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Table 2 Example of the translation process of one item from the Ability to Participate in Social Roles and Activities item bank

From: Simplified Chinese translation of 13 adult item banks from the Quality of Life in Neurological Disorders (Neuro-QoL)

NQPRF1 Item Wording
Original English I have to limit my hobbies or leisure activities
Forward 1 我不得不限制自己的爱好和休闲活动
Forward 2 我不得不限制我的爱好和休闲活动
Reconciliation 我不得不限制我的业余爱好和休闲活动
Back Translation I have to limit my hobbies and recreation activities
FACIT 1. Do you agree with the words chosen by the Reconciliation (REC) translation?
2. Also, we should confirm that the current translation is acceptable.
Reviewer 1 (Chinese) REC is OK
Reviewer 2 (Chinese) Suggestion:我必须限制我的业余爱好和休闲活动.
“不得不” indicates that you must do something for compelling reason. This is a written language rather than a usual expression. I am afraid that it is hard to understand for any person with low education.
Reviewer 3 (English) Suggestion: 我要限制我的业余爱好和休闲活动
“不得不” emphasizes that I cannot do that because of limitations of my body function. Instead, the word “要” indicates that I cannot paticipate in any activities, either because of my limitation or because I don’t want to.
Reviewer 4 (Chinese) Suggestion:我必须/要限制我的业余爱好和休闲活动.
“不得不” is a double-negative word. I think that most Chinese people do not understand. Conversely, I suggest “必须” and “要,” which are more acceptable and understandable by most people.
Reviewer 5 (Chinese) The translation is OK. However, “不得不” is not often used in the Chinese context.
Reviewer 6 (English) REC looks good for me.
Reviewer 7 (English) I suggested that we should get some feedback from our patients to decide if either one of these three words: “不得不,” “必须,” or “要” would work better.
Translation working team comments Reviewers agreed that REC is the final translation; however, they recommended keeping these terms and asked participants during cognitive interviews.
Proofreading 不得不限制我的业余爱好和休闲活动
Post-test final After cognitive review, the final translation was confirmed: 我必须限制我的业余爱好和休闲活动.
Most participants in the cognitive interview suggested that “必须” is idiomatic Chinese. Four participants reported that “不得不” is not often used in China, and they have difficulty understanding it. Three participants considered “不得不” difficult to understand for persons with low education. Three participants suggested that “要” is unsuitable because it does not describe the limitation the person faces to participate in social activities.