research. Nursing Research 50 (5), 300-304.

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