The ATA Chronicle - May/June 2024 - 20

Successful harmonization hinges
on addressing obstacles such as
team dynamics, time limitations,
information-sharing gaps, and
technological constraints.
and meet regulatory
requirements. Ensuring
cultural appropriateness
through culturally competent
translation also fosters
effective communication
between health care providers
and patients from different
cultural backgrounds,
ultimately promoting patient
safety and improving health
care delivery in multilingual
societies. Additionally,
in the health care
industry, localizing health
questionnaires is essential for
companies that want to enter
new markets and engage with
a global audience.
Harmonization of
Health Questionnaires
Harmonization is the process
of creating a unified version
of vocabulary and structure
for questionnaires across
different regional varieties
of a language.1
Imagine, for
instance, a questionnaire
designed to collect data
about the quality of life for
patients with kidney disease.
Initially developed in English,
the Vietnamese translation
can be used for Vietnamese
speakers in Vietnam, the U.S.,
and Australia. Similarly, the
French translation of this
questionnaire might be used
for French speakers in Canada
and Senegal. The challenge
lies in the fact that regional
varieties of a language
can differ significantly in
vocabulary and structure.
20 The ATA Chronicle | May/June 2024
Vietnamese spoken in
California can be different
from Vietnamese spoken
in Hanoi. French spoken in
Marseille differs from French
spoken in Québec. These
variations are not limited to
vocabulary and pronunciation
but extend to syntax and
other grammatical features.
Such differences can lead
to significant discrepancies
in the translation of the same
questionnaire when produced
in different countries.
Variations arise not only
because there are multiple
ways to translate a question
but also due to regional
language differences, social
realities, political ideologies,
and cultural nuances.
Therefore, translators and
harmonizers must decide
which differences are
essential and should be kept
and which are unnecessary
and should be avoided.
Differences arising from
factual distinctions, such
as political, educational,
and social security systems,
measurement systems,
or varying language uses,
should generally be retained.
To complicate matters, the
written regional standard
variety of a language might
differ significantly from
its spoken form even in the
same country. For example,
spoken Vietnamese varies
notably from the North to
the South. While written
Vietnamese is generally
standard, spoken dialects can
include significant regional
vocabulary and pronunciation
differences.
The Harmonization
Process
The harmonization
process varies depending
on each company's
protocols, budget, and
time. Nonetheless, the
basics of shared language
harmonization should
involve key steps to ensure
translations are accurate,
culturally appropriate, and
consistent across different
regions.
One company I've worked
with often begins by having
an experienced translator
from one country or region
produce an initial translation
of the questionnaire. The
questionnaire is then
reviewed and revised by
a team of translators.
Representatives from each
region then meet to compare
translations, identify
differences, and agree on a
common version. Necessary
differences in terms of
language variants are
retained, while unnecessary
ones are harmonized. The
harmonized translation is
then back-translated to
verify accuracy.
Another company that
regularly offers me jobs hires
two translators to translate
health questionnaires
independently. Once both
translations are finished,
the two translators compare
their work and then
collaboratively produce
a third translation. This
collaborative process,
involving discussion and
review to ensure consistency
and accuracy, is referred to
as " harmonization. " The
harmonized translation then
undergoes a back translation,
ideally by a native Englishspeaking
translator. The
project manager compares
the original English with the
back translation, discussing
any discrepancies with the
translators, who may revise
the translation accordingly.
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The ATA Chronicle - May/June 2024

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