Cultural Adaptation in Chinese Mental Health Translation

Yi Shan & Meng Ji (2024)

Springer: Singapore, pp. 56, ISBN 978-981-97-1726-2.

Reviewed by: Anna Li, University of Macau and Northeast Forestry University, PRC.

Translation is a cross-cultural process of adaptation from a source text to a target text. In the field of mental health translation, every subtle expression is of vital importance. Black held that “translation is essentially a multilingual and multicultural endeavor that can provide far-reaching implications for the growth and development of the mental health domain worldwide” (Black, 2018, quoted in Yi &Meng, 2024: 4). Most mental health scales are developed in English and applied in English-speaking countries where immigrants with multi-cultural backgrounds may score differently on the same item in the mental health scale. There is a pressing need for measures designated for immigrant populations with mental health problems. Currently, the area of mental health translation methodology has been largely neglected by research. Cultural Adaptation in Chinese Mental Health Translation, written by Yi Shan and Meng ji and published by Springer In 2024, focusses on the necessity and effectiveness of cultural adaptation in the translation of mental health scales. In addition to the introduction, the book is divided into four chapters, discussing issues related to culturally inclusiveness and comprehensible and appropriate English-Chinese translation of terms and expressions in the mental health field.

The introductory chapter opens with a concise review of the literature on global mental health, variations in the expression of mental disorders, arguing that mental health translation is as a pressing need. The principles of cultural adaptation in the translation of mental health scales are introduced, including “content equivalence, semantic equivalence, technical equivalence, criterion equivalence and conceptual equivalence” (Flaherty et al., 1988, as cited in Yi &Meng, 2024: 7). In particular, by describing an “oscillating line around the 45° line rather than a straight line at 45°” (8), the author introduces a graph showing that “any item or measure may be cross-culturally equivalent on one or more of these five dimensions but not equivalent on other dimensions” (8). In what follows, Yi and Meng explain equivalences in five dimensions. Through reviews and discussions, the authors explain the purpose of the book, i.e. an examination of cultural adaptation in the cross-cultural translation of mental health scales as a means to reduce the stigmatization of mental disorders and address the mental health needs of individuals with mental illness.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      

In Chapter 2, the authors highlight the importance of understanding the varying mental health needs of individuals from diverse backgrounds. It is recognized that there are numerous languages and cultures around the world, with each carrying its unique characteristics. Immigrants bring their native languages, customs, and cultural practices to their host countries, which leads to an increase in the diversity of languages and cultures within these regions. As the ethnic and cultural composition of communities continues to evolve, the mental health needs of multicultural populations also change and become more diverse. Presentations of mental disorders vary according to settings, particularly where somatic, emotional or psychological expressions are crucially important. Yi and Meng hold that “translated health-related materials must be relevant to the cultural beliefs and values of the target social settings and culturally comprehensible and acceptable to the target readers” (24), apparently, translation for mental health is expected to be consistent with clients’ multicultural backgrounds. Therefore, the authors propose an approach to the cross-cultural translation of mental health scales developed in different cultural settings, which focuses on three dimensions of equivalence: the relevance, comprehensibility, and acceptability of items on mental health scales in Chapter 3, 4, and 5.

Chapter 3, titled Cultural Relevance of Mental Health Scales, discusses and illustrates the concept of cultural relevance in the translation of mental health scales. In addition to ensuring linguistic and psychometric validity, cultural relevance is a crucial factor that significantly influences the success of achieving an equivalent translation. Recognizing this, the authors assert that mental health scales must be oriented toward the target culture. The primary aim of cross-cultural translation and adaptation of previously established mental health instruments is to ensure these tools are culturally valid and specifically applicable to the meanings, knowledge systems, and actions relevant to the target cultural group and local context. Consequently, Yi and Meng believe that developing cross-culturally adapted scales involves modifying existing measures to guarantee their cultural relevance, a process known as cultural grounding or evidence-based cultural adaptation. By citing some examples in this chapter, they hold that, when the definitions and indicators of certain concepts in the original scale items cannot be effectively conveyed in the target language culture, it may be necessary to omit these concepts or even the entire items from the translated and adapted scales.

Chapter 4 explores the concept of cultural comprehensibility in the context of translating mental health scales. Cultural beliefs and values significantly influence how individuals perceive health, interpret changes in their health status and relevant medical treatments. As a result, language barriers and cultural beliefs can hinder people’s ability to understand and effectively engage with mental health scale, thereby diminishing the meaningfulness of the data collected. Yi and Meng believe that “cultural comprehensibility is closely associated with semantic equivalence” (33). By using a few translated examples, they point out that semantic equivalence needs to be established during the English-Chinese translation of mental health scale, especially on some terms and expressions which are obvious to one cultural community, and might be unclear to another. One example is as follows, by citing an item on Day’s Mental Illness Stigma Scale, Yi and Meng translated “a close relationship” and “on an emotional roller coaster” in the item “A close relationship with someone with a mental illness would be like living on an emotional roller coaster” (Day et al., 2007，as cited in Yi &Meng, 2024) (34) into“谈恋爱”and“情绪可能会不太稳定, 会经历情绪上的大起大落”(34) respectively to enhance cultural comprehensibility.

Chapter 5 illustrates the concept of cultural acceptability in English-Chinese translation of mental health scales. It is essential to address cultural factors appropriately when translating mental health scales developed in source languages and cultures into target ones. To obtain valid data, the translated and adapted mental health scales must be culturally acceptable to the intended audience. By citing a few examples, the authors assert that cultural acceptability is closely associated with technical equivalence which is mentioned in the five dimensions of Chapter 1. During the translating process, when a translated term shows semantic equivalence, its evaluation methods and corresponding impacts need to remain consistent, as pertains to technical equivalence dimension. Yi and Meng assert that the cultural acceptability of translated mental health scales can be significantly affected by issues related to cultural context, for the reason that particular concepts that are obvious to one group of people may be completed obscure to another (Kuliś et al., 2011: 38). For instance, they rendered “alternative medicine” into“非西医的各种传统医学” (various traditional medicines other than western medicine) and provided specific instances, “针灸” (acupuncture) and “草药”(herbal medicine) (38), to enhance acceptability in target language and avoid unclear understanding in the item. Another good case is the adoption of deletion when the item mentioned in the scale does not exist in China or make sense for Chinese readers. For instance, “primary care physicians” cannot be translated into“初级保健医生” literally or into “社区医生”(38), due to the reason that there is no“初级保健医生” or “社区医生”in the English sense in mainland China, where people usually go to hospital directly to see a doctor when they are sick. While in Europe, America, Hong Kong and Macau, people need to first visit and consult their “primary care physician” before going to public hospitals with a referral from “primary care physicians” (38).

The book provides some insights into cross-cultural practices on mental health translation. First, the discussion shed lights on a functional approach to E-C translation for a special purpose, taking cross-culture into consideration. Yi and Meng hold that linguistic dependence on the source language needs to be carefully controlled. By adopting functional approach, such translation try to achieve more culturally neutral understanding and perceptions of mental disorders among the target readers. Secondly, Yi and Meng introduce and explain five dimensions of cultural equivalence put forward by Flaherty et al., which serves as a framework for mental health translation. Finally, based on the framework, Yi and Meng develop three principles for translating mental health scales, illustrated with a few examples.

However, the book is not free from limitations. First, the authors mention “functional translation” several times, but do not give detailed illustrations for functional approach in their translation, although equivalence in five dimensions is illustrated. Actually, the functional approach is expected to be the grounding methodology which serves as a base for the five dimensions. In this way, the book might be more logically understood. Moreover, examples illustrating how cultural adaptation is realized in Chapter 3, 4 and 5 are not enough to tell readers why those items and terms in mental health scales are translated in that way. Admittedly, Chapter 3, 4 and 5 are the main body part for the whole book, but only contribute 13 pages in a book of 39 pages (except appendix). More examples and illustrations are expected since the three chapters are the major part supporting the whole book. Readers studying mental health translation practice may be more interested in detailed illustrations on translated examples by adopting cultural adaptation strategy. Anyway, to set the ball rolling, this book is really an insight for those who focus on E-C Mental Health Translation. 

References

Black, A. K. (2018). Language translation for mental health materials: A comparison of current back-translation and skopostheorie-based methods.

Day, E. N., Edgren, K., & Eshleman, A. (2007). Measuring stigma toward mental illness: Development and application of the mental illness stigma scale. Journal of Applied Social Psychology, 37(10), 2191–2219.

Flaherty, J. A., Gaviria, F. M., Pathak, D., Mitchell, T., Wintrob, R., Richman, J. A., et al. (1988). Developing instruments for cross-cultural psychiatric research. Journal of Nervous Mental and Disorders, 176(5), 257–263.

Kuliś, D., Arnott, M., Greimel, E. R., Bottomley, A., & Koller, M. (2011). Trends in translation requests and arising issues regarding cultural adaptation. Expert Review of Pharmacoeconomics and Outcomes Research, 11(3), 307–314.