Lessons in Cultural Adaptations: Translation of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module From English to Chichewa in Malawi

Laurel Guthrie; Joseph Mkandawire; Emily Stevenson; Sharon Bonya; Brent Sherwin; Moses Kasumba; Linda Hong; Yevgeniya Ioffe; Sharon Lum

doi:10.1016/j.jss.2023.07.044

Lessons in Cultural Adaptations: Translation of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cervical Cancer Module From English to Chichewa in Malawi

J Surg Res. 2023 Dec:292:150-157. doi: 10.1016/j.jss.2023.07.044. Epub 2023 Aug 22.

Authors

Laurel Guthrie¹, Joseph Mkandawire², Emily Stevenson³, Sharon Bonya², Brent Sherwin², Moses Kasumba², Linda Hong⁴, Yevgeniya Ioffe⁴, Sharon Lum³

Affiliations

¹ Department of Surgery, Loma Linda University Health, Loma Linda, California. Electronic address: lguthrie@llu.edu.
² Department of Surgery, Malamulo Adventist Hospital, Malawi, Africa.
³ Department of Surgery, Loma Linda University Health, Loma Linda, California.
⁴ Department of Obstetrics and Gynecology, Loma Linda University Health, Loma Linda, California.

PMID: 37619500
DOI: 10.1016/j.jss.2023.07.044

Abstract

Introduction: To complete a culturally appropriate translation of the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Cervical Cancer module (QLQ-CX24) from English to Chichewa (one of the official languages of Malawi) in preparation for postsurgical outcomes research in rural Malawian cervical cancer patients.

Methods: Following the EORTC translation procedure manual, two distinct forward translations from English were reconciled into a preliminary Chichewa translation, followed by two distinct back-translations to English. The English back-translation was reconciled and the translation report sent for discussion and proofreading by EORTC; this was followed by pilot testing. All translators were physicians fluent in English and Chichewa.

Results: Of 24 questions in QLQ-CX24, three had prior translations available; all three required revision to clarify tense or wording. Three discussion exchanges with EORTC refined the translation and ensured faithfulness to the original English meaning; proofreaders contributed minor changes. Pilot testing was completed on 10 female patients (three with cervical cancer, four suspicious cervical lesions, and three screening only). Three patients were illiterate. During pilot testing, translation of question 46 (Q46) was misunderstood as referring to vaginal discharge instead of feeling "feminine". The remaining questions were understood, with minor feedback for six questions. Final revision of Q46 yielded a phrase describing "feminine" as "appearance or activities as a woman". Concepts comparable to "feminine" were absent in the Chichewa language/regional Malawian culture. The final revision of Q46 was pilot-tested on five patients (three illiterate) and found acceptable.

Conclusions: Translation of the QLQ-CX24 module was completed successfully and revealed absence of the modern concept of femininity in Chichewa language and regional Malawian culture. Care should be taken when creating and translating healthcare-related documents for surgical research to ensure broad applicability across cultures.

Keywords: EORTC; Patient-reported outcomes; Qualitative research; Quality of life; Surgical research; Translation.