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Multilingual Translation Issues in Qualitative Research: Reflections on a Metaphorical Process Philip J. Larkin, Bernadette Dierckx de Casterlé and Paul Schotsmans Qual Health Res 2007; 17; 468 DOI: 10.1177/1049732307299258 The online version of this article can be found at: http://qhr.sagepub.com/cgi/content/abstract/17/4/468

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Multilingual Translation Issues in Qualitative Research: Reflections on a Metaphorical Process

Qualitative Health Research Volume 17 Number 4 April 2007 468-476 © 2007 Sage Publications 10.1177/1049732307299258 http://qhr.sagepub.com hosted at http://online.sagepub.com

Philip J. Larkin The National University of Ireland, Galway, Ireland, and The Catholic University of Leuven, Belgium

Bernadette Dierckx de Casterlé Paul Schotsmans The Catholic University of Leuven, Belgium Focus on the translation and validation of measurement instruments has left a gap in the discussion on how to construct multilingual qualitative tools, such as interviews. Traditional methods of forward and backward translation have been criticized for weak conceptual equivalence, a crucial issue when multiple language interview methods are used. Through a creative arts metaphor of weaving, the authors describe an alternative process of multicentric translation used in the development of an interview guide designed to explore the impact of transition on palliative care patients in six European countries. Four identified core constructs illuminate this multicentric process: Cohesion, Congruence, Clarity, and Courtesy. Mutual reciprocity between researcher and translator offers greater possibility for construction of nuance and meaning, particularly where cultural parameters influence the collection and meaning of sensitive data from vulnerable populations. The translator therefore becomes a collaborator in the research process, which strengthens the rigor of language-based inquiry. Keywords: translation; culture; palliative care; metaphor

D

espite the limited debate within the qualitative research literature, there has been an increasing trend toward addressing the challenge of linguistics and the impact of translation on study findings. These include issues of translation and subsequent interpretation (Temple, 1997; Temple & Young, 2004), problems of cross-cultural research (Bradby, 2002), translation techniques for specific qualitative research methods (Esposito, 2001), and the use of interpreters in data collection (Kapborg & Berterö, 2002). There is particular criticism regarding the failure of researchers to recognize the role of translation on data and its subsequent analysis, which might ultimately have consequences for the final outcome of the study (Birbili, 2000; Temple, 1997; Temple & Young, 2004).The researcher-translator relationship and the methodological rigor of translation have also been debated (Temple & Young, 2004; Twinn, 1997). The translator has the potential to influence research significantly by virtue of his or her attempt to convey meaning from a language and culture that might be unknown to the researcher:

The translator always makes her mark on the research, whether this is acknowledged or not, and in effect, some kind of “hybrid” role emerges in that, at the very least, the translator makes assumptions about meaning equivalence that make her an analyst and cultural broker as much as a translator. (Temple & Young, 2004, p. 171)

Different languages construct different ways of seeing social life, which poses methodological and epistemological challenges for the researcher. Power dynamics between the researcher and the translator cannot be ignored, as they can directly affect the validity of the work (Edwards, 1998). Researchers have a responsibility to acknowledge their personal impact on fieldwork, and failure to perceive the translator as

Authors’ Note: Philip Larkin is holder of the 2003 Health Research Board Fellowship in Palliative Care, and this study is jointly funded by The Health Research Board of Ireland and The Irish Hospice Foundation, Dublin, Ireland.

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Larkin et al. / Multilingual Translation 469

coworker might inhibit access to understanding of the process and emerging data (Temple & Edwards, 2002). As robust qualitative research is based on a clear explication of the decision-making process (Cutcliffe & McKenna, 1999), failure to describe relationships and methods used to address linguistic challenges might signify weakness in study design and rigor. The dilemma of conceptual equivalence across language reflects the inherent nontransferability of descriptors of rigor across paradigms (Cutcliffe & McKenna, 1999; Morse, 1999; Sandelowski, 1986; Tobin & Begley, 2004). Arguably, current translation procedures applied to ensure word equivalence (such as forward-backward translation) have become the gold standard by which language-based academic research is judged (Usunier, 1999). This view is inherently flawed, however, as it makes global assumptions that research is language free and that the same meaning in the source language can be found in all target languages. Rigorous translation in the naturalistic setting should acknowledge the capacity of each language to create its own meaning, reflecting the view that people are “neither bounded, integrated or organized as a whole” (Geertz, 1983, p. 59). This suggests a shift away from fundamentalism to pluralism. There is a risk of falling into a rhetorical trap, arguing the value of fundamentalist positions about the appropriate language of rigor to challenge the dominant positivist paradigm. Such narrowness fails to embrace possibilities of a shift to multidimensional pluralism, which values infinite ways of thinking about rigor. This might, in turn, strengthen arguments for the qualitative way of research (Tobin & Begley, 2004). To heed this shift, and in the search for rigorous translation, a multilingual team approach to enhance conceptual equivalence has been proposed (Campbell & Werner, 1970). This supports the call for plurality and creativity in qualitative methods. In this article, we describe a creative approach to the multilingual translation of an interview guide used in a qualitative study of European patients with advanced cancer. Insights gained in this process informed the translation of supporting documentation (consent forms, etc.) and the subsequent analysis of interview data. We propose to outline the overall design, aims, and objectives of the study, with specific reference to the methodological questions raised by translation. We will offer the metaphor of weaving as a construct by which the translation process may be understood more clearly. Finally, we will present a new and innovative multilingual translation method in keeping with the qualitative paradigm.

Table 1 The Interview Guide Can you describe in your own words what it meant for you when you were transferred to this palliative care service? Can you tell me if there is anyone or anything that made it easier for you when you were transferred to this palliative care service? Can you tell me if there is anyone or anything that made it difficult for you when you were transferred to this palliative care service? Now, has anything changed for you at all since being transferred to this palliative care service?

The Study The Transition Towards Palliative Care in Europe study was designed to describe and explore patients’ experiences of the transition process through the phases of curative, palliative, and terminal care. Recognizing the fundamental role of language in a hermeneutic paradigm (Heidegger, 1959/1993; Smith, 2002; van Manen, 1990, 1997), this study was based on the philosophical premise that language provides a medium for understanding culturally embedded concepts, such as transition and palliative care. The latter theoretically offers a support structure wherein people with advanced disease might address transition issues (Lawton, 2001). In this study, we proposed an interview method to seek the meaning of those transition experiences. One hundred patients from six European countries were interviewed. An interview guide based on four questions (Table 1) was developed in English and subsequently translated into Dutch, French, Spanish, and Italian. Given the potential frailty and vulnerability of the respondents, the interview guide needed to be succinct and comprehensive, and we were cognizant of the fact that it would be used by us in three languages (English, French, and Italian) and by a locally based palliative care nurse in Dutch and Spanish. This guide framed interviews undertaken in the native language of the respondent, recorded, transcribed verbatim, and translated into English for comparative analysis within and between languages. Data were analyzed through the ATLAS.Ti program.

Weaving as Metaphor Metaphor as a tool to facilitate understanding has resonance for the creative process of qualitative research, particularly in relation to the cancer patient (Bowker, 1996; Gibbs & Franks, 2002; Maeve, 1998;


470 Qualitative Health Research

Figure 1 Conceptualization of a Weaving Metaphor Multilingual Translation Process

Reisfield & Wilson, 2004; Skott, 2002). The process described here is based on a metaphorical premise that one can understand abstract and complex ideas through reference to other more familiar concepts, in this case, weaving (Lakoff & Johnson,1980). Osbourne’s (1975) Oxford Companion to the Decorative Arts defines the process of weaving as “the binding of elements to create a coherent fabric in a determined order or pattern” (p. 34). These elements of warp and weft have come to mean an essential foundation of strongly twisted threads that intersect in a predetermined way called a weave. Metaphorically, translation becomes a frame (“loom”) on which hidden and visible meaning in language intersect (Figure 1). The “warp” arrow, running vertically from top to bottom, serves to reveal clear, reasonable understanding from things that are obscure or covert to both researcher and translator; in the first case limited language to express the research question, and in the second limited understanding of the meaning and motivation behind the research project, which, when clear, ultimately shapes the final translation. The horizontal “weft” arrow, which crosses and binds the warp, represents that which is visible to both researcher and translator. Binding these threads of meaning together represents the union of the researcher and translator in creating the fabric of the translation, mindful of cultural sensitivity. The whole is a process of interweaving

hidden and visible meanings to make sense of the text in its source and subsequent translations. Creating a coherent pattern leads to greater possibilities for a conceptual equivalence as a final outcome. The preparation of interview questions holds specific difficulties (Fontana & Frey, 2000) without the added complexity of translation into multiple languages. Overly structured questions make insufficient allowance for the degree of difference between and within languages and offer limited scope for the researcher to clarify or develop responses for fear of misrepresenting the question. Similarly, the breadth of possible responses from unstructured interviews in multiple languages can make any possible inference from the data difficult to interpret. Guided by Barriball and While (1994), we created a series of questions, which were then independently rated by two qualitative researchers using a seminal description of the principles of question construction in sociological research (Lazarsfeld, 1955). This framework addressed the focus (specification) sequence and wording of questions (division), and the possible ambiguity of meaning (tacit assumption) underlying each question. Each option was given a score from 1 to 10, with 10 being judged the closest fit to the research question. The agreed questions were finally given to two independent clinical experts in palliative care to “assess the appropriateness



and completeness of the contents in relation to its subject domain and purpose” (Barriball & While, 1994, p. 333). The translation process required two phases: the first to translate the interview guide into the respective language and the second to agree on that translation across all five languages.

Phase 1: Accessing the Target Language Decisions about translation have a direct impact on the trustworthiness of research and, as such, require a balance between language proficiency and cultural knowledge (Birbili, 2000; Denzin & Lincoln, 2000). Scientific inquiry that involves multiple languages requires a thorough description of the decisions made and problems derived during the research process (Temple, 1997). Four “dyads” of translators were recruited from the language department of an Irish university. Each translator was undertaking a master’s-level program in translation studies and/or taught his or her native language through adult education. All translators had been living in Ireland for less than a year at the time of this study. The literature contends that translators’ lives and experiences influence their translation, and the impact of living outside the native language environment, acculturation into the host community, and potential loss of linguistic nuance in the native language can influence the quality of the translation (Esposito, 2001; Spivak, 1992; Temple, 2002). It was proposed that limited residency and continual academic exposure to both source and target language would address some of these difficulties. Philosophical assumptions that underpin the interview process are equally important to the complexities of fieldwork (Price, 2002). None of the translators was familiar with the concepts under investigation, which might have posed a weakness to the study, given the emphasis on mutual reciprocity. To address this, the researcher met with each translator, explained the purpose of the study, and clarified some of its philosophical propositions and theoretical frameworks. This included epistemological and ontological assumptions of qualitative research methods, the construction of interview questions within the context of a qualitative paradigm, and the philosophical underpinning of palliative care. The interview guide was given to each dyad of translators in a sealed envelope. Translators were specifically asked to provide an independent translation and not to collaborate with their counterpart at this time. The value of having two independent translations for comparison against the source language is supported in arguments

for translation as a creative process that values logical and rhetorical dialogue (Temple & Young, 2004). On completion of the translations, a meeting was arranged between the researcher and the translators where decisions for respective translations were debated and, based on mutual skills in language and research, we selected the most appropriate sections from both translations to create one version in the target language.

Phase 2: Accessing Multiple Languages Once agreement was reached with each dyad, all translator dyads met, and global conceptual equivalence across the languages were reviewed. This involved a rereading of the interview schedule in both the source and the target languages and a reflection on its content in terms of word, syntax, grammar, and conceptual equivalence (translators) and its use in the palliative care context (researcher). Based on discourse using multiple source and target languages simultaneously, a form of cognitive mapping was established (Eden, 1988, cited in Usunier, 1999). Each dyad displayed keywords related to the broad conceptual area (such as palliative, helpful, difficult, and change) on colored memo cards. These were then debated and discussed in terms of all possible meanings of the words and phrases relative to the language and culture. As meanings became more focused and cards discarded, the group was able to move from emic to etic conceptualization, closer to the context required for this study. Debate culminated in agreement on four dimensions of this translation process, which we frame within the proposed weaving metaphor: Cohesion, Congruence, Clarity, and Courtesy (Figure 2). Although further analysis of these concepts in relation to their rigor is warranted, their use in contributing to the discourse on multicentric translation for qualitative work might be valuable. Cohesion Cohesion can be defined as the connection of dissonant parts, reflecting the combination of threads to create a pattern (Simpson & Weiner, 1989, p. 450). A cohesive approach applies equally to the researchertranslator partnership and to the potential researcherrespondent relationship, with the researcher as common denominator. The ability to translate concepts was dependent on a balance between translators’ inherent knowledge of language and researcher clinical expertise. Such mutual reciprocity encourages sensitive translation.



Figure 2 Multilingual Translation as a Weaving Metaphor

There is an onus on a researcher to be sure that the research tool is well constructed and efficiently delivered to reduce the tension of possible burden to the patient and the overall benefit to the research study (De Raeve, 1994; Lawton, 2001). Where multiple languages are being used, this requires sensitivity in both translation and interaction in the researcher-translatorrespondent triad. Sensitivity extends to the researcher’s being cognizant of the “material circumstances” of the translators (Temple, 1997, 2002) and potential impact of the study on them. Between the individual and group translation processes, the father of one of the translators died in the care of a palliative care team. As Temple (1997) and others have argued, life experience of the translator affects the quality and nuance of translation. This experience clearly affected the group and deepened members’ ability to reflect on the context of their translation. Much as the weaver has to balance the tension of the weave to ensure its overall strength, a “linchpin”— the researcher—was required to balance the critical appraisal of the translation work against the impact of a recent bereavement on the group dynamic. Congruence As definitions of congruence are suggestive of equivalence and agreement (Simpson & Weiner, 1989, p. 732), the conclusion that a tension exists between palliative care as philosophy and palliative

care as practice is an interesting one (Illhardt, 2001). Illhardt concluded, When someone refers to palliative care, it is unclear how he appreciates it because the use of the term in itself is not sufficient to clarify the position he or she has with respect to supporting the dying. (p. 110)

In the weaving analogy, congruence, like words, evokes repetition of patterning, particularly patterns that represent cultural meaning, as often seen in indigenous peoples’ weaving. All translators were unable to find any equivalence for the concept of palliative care in their native language, partly arising from the differing perceptions of palliative care as a practice discipline across Europe (Ten Have & Janssens, 2001). Palliative care was, in effect, an adaptation of an English term having no place within nonmedical speech and, hence, unknown to the translators. Conversely, the word hospice had significant negative connotations in French, Italian, and Spanish, relative to ideas of poverty and charity, and contrary to the clinical application of palliative philosophy. As a consequence, it was avoided in all translations. Following consultation with palliative care experts in the respective countries, it was agreed that the term palliative care, as translated in local medical language, would be understood by respondents, even if the words had no formal meaning. Based on the researcher’s experience, it was accepted by the group. The translation could not guarantee conceptual clarity until field-tested, however, where its true meaning for the respondents might become apparent. However, this situation supports the argument for a mutual consultation process in translation, as posited in the literature (Temple & Young, 2004). Clarity Clarity gives “brightness and illustrious quality” (Simpson & Weiner, 1989, p. 276), to enable clear meaning to emerge in much the same way as the detail of woven threadwork reveals something of the mastery of the designer. From the assertion that there is never one meaning or one translation, one cannot necessarily ensure insight into another world (Temple, 1997). In English, the word transition suggests a dual meaning of a process of transfer and state of being. The implication of the English version (Table 2) is that all experiences of transition, both processual and existential, are under investigation. This dual meaning clearly did not apply in other languages, and a differentiation between process and state was required.



Table 2 Transition Described as Process or State (English/Spanish) English . . . when you were transferred to the palliative service . . .

Spanish Translation 1

Spanish Translation 2

. . . al ser trasladados a los servicios de cuidad paliativo

. . . cuando pasar a formar parte del servicio de cuidadas paliativos . . .

Table 3 Cultural Decorum in Translation (English/Italian) English Can you describe in your own words what was significant for you . . .

Italian Translation 1 Può descrivere a parole sue cosa ha significato per lei . . .

Here, the first Spanish translator describes the process of transition as “trasladados” which reflects transfer of place, as opposed to the concept of “pasar a” suggested by her counterpart, which relates more to impact on the person. In the larger group, this clarified the research concept for other translators, who subsequently adapted their translations to meet equivalence across languages. Courtesy Cultural decorum was a further issue raised by the translators. Defined as “considerateness in intercourse with others” (Simpson & Weiner, 1989, p. 1061), and given the nature of the study, it was considered important to obtain balance between formal and informal language to obtain the best data. Translators often disagreed on the appropriate level of politeness required when addressing patients both in writing and speech. The Italian example in Table 3 demonstrates this. Here, the first translator used an informal singular tense to reduce the formality of the interview process and, possibly, generate more conversation. The second translator contended that the interview was to be conducted by a nonnational researcher unfamiliar with Italian culture and predominantly with an older population, implying a need for greater politeness than the first translation offered. The formal “Lei” was suggested as a way of conveying respect. Understanding the weaving metaphor here is important in the hermeneutic context of trust building, synchrony, and respect for differing worldviews (Smith, 2002). The whole is representative of shared and mutual understanding, bound by the different lines of thread, which make the fabric complete.

Italian Translation 2 Può descrivere con parole Sue che cosa è per Lei significato . . .

Discussion As we contend in this article, the success of a multilingual translation process is dependent on balancing the tension of the weave between conceptual equivalence and process. Although it is not within the remit of this article to offer a comparative analysis of the method described here against more traditional methods of forward-backward translation, the multicentric approach offers a range of conceptual options and choices for the principal researcher to use and discuss with the field team that might not have been available through more standard methods of translation. Temple and Edwards (2002) referred to border crossings as metaphorical addresses to the qualitative researcher doing multilingual research to demonstrate clearly the place of the interpreter/translator in the production of research. Through a process of reciprocity that transcends current boundaries between translator and researcher, the former became a visible, rather than silent, partner in research. The value of this became apparent in the fieldtesting of the interview schedule, when inconsistencies in meaning could be reviewed by telephone in light of the translators’ understanding of the study goals. The interview guide became a flexible, focused, rigorous tool for qualitative research rather than an impediment to the research process. Dialogue led to succinct and fluent data’s being obtained in each language with little, if any, difficulty in comprehension for the respondents. In embracing Tobin and Begley’s (2004) call for a pluralistic approach to rigor, qualitative researchers have a responsibility to expand these paradigm boundaries and create new language to shape their methods.



Traditional methods of translation could offer only an interpretation of the material based solely on language comprehension, with no reference to method “steeped in a tradition of reflexivity and context” (Temple & Edwards, 2002, p. 2). This requires sensitivity to philosophical principles, which suggests that meaning can precede method (van Manen, 1997). To share ideas with people who could legitimately speak for the technicality of their language within a given culture was extremely valuable in helping us not only to feel secure in the tools for research but also to know that the translators understood the perspectives and values of the research process. This supports the earlier assertion that we meet the world ostensibly through conversation (Smith, 2002). It can be argued that qualitative researchers need to justify their use of positivistascribed methods of translation, particularly if language is a major component of their research study. As discourse related to decisions made in translation can be vital, the philosophical tenets of a project must be explicit to the translator. This said, insofar as outright rejection of positivist thought on validity might do a disservice to qualitative research by suggesting that it is less than scientific (Morse, 1999), it is to be acknowledged that methods such as those described here need to stand up to scrutiny. The choice of locally based linguist students over professional translators was made out of the practical necessity to obtain multiple translations in a specified time frame. Lack of professional translation services also posed problems that warranted an exploration of alternative possibilities. Given the average age of the translators (22 years) and their assumed exposure to death in their lifetimes, additional time was required, so that we could ensure that the impact of exposure to end-of-life themes was not deleterious to them. I would argue that the effect of bereavement on the group required significant emotional support and would caution researchers of the need to build such mechanisms into the research process. The group met on only one occasion, and additional meetings would have proved useful in further development of translation work. As students, many of the translators returned to their own countries at the end of the academic year, which limited further collaboration. The complexity of interview as a data collection method has been addressed in terms of the modern “interview society” (Atkinson & Silverman, 1997, p. 304), power dynamics (Kavanagh & Ayres, 1998; Mishler, 1986), the sequence of questioning and sensitive probing (Price, 2002), and interviewing on sensitive

subjects with vulnerable populations (Lawton, 2001; Sque, 2000). All play some part in the construction of a research-sensitive tool. Even with a set of agreed translations, these issues remain as culturally embedded concepts to be negotiated, and pretesting the interview is, therefore, of particular importance (Dunkley, Hughes, Addington-Hall, & Higginson, 2003). As translators, this group offered a multifaceted reflection of their respective societies: in metaphorical terms, the textile and fabric of their cultures. This suggests that a group translation method might be useful at an interpretive level and therefore highly relevant to qualitative work. Thus, the preparation, collation, and interpretation of data in a multilingual context is a cocreative process. Failure to acknowledge this might seriously weaken the rigor of a study (Birbili, 2000; Temple, 1997; Temple & Edwards, 2002; Temple & Young, 2004). In this article, we have described one method used to address the complicated and laborious task of translation. The small but growing body of literature in this area would support the notion that failure to acknowledge both process and influence of translation in research poses considerable threats to rigor, and studies that incorporate multiple languages in particular warrant close and detailed attention to the description and decision-making process associated with the inquiry (Birbili, 2000). It is insufficient to address translation in the analysis of data, when issues of rigor apply equally at the formative level in interview construction (Twinn, 1997). We have argued here that multiple language sources and ongoing discourse around translation during all stages of a study can strengthen rigor commonly associated with qualitative work (Denzin & Lincoln, 2000; Tobin & Begley, 2004). There are many areas beyond the scope of this article that merit further discussion, including the role and use of interpreters in qualitative research (Davidson, 2000; Kapborg & Berterö, 2002), the problems of transcultural interviewing (De Figueiredo, 1980), and the collation and interpretation of language-dependent qualitative data (Esposito, 2001). The fact that conceptual equivalence across languages can be complex does not imply that it may be ignored. Arguing for rigorous standards in the translation of clinical tools, we assert that there is a need for high-quality translation methods coupled with a strong sense of awareness of cultural sensitivity (Dunkley et al., 2003). The need for similar standards for qualitative research should be no less exacting, and one way in which this can be achieved is to remove the translator from the role of a “ shadowy



figure” (Temple, 2002, p. 853) in research to that of interpretive guide and coresearcher.

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Philip J. Larkin, RN, MSc, is a lecturer in Nursing (Palliative Care), the National University of Ireland, Galway, Ireland, and a doctoral candidate in the Faculty of Medicine, The Catholic University of Leuven, Belgium. Bernadette Dierckx de Casterlé, PhD, RN, is an associate professor of Nursing Ethics, Centre for Health Services and Nursing Research, Faculty of Medicine, the Catholic University of Leuven, Belgium. Paul Schotsmans, PhD, is a professor of Medical Ethics, Interfaculty Centre for Biomedical Ethics and Law, Faculty of Medicine, the Catholic University of Leuven, Belgium.
