Reconciled Translation

• Question number 73: FT1 was “Tumhala chawtana kahi tras janwat hota ka?” and FT2 was “Chawane awaghad watle hote ka?” We accepted FT2 for reconciled translation.

• The foot note stating “Sarva adhikar rakhun, Chawthya payritil aabhyasika” from FT2 was included in reconciled translation.

• For all other questions, FT1 was accepted with few corrections like the words “apnas/aaplya” were used in place of “tumhala/tumchya” which was showing more respect for the patients.

• Although the instructions for EORTC QLQ-H&N35 were the same as EORTC QLQ-H&N35, it was changed for the more respectful words for patients like “apnas” in place of “tumchya.” The word “Gelya aathawdyat” was changed to “Gelya aathawadabharat” as per FT1. Question numbers 31 to 33 and 41 to 45 were accepted as it is in both FT1 and FT2 but in reconciled translation, the words “tumhala/tumchya” were replaced with “apnas/aaplya.”

This reconciled translation was then back translated in English by two other independent translators who were fluent in both the languages and had not seen the original English questionnaire. The FIT was formed by comparing the two BTs with the original English tool. BT1 and BT2 were comparable and giving same meaning as the original English questionnaire. Hence, the reconciled translation was used as FIT and was sent to EORTC TU for discussion and comments. Incorporating the suggestions and after explaining the queries from EORTC TU, Marathi translation was prepared for external proof editing. The following were the suggestions and explanations for EORTC TU queries.

Translation for external proof editing is as follows:

• Instruction: “Krupaya yogya aakdyabhowati vartul karun aaple uttar dyave” was changed to “Krupaya aapnasathi yogya aslelya aakdyabhowati vartul karun aaple uttar dyave.”

• Question 33: clarification was given for the word soreness versus ulcers.

• Question number 51: the meaning in BT was confirmed for “problems with eating” versus “problems while eating.” Furthermore, the meaning of word “Giltana” was confirmed as swallowing and not ingestion.

Incorporating the corrections suggested by external proof editor appointed by EORTC TU, SIT for pilot testing was formed. Postexternal proof editing changes were as follows:

• Instructions: “Barechda rugna tyana khalil pramane tras hot aahe kiwa khalil lakshananpaiki kahi lakshne disat aahet, ase sangat astat” was edited as “Kadhikadhi rugna tyana khalil pramane lakshne disat aahet kiwa samasya aahet, ase sangat astat.”

• Instruction: “Krupaya aaplyasathi yogya aslelya aakdyabhowati vartul karun aaple uttar dyave” was edited as “Krupaya aapnasathi sarvat jast lagu asnarya aakdyabhowati vartul karun aaple uttar dyave.”

• Instruction: “Jarase/thode” was edited as “jarase.” The alternative word was removed.

• Question number 41, 44 to 47, 52 to 56, and 58 and 59: the part of the sentence “Adchan aali hoti ka?” was edited as “samasya aalya hotya ka?.”

• Question number 73: “Chawane awaghad wattle hote ka?” was edited as “Aapnas chawnyat samasya aalya hotya ka?.”

This postedited translation was discussed with the study team and was accepted as SIT which was used for pilot testing.

Part III: Pilot Testing

The Marathi translation for pilot testing, before SIT, was given to literate Marathi speaking and histopathology-proven nonmetastatic HNSCC patients, of all age group and either sex with Karnofsky’s performance score of more than or equal to 70, who had never seen these questionnaire before and gave informed written consent for the participation in the study. The characteristics of patients are described in Table 1. After completing the questionnaire, the translation was discussed individually with the patients. Patients were interviewed about difficulty in understanding, difficulty in answering, and confusion regarding any question or word. They were also asked whether any question or word was objectionable or offensive. Patients were asked for their suggestions for framing a specific question or replacement of a specific relevant word.

Patient interview report is as follows:

• Difficulty in answering: none of the patient-reported difficulty in answering any question.

• Confusing:

  • Question number 32: one patient reported confusion in word “jabda (jaw).” After explaining, he understood the difference between the jaw and mouth. All other patients understood the question and there was no confusion.

  • Question number 46: five patients had confusion in understanding the question. They said that there will always be a problem during coughing. Both the forward and BTs were rechecked. The FT1 was accepted for proof editing. However, when rechecked with BT, we found FT2 was appropriate. The FT1 meant “problem during coughing” and FT2 meant “problem with coughing.” Hence, we accepted the FT2. The word “khoktanna” is replaced with the word “khoklyammule.”

  • Difficult words:

    Questions 35 to 37: two patients suggested, it would be easier to answer if we use the word “tras” in place of “samasya.” However, the BT meant difficulty and not the problem as asked in the original questionnaire. Hence, the translation was not changed, as all the patents have answered and understood the question.

  • Upsetting: none of the patients reported that any question was upsetting.

    Question numbers 60 and 61: although the question was not upsetting, six patients were shy during the interview and one patient refrained from answering the question. Rather seven patients said that the things should be explained to their partner that the disease is not contagious which is the common belief in the society.

  • Alternative wording or suggestion:

    The alterative word was suggested for question numbers 35 to 37. However, it was not changed as explained earlier (tras vs. samasya).

  • Question number 57: six patients pointed out that there is a repetition of the word “apnas.” Hence, the second “apnas” in the sentence was deleted. “Apnas gongat aslelya watavarnat boltana samasya alya hoyta ka?.”

None of the patients reported that the questions or any specific words used in the questionnaire were objectionable or offensive. The suggested corrections were incorporated and rechecked with BT. It was then sent to the EORTC TU. It was accepted and permission was granted for the future use of the final Marathi translation (Annexure 1).

The psychometric statistical analysis of pilot testing was performed using the statistical analysis software SYSTAT version 12 by Cranes Software, Bengaluru, Karnataka, India. The mean values of item scales are shown in Figs. 1 and 2, respectively. The internal consistency was measured to test the reliability of the translated questionnaire by calculating the Cronbach’s α. The Cronbach’s α value item scales is given in Table 2. It was >7 (acceptable) for most of the functions/symptoms.

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Fig. 1: Distribution of mean values of functional scale.

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Fig. 2: Distribution of mean values of symptom scale.

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