COPD Exacerbation Recognition Tool: Translation, Linguistic, and Cross-Cultural Validation.

Background: The Chronic Obstructive Pulmonary Disease (COPD) Exacerbation Recognition Tool (CERT) was developed to improve patients’ recognition of COPD exacerbations. This validation study concerned the cross-cultural and linguistic validation of 46 CERT translations across 25 countries and 6 continents. Methods: This study employed a rigorous, certified (International Organization for Standardization-17100) methodology. Dual forward translations for each language were developed by independent translators who were native speakers of the target language and then reconciled by a linguistic validation consultant (LVC). Independent linguists provided a back translation of the reconciled translation, which was reviewed by the LVC and project manager. Linguistic validation was performed for each language through cognitive debriefing interviews with at least 5 participants with COPD who were native speakers of the target language. These participants also reviewed 7 sets of images produced for different global regions to reflect patients from a diversity of cultures, countries, and religions, to determine if the images were representative of themselves and/or other people living with COPD. The images were amended as needed and reshown to the participants for approval. Results: The translations were found to be conceptually equivalent to the original CERT and harmonized with each other. Participants found the CERT easy to use and understand and confirmed that the images were representative of themselves and/or other people living with COPD. Conclusion: CERT translations were created using a patient-centric approach and appear to be easily understandable and valid across many languages and cultures.