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Table 4 Most problematic SCQ items classified by type of difficulty (Diff.) - Cultural (C), Idiomatic/Pragmatics (I), Semantic (S) and Syntactic (Sy)

From: Cross-cultural adaptation of the Schizophrenia Caregiver Questionnaire (SCQ) and the Caregiver Global Impression (CaGI) Scales in 11 languages

Item Diff. Lang.* (country) LV§ Step Description Solution
F/B IS
15. Over the past four weeks, how often did you feel that you didn’t have enough money to care for him/her, in addition to the rest of your expenses? C ENG (Canada)   All respondents were somewhat confused by this item, since in Canada patients with schizophrenia automatically qualify for government assistance and their medications are covered by social insurance. Item reworded as follows: “Over the past four weeks, how often did you feel that, in addition to the rest of your expenses, you needed more money to care for him/her?”
31. Over the past four weeks, how often did you experience emotional highs and lows (“an emotional rollercoaster”) because of his/her schizophrenia? I ENG (Canada), FRE (France), FIN, ITA, SPA, SWE “High and lows” was translated either by a corresponding idiomatic expression or by a non idiomatic equivalent. ENG, FRE (France): “ups and down”, FIN, ITA, SPA: “mood swings”, SWE: “valleys and tops”
FRE (Canada, France), GER, ITA, SPA “Emotional rollercoaster” was perceived as too idiomatic by translators and respondents of romance languages. FRE (Canada), ITA, SPA: deleted, FRE (France): “up and down morale”, GER: “rollercoaster feelings”
1. Over the past four weeks, how often did you feel that he/she asked for more help than needed? S ITA, SPA   Meaning of “he/she” was found unclear by translators. “He/she” translated by “ill person” (Italian) [changed made for all items including he/she], “the person you take care of” (Spanish)
3. Over the past four weeks, how difficult was it for you to care for him/her and meet your other responsibilities? S ITA   Meaning of “you” was considered too ambiguous by respondents. “You” was removed, “him/her” replaced by “ill person”. Change made for all items with him/her.
4. Over the past four weeks, how embarrassed did you feel about his/her behavior? S DUT   “Embarrassed” was translated with a word meaning both “ashamed” and “embarrassed”. The interviews suggested that the respondents gave it a meaning that had a strong connotation. Replaced by a more direct equivalent of “embarrassed”
GER   Two respondents were disturbed by the translation of embarrassed (“ashamed”). No change
5. Over the past four weeks, how frustrated did you feel about his/her behavior? S DUT   The literal translation of frustrated was not understood by some respondents. Translated by an equivalent of “dissatisfied”
FRE (France) The literal translation of frustrated was not possible. It was translated by an equivalent of “irritated”. The interviews suggested that the respondents gave it a meaning that had a strong connotation. “Irritated” replaced by an equivalent of “annoyed”
11. Over the past four weeks, how often did you feel that you didn’t have as much privacy as you would have liked because of him/her? S DUT   Respondents argued that the Dutch word did not convey the meaning of “time for oneself” and suggested another expression. “Private life”
FRE (France)   The word “privacy” in French could also mean “intimacy”. No change
14. Over the past four weeks, how often did you feel that he/she was overly dependent on you to help with daily activities? S DUT   The meaning of “overly” was not clear for some respondents. “Overly” replaced by an equivalent of “too”
20. Over the past four weeks, how often did you feel you should be doing more for him/her? S FRE (Canada)   Item well understood. However the respondents found that its meaning was too close to the meaning of item 21. “Doing more” was underlined in the translation
27. Over the past four weeks, how often did you worry that he/she might have an episode? S FRE (Canada)   “Episode” was found unclear by translators. Addition of “psychotic” to clarify meaning
ENG (Canada), ITA, GER, SPA, SWE   “Episode” was either perceived unclear or too technical by respondents. ENG: “psychotic break”, “GER: “schizophrenic episode”, ITA SPA: “crisis”, SWE: “relapse”
7. Over the past four weeks, how often did you feel that his/her schizophrenia affected your relationship with other family members or friends in a negative way? S ENG (Canada, UK), FRE (Canada)   Items well understood. However some respondents were strongly opposed to the use of “schizophrenia” because of the stigma attached to it. No change [decision of the developer]
17. Over the past four weeks, how often did you feel you weren’t in control of your life because of his/her schizophrenia? Sy ITA   The use of the courtesy form (3rd person singular) leads to an unwanted ambiguity: “your” is also translated as “his/her”, i.e., “your relationship” may be understood as “his/her relationship”, “his/her schizophrenia” as “your schizophrenia”. “His/her” was deleted in the Italian version
28. Over the past four weeks, how often did you worry that his/her schizophrenia might get worse?
31. Over the past four weeks, how often did you experience emotional highs and lows (“an emotional rollercoaster”) because of his/her schizophrenia?
8. Over the past four weeks, how afraid were you of what the future holds for him/her? Sy DUT   The item was well understood but the respondents found its structure unnecessarily too complicated. “How worried were you about his/her future”
  1. * Lang.: Language; § LV: Linguistic Validation; F/B: issues discussed at forward/backward steps; IS: issues discussed during interviews step