2.2. Phase 2: Translation and Cultural Adaptation Phase

In this phase, two bilingual translators with the skills to translate the questionnaire from the original English into the Malay with general terms that are easily understood in Malaysia performed the forward translation. The conciliation stage involved determining the appropriate forward translation and changing items in the forward translation or changing the forward translation completely if necessary, reconciling and harmonising the Malay version of the instrument. Any discrepancies were resolved with intensive discussions among the experts and translators. A written report recording all synthesis processes, with each issue addressed and how they were resolved, was produced (Supplementary Materials Table S1).

The backward translation involved translating the reconciled questionnaire (Malay) back to the original language (English). To review the backward translation, the backward translated (English) items were compared with the original English version to identify any equivalent conceptual differences. Both the English and Malay versions were refined to reach agreement on a satisfactory equivalent version of the instrument.

In the harmonising stage, all translation items in the desired language were compared with the source version. Any discrepancies were resolved with intensive discussions among the experts and translators. At the cognitive briefing stage, pre-draft version of the questionnaire was field-tested among the target population. Ten respondents were recruited to answer the pre-test questions of the Malay version FIXED questionnaire, which was distributed online. The respondents, who were randomly selected based on their participation in the Melaka CPR Fun Run programme between 2018 and 2020, were at least 18 years old, Malaysian citizens, understood Malay, and were residents or permanent residents of Melaka State.

The cognitive debriefing review was guided by the respondents’ feedback. The researcher and supervisor agreed via consensus to make changes to the items in terms of word substitution, word deletion, word addition, and sentence structure. The Malay translation was modified carefully to maintain the conceptual meaning of the item and the translation was finalised through discussion with the researcher and supervisor. The draft version would undergo validation before the FIXED instrument was finalised.