Translation & Cultural Adaptation of the NeoEAT, InfantEAT, GIGER, PediEAT, & ChOMPS Instruments

Thank you for your interest in the NeoEAT, InfantEAT, GIGER, PediEAT, and/or ChOMPS. We have taken great care to develop these instruments in a psychometrically-sound way. We are thrilled that you are interested in the translation of our instrument(s) to another language, but in order to ensure that the integrity of the instrument is maintained, we ask that you follow the proper process for translation and cultural adaptation of health-related instruments. These steps have been adapted from a variety of literature, which can be found in the reference list (Acquadro et al., 2008; Beaton, Bombardier, Guillemin, & Ferraz, 2000; Carter et al., 2005; Gjersing, Caplehorn, & Clausen, 2010; Maneesriwongul & Dixon, 2004; Perneger, Leplege, & Etter, 1999; Sousa & Rojjanasrirat, 2011; Wang, Lee, & Fetzer, 2006; Wild et al., 2005). Please also see the PROMIS guidelines for translation and cultural adaptation (available at: http://www.healthmeasures.net/images/PROMIS/PROMISStandards_Vers2.0_Final.pdf)

Please Note: All steps taken and revisions made need to be carefully documented and will be requested by Britt Pados for review. Steps 1 – 4 are required before the instrument can be used. Steps 5 and 6 are additionally required before the instrument can be considered a valid and reliable measure.

Step 1. Simultaneous forward-translation (i.e., translation from English to the new language) by two native speakers of the new language. These two translations are to be done independent from each other.

Step 2. A third native speaker then looks at the two forward-translations created in step 1, reconciles the differences, and decides on the ideal forward translation. This reconciliation may be done as a team.

Step 3. A fourth native speaker (who has not been involved previously and who has not seen the original instrument) then back translates the version of the instrument created in step 2 into English (i.e., translates from the new language to English).

Step 4. A team of people then needs to review and reconcile issues with the back-translated English version created in step 3 to compare it to the original instrument. This team should include as many of the translators that have been involved as possible, at least one professional with experience caring for children with feeding problems who is a fluent speaker of the new language, and at least one lay person who is a parent of a young child. If a lay person/professional was a translator, they may fill both of these roles. Once the team has resolved all issues with the back translation, the finalized back translation needs to be sent to Britt Pados for review.

Step 5. If possible, cognitive interviews in the new language should be conducted with 5-10 parents of children with and without feeding difficulty to ensure that that the language used in the translated version is understandable to parents. Please see the following publications on the development of the instruments for details on the process of cognitive interviews: Pados, Estrem, Thoyre, Park, & McComish, 2017; Thoyre et al., 2014. The cognitive interviews will ensure content validity in the new language.

Step 6. Psychometric testing of the instrument in the new language will need to be conducted before it can be considered a valid and reliable measure, including internal consistency reliability, test-retest reliability, and construct validity with another related measure available in the new language that has strong psychometric properties. Please see the following publication on the process of psychometric testing for guidance on this process: Thoyre et al. 2017.

Factor analysis – confirmatory or exploratory - is not needed. Negative consequences of conducting a factor analysis should be carefully considered before deciding to conduct this type of study. A factor analysis of a newly translated tool will likely derive different results than the original factor analysis. No sample is exactly like a prior one so a new factor analysis is likely to result in the addition or loss of a subscale, the loss of an item or items, and/or the movement of items from one subscale to another. If the number of items or subscales or location of items of the original tool are altered, the integrity of the tool will have been altered. The altered tool will no longer be able to be scored using the original tool’s scoring system and study findings using the altered tool will not be comparable to studies using the original tool. Protecting the scoring system is especially important. The age norming studies of the NeoEAT, InfantEAT, GIGER, PediEAT and ChOMPS were conducted with 1000s of children; the age- normed reference values are invaluable in determining when children need to be seen by experts and in tracking progress of feeding treatments. It would be a loss for you not to be able to use them. We therefore, advise against conducting a new factor analysis.

Should you decide to conduct a factor analysis despite these cautions, please understand this is optional and not necessary. We recommend confirmatory factor analysis with careful attention to the sample size and the characteristics of the sample. A minimum of 5 participants per item are recommended for an acceptable factor analysis (DeVellis, 2012; Pett, Lackey, & Sullivan, 2003). For example, the PediEAT has 78 items so a minimum sample size of 390 participants will be required. In addition, a sufficient number of participants caring for children with feeding problems is required and needs to be similar to the sample used in the original factor analysis. For example, 54% of the PediEAT’s factor analysis sample were caring for children with a diagnosed feeding problem or a child with feeding concerns. It is also important to conduct a factor analysis with a sample that fully represents the age groups the tool is meant for. For example, the PediEAT is for children aged 6 months to 7 years so the sample needs to fully represent all of these ages. Violations of the sample size or characteristics of the sample will invalidate the translated tool’s factor analysis findings.

After steps 1-6 have been completed, we encourage you to publish your findings in a peer-reviewed, relevant journal. Please be aware that there are predatory publishers who will publish articles for a monetary fee, but do not follow the widely-accepted ethical standards for publishing practice. Feel free to consult with Britt Pados if you are unsure about the selection of a journal for publication. It is important to us that any publication that comes from our work meet standards for ethical and high-quality research. If you are signing this agreement and working with Britt Pados through the process of translation and cultural adaptation, Britt Pados should be a co-author on any publication that results from that process. Britt will need to approve the final version of the manuscript before it is submitted for publication. 

By signing below, I agree to the following:

• I will conduct steps 1-4 to create a version of the instrument translated into the new language that has followed appropriate steps for translation and cultural adaptation.
• I will share documentation of steps 1-4 with Britt Pados, upon request.
• I will provide Britt Pados with the back-translated version of the tool and will wait for her review before proceeding.
• I understand that the translated version will be made available to others for use.
• I understand that the the original authors of the tools, who own the copyright of the English version of the tool, will maintain ownership of the copyright of the translated version of the tool.
• I agree to reference the original English version (and its authors) in any publications or presentations of the translated version.
• I will reference the new, translated version of the tool as the translated version (e.g., Pediatric Eating Assessment Tool – Spanish version)
• I will not refer to the new, translated version as being a valid and reliable measure until steps 5 and 6 have been completed and there is acceptable evidence of validity and reliability.
• I will include Britt Pados as a co-author on any publication that results from the translation and cultural adaptation of the NeoEAT, InfantEAT, GIGER, PediEAT, or ChOMPS and I understand that Britt Pados will need to review the final version of the manuscript prior to submission for publication.
• I will share the final, translated version of the tool(s) with Britt Pados at the conclusion of this process. 
• I understand that the Pediatric Eating Assessment Tool (PediEAT), Neonatal Eating Assessment Tool (NeoEAT), Infant Eating Assessment Tool (InfantEAT), Gastrointestinal and Gastroesophageal Reflux Scale for Infants and Toddlers (GIGER), and Child Oral and Motor Proficiency Scale (ChOMPS) are covered by United States copyright law and infringement of copyright law is punishable by criminal prosecution in the United States as well as internationally.

• Acquadro, C., Conway, K., Hareendran, A., Aaronson, N., European Regulatory, I., & Quality of Life Assessment, G. (2008 Literature review of methods to translate health-related quality of life questionnaires for use in multinational clinical trials. Value Health, 11(3), 509-521. doi:10.1111/j.1524-4733.2007.00292.x
• Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000 Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976), 25(24), 3186-3191.
• Carter, J. A., Lees, J. A., Murira, G. M., Gona, J., Neville, B. G., & Newton, C. R. (2005 Issues in the development of cross-cultural assessments of speech and language for children. Int J Lang Commun Disord, 40(4), 385 401. doi:10.1080/13682820500057301
• DeVellis, R. F. (2012Scale development: Theory and applications (3rd ed Thousand Oaks, CA: SAGE Publications, Incorporated.
• Gjersing, L., Caplehorn, J. R., & Clausen, T. (2010 Cross-cultural adaptation of research instruments: language, setting, time and statistical considerations. BMC Med Res Methodol, 10, 13. doi:10.1186/1471-2288-10 13 
• Maneesriwongul, W., & Dixon, J. K. (2004 Instrument translation process: a methods review. J Adv Nurs, 48(2), 175-186. doi:10.1111/j.1365-2648.2004.03185.x 
• Pados, B. F., Estrem, H. H., Thoyre, S. M., Park, J., & McComish, C. (2017 The Neonatal Eating Assessment Tool (NeoEAT): Development and content validation. Neonatal Network: The Journal of Neonatal Nursing, 36(6).
• Perneger, T. V., Leplege, A., & Etter, J. F. (1999 Cross-cultural adaptation of a psychometric instrument: two methods compared. J Clin Epidemiol, 52(11), 1037-1046. 
• Pett, M. A., Lackey, N. R., & Sullivan, J. J. (2003Making sense of factor analysis: The use of factor analysis for instrument development in health care research. Thousand Oaks, CA: Sage Publications, Inc. 
• Sousa, V. D., & Rojjanasrirat, W. (2011 Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract, 17(2), 268-274. doi:10.1111/j.1365-2753.2010.01434.x 
• Thoyre, S. M., Pados, B. F., Park, J., Estrem, H., Hodges, E. A., McComish, C., . . . Murdoch, K. (2014 Development and content validation of the Pediatric Eating Assessment Tool (Pedi-EATAmerican Journal of Speech Language Pathology, 23(1), 46-59. doi:10.1044/1058-0360(2013/12-0069) 
• Thoyre, S. M., Pados, B. F., Park, J., Estrem, H., McComish, C., & Hodges, E. A. (2017 The Pediatric Eating Assessment Tool (PediEAT): Factor structure and psychometric properties. J Pediatr Gastroenterol Nutr. doi:10.1097/MPG.0000000000001765 
• Wang, W. L., Lee, H. L., & Fetzer, S. J. (2006 Challenges and strategies of instrument translation. West J Nurs Res, 28(3), 310-321. doi:10.1177/0193945905284712 
• Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., . . . Cultural, A. (2005 Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health, 8(2), 94-104. doi:10.1111/j.1524-4733.2005.04054.x

If you do not have access to any of these publications and would like to read them, please contact Britt Pados at britt@infantfeedingcare.com