Developing a Conceptually Equivalent Type 2 Diabetes Risk Score for Indian Gujaratis in the UK

Table 1

An illustration of the challenges addressed in the translation with Gujarati words.

Terms and concepts	Challenge	How addressed
Risk and risk factors	A Gujarati equivalent that would convey the idea of risk in relation to diabetes was felt to be lacking; an appropriate Gujarati equivalent to the term risk factors was also felt to be lacking; initially, a phonetic translation of the English term was used, but some interview participants did not fully understand this	Initially, it was considered that a phonetic translation of the English word “risk” would be best, but many of the interview participants preferred the Gujarati word; in the final version, the initial paragraph used the phonetically spelt term “risk” with “jokhem” in brackets to help familiarise the reader, thereafter, throughout the document the Gujarati word for risk was used; an explanation of what risk factors are was provided, spelling “factors” phonetically and using the translated word for “reasons” rather than factors; this was tested on participants in the later interviews and it helped to aid comprehension
Ethnicity	Lack of equivalent Gujarati term to convey meaning	Rather than using a single word, a detailed explanation was given to aid conceptual and linguistic understanding and examples were given to aid comprehension-
Lifestyle	Difficulty of conveying the intended meaning; some of the terms suggested by a minority of the interview participants had multiple meanings or were too general and did not capture the full meaning of the word lifestyle, as opposed to life	We retained the translators’ use of the Gujarati term for lifestyle as participants understood the meaning
Questionnaire	Translation of the word questionnaire as prashnavali was perceived as being pitched at too high educational level by a minority of interview participants	A simple term used (savalo ne yadi-
Term for diagnosis	A minority of interview participants suggested that the Gujarati word might be too technical, although they understood it themselves; discussion with the translators about other possible Gujarati equivalents suggested that these would give rise to ambiguity	It was decided to retain the original translation as this had been understood by interview participants and the translated version was aimed at people with a reading age of 12 or over
Terms used for “waist size group” (in the questionnaire) and “waist measurement” (in “how to measure your waist” instructions)	Some participants suggested using the Gujarati word for measurement (map) instead of waist size, acknowledging that it was not technically correct but commonly used and understood	After discussion, the word map   was used in the risk score and how to measure your waist instructions
The LSA states that…the good news is being diagnosed sooner rather than later…	The majority of interview participants found use of “good news” to be inappropriate and insensitive	This was revised to “it’s good to know” because you have been diagnosed early
Thrush (as a symptom of diabetes)	A detailed explanation of this term was deemed by the project team to be too technical, overly descriptive, and potentially distressing; the Gujarati word for thrush suggested by a few participants can also mean weakness and had the potential to create misunderstanding	The word for thrush was phonetically translated in English
BMI table (the LSA includes a table for self-estimation of BMI)	The table was felt to be conceptually and practically challenging to use; the language used was not entirely the cause of the problem; providing examples did not appear to help with self-completion	This table was changed 3 times in response to feedback; what helped was simplifying the explanation and using systematic instructions similar to those used in for waist measurement; towards the end of the pretesting stage, it could be self-completed by some interview participants