Abstract
Translation in qualitative research is an essential process to accurately convey participants’ meanings between languages, thus ensuring the trustworthiness of qualitative research. However, detailed reporting of this crucial process is not included in current reporting guidelines. We will illustrate the complexity of the translation process based on our experiences across research contexts in three countries. We also provide recommendations to preserve participants’ meanings and research trustworthiness. These experiences highlight the importance of accurately reporting the translation process in cross-language qualitative health research and emphasise the need for a clear and comprehensive reporting guideline.
Background
Qualitative research addresses the meaning individuals ascribe to a problem, often conducted in a natural setting and frequently informed by an interpretative theoretical framework to guide the methodology (Creswell & Poth, 2018). As the interpretation of meanings is a central focus in qualitative research, language differences may affect the understanding and interpretation of meanings across all phases from participants to readers, thus jeopardising qualitative research trustworthiness (van Nes et al., 2010). The risk of loss of meaning increases when the research is published in a different language from which it was conducted (van Nes et al., 2010) or when the researchers and interviewees speak different languages, complicated by cultural differences surrounding the languages (Sun, 2011).
English is the primary medium of well-recognised and high-impact academic journals. With the increase in knowledge production and sharing worldwide, research in non-English speaking countries is increasingly translated into English for the broader dissemination of knowledge (Hyland, 2016; Martín et al., 2014). Researchers believe that publishing in English is crucial for increasing the visibility of their work within the global scientific community as well as for completing the requirements for professional advancement and grant applications (Martín et al., 2014). This translation process brings the views and perspectives of the non-English speaking population into the global body of knowledge, which helps expand and enrich the knowledge (Hyland, 2016). It also delivers the voices of less explored non-English-speaking populations, which is essential for healthcare equity.
Translation is a crucial process to ensure a correct transfer of meanings from non-English populations to the world (Gawlewicz, 2020). It is influenced by the researchers’ background, the language or words, the role of the translator or interpreter and the translation style (Al-Amer et al., 2015; Regmi et al., 2010). Yet, the translation process is frequently insufficiently reported in cross-language qualitative research despite its acknowledged importance (Gawlewicz, 2020; Squires, 2009). Translation is often regarded as an objective and neutral process where the translator is the “technician” to produce the texts in different languages (Wong & Poon, 2010). Moreover, established reporting guidelines for qualitative research do not clearly guide documenting the steps within this critical process (O’Brien et al., 2014; Tong et al., 2007).
In this article, three research teams from Malaysia, Australia and the Netherlands came together to share our experiences on the translation process in qualitative health research within our different research contexts. We initially met as a group of qualitative researchers and discussed the challenges of the translation process in our research. In the discussion, we noticed that one of the main issues was a lack of guidelines on reporting the translation process in qualitative research. Therefore, in this article, we describe our experiences and reflections on translation in qualitative health research in three different research contexts to illustrate the complexity of the process and provide recommendations for preserving the trustworthiness of qualitative research. We hope these experiences could stress the importance of reporting guidelines for translation in qualitative health research.
Research Context of the Malaysian, the Netherlands and the Australian Research Projects
Timing and Objects of Translation in Cross-Language Qualitative Research (Santos et al., 2015).
The Malaysian Research Context
We conducted collaborative research between Malaysia and Australia on adults’ lived experience with obesity in Malaysia and their experience accessing care for obesity. The principal researcher (NY) is a Malaysian medical doctor completing a PhD in Australia, and RM, another Malaysian researcher, is a medical lecturer at a public university. Both researchers are Malay ethnics and bilingual Malay and English speakers. Malay is one of the native ethnicities that make up around 60% of the Malaysian population (Mahadin, 2021). ES, GR and CB are three Australian researchers who are all monolingual native English speakers. Our participants were adults from Peninsular Malaysia, and most were Malay ethnic. NY conducted teleconference interviews in Malay, Malaysia’s official language, as chosen by the participants. All interviews were recorded and transcribed verbatim in Malay.
The Netherlands Research Context
We conducted multiple qualitative studies on medically unexplained symptoms in primary care. We interviewed patients and physicians about their experiences and opinions of the unexplained nature of the symptoms and the communication and relation between physicians and patients. These studies involved Dutch-speaking participants and Dutch-speaking researchers. All interviews were recorded and transcribed verbatim in Dutch. After the analysis process, we translated our findings during the writing of the manuscript, as we commonly publish in English. So, we must correctly translate the names of themes and categories, especially the citations. We usually have our translations checked by a native speaker in this process.
The Australian Research Context
We conducted a phenomenological study exploring the lived experience of Iraqi refugee women living with chronic pain. The research team consisted of four researchers from Australia, with the principal researcher (AA) being a PhD student. AA is a bilingual Australian-born woman with a central Asian/European background and whose predominant language is English. GR, ES and HB are Australian, monolingual native English speakers. The study has recruited Iraqi refugee women living within Metropolitan cities in Victoria. These women identify as Assyrian, an ethnic group indigenous to the middle east and a minority Christian population within Iraq. These women speak Arabic, using a specific dialect of Assyrian peoples. Interviews were conducted in both English and Arabic. Where interviews were conducted in Arabic, an interpreter fluent in both English and Arabic was used. All interviews were recorded and transcribed in English.
Translation Process and Reflection
The Malaysian Experience
Our translation process happened before data collection and during analysis (Table 1). We developed the interview guide in English to allow discussion with the English-speaking researchers. NY and RM translated this interview guide into Malay as we anticipated many participants would want to be interviewed in Malay. Both researchers are bilingual and have a good understanding of qualitative research, the research topic and the Malaysian culture, as both are Malay ethnic Malaysians who live in Malaysia and share the same socio-cultural background with the participants. They started by translating the questions independently, then discussed the translation and decided on the most appropriate words in Malay to ensure conceptual equivalence between the two languages (Squires, 2008). Backward translation, an independent translation of the translated texts in the target language back into the original language (Gawlewicz, 2020), was not applied at this stage.
The second translation occurred during the analysis. We decided to analyse the interview data in the original Malay language, as it was costly to translate all transcripts into English. Moreover, we had bilingual researchers in our team to analyse the transcripts independently for researcher triangulation, thus preserving the trustworthiness of the data. NY and RM independently analysed the first three transcripts and developed codes in English from the Malay transcripts. Both researchers studied and practised medicine in English, allowing them to give labels or codes to the data in English based on their medical and research experience. The shared cultural background helped them to understand the data’s socio-cultural context. A codebook and participants summary were prepared in English to facilitate discussion with monolingual team members. We had regular team discussions in English to review developing themes and interpretation of the data.
We employed a professional translator (a Malay lecturer in Malaysia with a translation qualification) to translate relevant text fragments into English. She was given the selected quotes for translation, the specific codes, and the relevant text fragments to help her understand the interview context. The team members discussed the translated quotes, and ongoing translation refinement was done between NY and the translator. After receiving the translated texts, NY checked for mistranslated texts and highlighted them with comments on the context and suggestions for more suitable words. The translator then revised the text, and this process continued until both parties were satisfied with the translation.
The Netherlands Experiences
Since the interviews and analysis were conducted in Dutch, our translation process started when publishing the research in English (Table 1). We wrote the manuscript in English and translated the themes and participants’ quotes from Dutch into English. In most of our research, we did the translation by ourselves (researcher-translator) and had a native English speaker from our department check the translation.
During the translation process, we, as researcher-translator, had to consider how to translate the Dutch text into English while preserving the meaning and richness of the data. In our experience, grammatical errors are frequent. For example, “the doctor listens to me” versus “the doctor is listening to me”. Second, we sometimes use the wrong words when translating quotes into English. For example, we translated the Dutch word “vooroordeel”’ into “prejudged”, while the correct translation should be “prejudiced”, as one reviewer rightly commented. We had an experience where a native speaker picked up a wrong translation before submission to a journal. The original text in Dutch: “nee, hij (the doctor) blijft ook goed in contact” was translated by the first translator (the researcher) as “the doctor has good contact with me”. The native speaker translator corrected this to “he just maintains contact”. The difference between the two translations was that the first translation was static - describing a situation. The second translation was dynamic and included activity from the doctor, which was present in the original Dutch text.
Other than that, we had difficulties translating metaphors used by interviewees into English. For example, “spraakwaterval” means someone keeps talking (is talkative). The Dutch phrase contained the word ‘waterfall’. However, the omission of ‘waterfall’ in an English translation reduced the intensity of action expressed in Dutch. From then on, we explicitly discuss translating metaphors with a native speaker in light of this experience.
The Australian Experiences
The translation process during this study happened during data collection (Table 1). The semi-structured interview guide was developed in English. During the interview, the researcher’s questions were asked in English and were translated to Arabic via a professional interpreter who was a woman of an Assyrian Iraqi background. Participant responses were translated from Arabic to English by the interpreter. However, sometimes the interview was translated by a family member. In both instances, but more specifically the latter, there is a possibility of misinterpretation. The challenge with our research, where the researcher and participants speak different languages, was that the translation process needed to occur immediately during the interview with the help of an interpreter. The use of a professional interpreter offers safe, supportive and clear communication. This is very different to the experience when using family members as key informants, as oftentimes their position feels less neutral, and there is difficulty in removing their perspective when translating dialogue. However, refugee women are a unique patient population who may exhibit particular distrust towards health care staff. In an effort to hear all perspectives of all women, we still included those who preferred to use family members as interpreters in the study.
Live translation plays a decisive role in forming cultural realities in these intercultural encounters, particularly influenced by the person translating. Translation in the interview process can provide prime insights into a cultural phenomenon but may also be subject to error through intercultural misrepresentation. The lead researcher (AA) conducting the interviews shared some of her cultural heritage during the interview with the participants. This shared experience made participants feel at ease when expressing the cultural implications of accessing care in Australia. The English part of the verbal data was transcribed for analysis.
Reflections on the Translation Experiences Across Three Countries
The experiences from three countries illustrated the complex translation process across several research contexts. Each team had different researchers’ and participants’ characteristics, which influenced the translation process, including the timing of the translation, the material for translation and the person who did the translation (Table 1). The experiences from the three countries cover most of the different contexts of the translation process in qualitative research from early to late timing of translation.
Due to their collaborative study, including both monolingual and bilingual researchers and the publication of research findings in the target language, the Malaysian experiences provide an example of multiple translation processes in one research project. The experiences of the Netherlands serve as an example of late translation and when researchers become the researcher-translator. They encountered difficulties due to the divergent grammatical structures of Dutch and English. Australian experiences provide a distinct example of the translation process where the translation takes place during interviews that needs a real-time interpreter who is not a research team member.
Recommendations
While the timing and material for translation are determined by the research methodology designed by the research team, the method and quality of the translation product are influenced by the person who does the translation (Al-Amer et al., 2015). The person who does the translation, whether a translator, researcher-translator or interpreter, plays a crucial role in the knowledge creation of qualitative research. The translator’s role is beyond the language’s literal translation but informs the contextual meanings of the participants’ words (Squires, 2008). Therefore, the translator or interpreter should have a comprehensive understanding of both original and targeted languages, the translation process and the culture surrounding those languages (Gawlewicz, 2020) to achieve a conceptual equivalence of the meanings across both languages (Regmi et al., 2010). Translation without technical and conceptual accuracy may jeopardise the credibility and transferability of qualitative research findings (Squires, 2008). However, researchers may face challenges finding a suitable translator or interpreter in some circumstances and resort to less suitable options.
Previous literature suggests several ways to overcome translation issues: back-translation, consultation, collaboration and piloting, and each strategy has its strengths, limitations and associated costs (Gawlewicz, 2020; Sechrest et al., 1972). While some studies consider forward and backward translation to produce the best possible rhetorical translation (Behling & Law, 2000; Kwok & White, 2011), other scholars argue that this method has weak conceptual equivalent in qualitative research (Duyck & Brysbaert, 2004; Larkin et al., 2007). Furthermore, this approach is more time-, financial- and labour-demanding and tends to produce a word-for-word translation which could be problematic (Al-Amer et al., 2015).
A feasible strategy to overcome the threat of meaning loss is consultation (Gawlewicz, 2020). Even in the ideal translation process, the translation should not be regarded as a one-off process that finishes after receiving the translated materials from the translator. Consultation involves discussions between the researcher – who has expertise in research methods - and the translator – with expertise in language and culture. Early on, the researcher should brief the translator on the research context and language used to ensure a shared vision of the translation strategy (Gawlewicz, 2020). During the translation process, discussion of any translation dilemmas with the translator can improve the nuance and accuracy of the translation (Larkin et al., 2007). The three-way interaction that occurs between the interviewees, the researcher and the translator is described by some scholars as “triple subjectivity” (Gawlewicz, 2020; Temple & Edwards, 2002). In this situation, the interpretation of participants’ subjective experiences in cross-language qualitative research is filtered through the translator’s contextual experience and subjective positioning before being interpreted by the researcher.
Next, the rechecking process is crucial to ensure the correct assignment of meaning from the original material into the target language, which can be done by discussing with other research team members or experts who have a good understanding of both languages and the field of study (Gawlewicz, 2020; Regmi et al., 2010). If the researcher is bilingual, they could compare the translation with the original data themselves (Gawlewicz, 2020). Another study suggests that bilingual members of the recruiting community verify the translation (Karwalajtys et al., 2010). Having another native speaker check the translation is valuable as sometimes the translation by a non-native speaker of the target language is grammatically correct, but the phrases may not be expressed as native speakers usually do. However, cost and time can be barriers. Furthermore, finding a native English speaker might not be easy for researchers in non-Western countries.
The use of non-professional interpreters such as relatives or friends of participants may exhibit emotional involvement, their language skills are untested, and they are likely not skilled in medical terminology. Whilst these pose clear limitations in qualitative research, this informal interviewing style can help build rapport, and participants may prefer to have a known person to translate. With this in mind, we recommend that researchers use professional interpreters when interviewing non-English speaking participants. As this may be the participant’s preference, family members pose several challenges when translating research interviews, particularly because they often cannot separate themselves from the emotional component and connection with the participant.
The research process should be thoroughly reported in the final manuscript (Table 1). Being reflective about translation not only ensures trustworthiness but also enriches the research findings (Helmich et al., 2017). As rigorous qualitative research is built on a clear description of the decision-making process, failing to explain and report the relationships and strategies used in handling cross-language issues may indicate a lack of rigour and weakness in the study design (Larkin et al., 2007). However, current reporting guidelines for qualitative studies do not emphasise reporting the translation process in detail (O’Brien et al., 2014; Tong et al., 2007).
Conclusion
Translation in cross-language qualitative health research is more than a technical process. It requires a comprehensive understanding of the original and target language, the translation process, and the culture surrounding the languages. As qualitative research focuses on representing the participants’ voices, correct techniques and accurate translations are vital to ensure a valid representation of participants’ meaning and trustworthy knowledge production. Therefore, researchers involved in cross-language qualitative research should be mindful and reflective of the translation process and report their translation process thoroughly. A clear and comprehensive reporting guideline for translation in qualitative research is very much needed to assist this process.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The work was funded by the Australasian Association for Academic Primary Care (AAAPC) Travelling Fellowship 2021. NY’s PhD is supported by the Bumiputera Academic Training Scheme (SLAB) from the Ministry of Higher Education Malaysia. AA’s PhD is supported by the Australian Government Research Training Program.
