Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

1 

Abstract for 1994 AAPOR 

Translating a Telephone Survey on Alcohol and Drug Use: 

Processes and Lessons Learned 

By 

Roberta L. Sangster 

Behavioral Science Research Center 

Bureau of Labor Statistics 

Robert W. Reynolds 

Department of Sociology 

Weber State University 

John Tarnai 

Social & Economic Sciences Research Center 

Washington State University 

This paper discusses the many aspects of concern that confront a researcher when translating a survey 

into another language. It details the steps within the translation process: recruiting and training 

translators, first translation and back-translation, pretesting the translated questionnaires, preparing the 

final questionnaire for use with a computer assisted telephone interview (CATI) system, and 

implementation of surveys. The study comes from research being conducted by the Social and Economic 

Sciences Research Center, at Washington State University for the Washington State Department of 

Social and Health Services (DSHS). The drug and alcohol assessment survey was translated into six 

languages: Cambodian (Khmer), Vietnamese, Korean, Chinese (Mandarin), Japanese, and Spanish. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

2 

Introduction 

 This paper describes the procedures involved in translating a lengthy survey on aspects of alcohol 

and drug use, into six separate languages: Cambodian (Khmer), Vietnamese, Korean, Chinese 

(Cantonese), Japanese, and Spanish. These six languages are the primary languages, other than 

English, spoken in Washington State. The emphasis in the paper is on what procedures were followed 

and what was learned about the process of translating a survey into other languages 

 The procedures discussed in the paper include: Identifying and training translators, translation and 

back-translation, preparing the questionnaire for use with a computer assisted telephone interview (CATI) 

system, and pretesting the translated questionnaires. The paper explains the reasons for conducting the 

translations, the issues and problems encountered during each phase of the translation process, and how 

the translated questionnaires were used with the CATI system for conducting telephone interviews. 

 The translations were completed for a study being conducted by the Washington State Department 

of Social and Health Services, and funded by the Center for Substance Abuse Treatment. Washington 

State was one of thirteen states that received funding in 1993 to conduct a statewide study of alcohol and 

drug use and prevalence among state residents. The Social and Economic Sciences Research Center 

(SESRC), in Pullman, Washington, is currently completing over 500 telephone interviews with statewide 

residents each month over a one year period. Washington State's population, however, has substantial 

numbers of Asian and Hispanic residents who do not speak or have a limited ability to speak and 

understand the English language. To ensure representation of these groups and thus obtain accurate 

estimates of statewide prevalence rates, it was important that interviews be completed in languages other 

than English. Consequently the survey was systematically translated into each language. This method 

was chosen because of the concerns regarding reliability and validity should the translation of the survey 

depend entirely on bilingual interviewers to translate the survey from English as they conducted the 

interview. If interviewers translated the interview as they conducted it, there would be a good chance that 

the questions would be translated differently by each interviewer across languages, as well as across 

interviews. Having a translated version of the interview would standardize the questions, and give more 

assurance that the interviews would be consistent across languages. Furthermore, the conceptual 

difficulty of the questionnaire also precluded simultaneous translation. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

3 

A. Identifying and Training Translators

 One of the early lessons learned was that recruiting of translators and interviewers is not a 

straightforward process. Translators for some languages were particularly difficult to find in rural 

Washington State (Korean). The SESRC advertised for translators both on campus, with posters and 

classified ads in the campus paper, and through the local town newspapers. Translators needed to be 

fluent both in English and in the target language. The purpose of the survey and the meaning of the 

individual questions needed to be thoroughly explained to the translators. Since none of us were 

conversant, let alone fluent in the target languages, our ability to communicate with the translators was 

viewed as of paramount importance. Even when fluent in both languages, the specialized vocabulary 

used in the study was difficult to translate and required someone able to conceive new concepts and 

flexible enough to translate these ideas into the target language. For example, the Cambodian translators 

both spoke and wrote English very well. However, one was better at relating concepts into the (spoken) 

Cambodian language, while the other was better at writing Cambodian. 

 This flexibility and ability to relate concepts to language was also important for the translators 

because, for the most part, the translators had a very different cultural background from the writers of the 

survey instrument. The translators frequently did not share similar biases and background knowledge 

about drug and alcohol use as the primarily European-American researchers. Because of the crosscultural context of the research, the researchers were imposing their beliefs about what was important 

onto members of other cultures (Matsumoto, 1994). Non-European-American's may not necessarily 

share the feeling that the survey was of importance. This is also a potential problem that the interviewers 

may encounter during the interviewing phase of the project, that may impact the validity and reliability of 

the questions and their subsequent analysis. 

 The willingness of members from different ethnic communities to participate as translators and 

interviewers varied as well. In particular, it was very difficult to recruit translators and interviewers from the 

Korean community, even though it was one of the largest communities in the local area. Whereas it was 

relatively easier to recruit translators and interviewers that spoke Spanish, the ethnic background of the 

translators was Colombian and Puerto Rican, while the largest population of Hispanic Americans in 

Washington State are Mexican-American. Our concern was that while the language would be very similar, 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

4 

the nuances may not. This was sometimes evident during the pretests and appropriate modifications 

were made at that time (See McKay and Lavallee, 1993, for a discussion). 

 Skill levels in writing and grammar varied by individual. Applicants consisted mostly of international 

students attending college in America or college students who were immigrants or refugees. We found 

that word usage and grammar skills varied based on the reason the person came to America (student, 

immigrant, refugee), when the person left the home country (recently versus many years ago), and at what 

age (as a child or an adult). For example, because of the difficulty experienced in getting applicants for 

the Korean translation, our choice of selection for translators was limited (translation "you take who you 

can get"). As a result, we hired a Korean translator who left South Korea as a young girl (9 or 10 years 

old). The majority of her written Korean was learned in the primary grades. Her spoken language skills 

developed mainly from interaction within her family network. She originally began as the translator of the 

survey. Subsequently, we found that it was better for her to back-translate because her grammar skills 

were weak and the back-translator tended not only to back-translate the survey, but edit the translation as 

well! 

B. First-Translation and Back-Translation Process 

 We used Bernard's (1989) model for the translation process of the survey. The simple model has 

three main components. The questionnaire is first written in English. The second step is for the 

questionnaire to be translated into the second language (Translation). The final stage is for the translated 

version of the questionnaire to be translated back into English (Back-translation) by a second translator. 

Once the back-translation is finished, the text is compared to the original script. The translators then meet 

and negotiate changes (Negotiation). The goal of the negotiation process is to have the final translation 

match as near as possible to the English version (Literal translation). 

 Translators initially met with one of us and the questionnaire was jointly reviewed. We discussed 

the intent and content of questions, as well as the interviewer instructions. Individual words that were new 

to the translators were discussed, so that their meaning would be clear. Some words, such as "high," are 

specific to drugs, but not to alcohol in Asian cultures, whereas the questionnaire used it in both contexts. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

5 

These nuances and subject specific vocabulary such as "halfway house" or "detox," were the hardest to 

comprehend and to translate. 

 The translation process began with the first-translator receiving a copy of a section of the survey to 

translate. The survey is broken into 15 parts (See Figure 1). By handing out one or two sections at a time 

we were able to track the progress of the translations. As sections were completed the first-translators 

brought the sections into the SESRC and received new sections to translate.1 The completed sections 

were logged in, copied and the copy was given to the back-translator. When the back translation was 

completed an SESRC staff person compared the back-translation to the original text of the survey. Any 

discrepancies were noted so that they might be discussed during the negotiation phase. The speed with 

which first-translators completed their worked varied greatly. This in turn influenced how quickly the backtranslators were able to begin their work. The back-translator began as soon as a section of the 

questionnaire was translated. This method decreased the overall translation time, but made it more 

difficult to ensure that changes being made to the English version were reflected in the translation. The 

English version was not finalized when the negotiation stage started, and in fact, changes to the English 

version were introduced during the translated version pretest. Because of the differences between the 

time to translate and back-translate some of the languages, the six translations were completed at 

different times, some taking several weeks longer than others. This considerably increased the cost of 

some translations compared to others. 

 Along with increasing the speed of the overall process, and based on the experience with the 

Korean translator who left Korea as a young girl mentioned earlier, we recommend that the backtranslation occur as the translation is being completed. Not only does this speed up the translation 

process, the interaction between the translators will likely help in the assessment of the quality of the 

translation as it progresses. Ideally, of course you would have someone who is an expert in translating do 

your translation. When considering this option, be sure the expert is also comfortable using the common 

language usage that even those with little education can understand. However, hiring two experts for 

 

 1 The translators worked at home. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

6 

each language would cost considerably more than hiring local immigrants, refugees, or visiting students to 

do your translation work. 

 Translators relied on dictionaries for clarification of unfamiliar terms. While this proved to be helpful 

to understand new terms, dictionaries could not be relied on to produce understandable text. We found 

that the translators would simply insert a dictionary term for an unfamiliar English word. Frequently it was 

better to describe something that was unfamiliar to the translator and use that description (a conceptual 

translation) rather than use the dictionary term. It is logical when you think about this. If the translator had 

to use a dictionary because the term was unfamiliar, the concept behind the term is likely to be equally 

unfamiliar. Using a dictionary term for the word does not alleviate the problem since the respondent would 

also be likely to use a dictionary in order to understand the meaning of the term. Other times we found 

that while the word might be in the dictionary, the usage would not be correct. Thus, we learned it was 

better to encourage the translators to talk to us about any terms that were unfamiliar. 

 An insight we gained from the translator's use of dictionaries was that a literal translation is difficult 

to understand. Allowing for a conceptual interpretation of the meaning of the term or using examples, 

produced a more comprehensible translation. This corresponds with Matsumoto's (1992) premise that 

researchers may be placing importance on beliefs that someone from another culture find of little 

importance. This premise is somewhat supported by the need to use descriptions rather than terms to 

make the concept understandable in other languages. Because we realized this during the translation of 

the survey, the translations that lagged behind the others were given permission to use more conceptual 

translations in their work. These translations proved to encounter less problems during the pretest. 

Negotiation 

 Once the back-translations were completed, the English version and the back-translated version of 

the questionnaire were compared for discrepancies. These discrepancies were then the focus of the 

negotiation sessions. During the negotiation sessions between the first-translator and back-translator, an 

SESRC staff person would be present to ensure that the meaning of the words and questions were clear 

to both translators, who would then discuss the best translation. The age and education of the translators 

were a factor in the negotiation process. For example, the Chinese translators were both women, one a 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

7 

graduate student in her late twenties and the other an undergraduate in her late teens. Differences in age 

and education are cultural measures of status among the Chinese. We found that the younger woman 

would not speak up without encouragement, and that the older one tended to domineer the negotiation. 

Revisions of the Translations 

 The translations were edited considerably due to the fact that the "final" copy of the survey 

instrument underwent six revisions after the translations had commenced. This proved to be both 

expensive and time consuming. Probably more so for the Chinese, Korean, Vietnamese, and Cambodian 

translations, which were hand-written, than the Vietnamese and the Spanish translations which were typed 

using word-processor programs written for the respective languages. 

 One tool we used for editing the hand-written translations was paper correction tape. The 

translators tried using "White-out" but it had to dry before it could be written on and when dry it was often 

too rough to write on. Paper correction tape has a smooth texture that is easily written on. It comes in 

single space and double space widths which made it very adaptable for our needs. 

 We also became "masters of cut and paste." When large edits were made we cut out the parts of 

the translated survey that were still useful. We then pasted up a new page, writing in the revisions where 

needed. This made for a much edited "final" copy that had to be photo copied one page at a time rather 

than sending it through the paper feeder on the copy machine.2 The hand-written translations of the 

survey doubled and sometimes tripled the size of the survey instrument, which in English constitutes 

nearly an inch of paper when printed on one side. 

 The editing was much easier with the word-processor versions. However, we found we lost control 

of the translations at times because we had to rely on the translators to get the document printed. We 

found that problems with printers and losing files could create problems we had not anticipated. We ran 

behind schedule on the pretest for the Spanish version while we searched for someone who had a printer 

capable of printing the final sections of the translated survey. Two sections in the Vietnamese translation 

were deleted because the translator thought we were finished with the sections. However, because of the 

 

 2 Much thanks to our SESRC clerical staff who assisted in this arduous process. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

8 

many changes in the survey instrument those sections had to be reproduced. A lesson learned here is to 

be sure to have the equipment or ability to produce the document when you need it. It is a good idea to 

have the translator give you a copy of the translation on diskette as it progresses. However, this does not 

guarantee you will be able to get the document printed if they are using a program you do not possess. It 

is best to keep a printed copy as well. Another issue to consider is to be sure the translator is faster at 

typing then they are at writing their language. We sometimes wondered if it might have been quicker to 

have them write the survey in long-hand. Most important of all is to make sure the English version of the 

survey is finalized before translation work begins! 

Interesting Attributes Encountered 

 We encountered different characteristics of the languages as the translation process progressed. 

We learned that the Cambodian written language comes from the Sanskrit. It is far removed from the 

spoken language. In fact, many Cambodian people would not understand the written language when it is 

spoken if they did not know how to read and write the language. Disparity in the education among the 

Cambodian refugees who came to Washington is fairly extreme. The Washington Cambodian population 

include the Montaguard and Mhong peoples (Mountain people). The translators forged new ground by 

blending the written into the spoken language so that the outcome was a text that could be used in 

"normal" conversation. This translation was a complex task for the translators who spent many hours 

talking with each other and pouring over their dictionary. That we are able to conduct interviews in 

Cambodian is a tribute to their dedicated effort. 

 However, the Vietnamese and Cambodian interviewers report that because the translated interview 

is written in formal language, respondents sometimes have difficulty understanding what is being asked 

for certain questions. This is particularly true for recent immigrants with relatively low levels of formal 

education. Interviewers have found they sometimes need to paraphrase and provide additional 

explanations for what is being asked in a question. 

 The "most recent birthday" method of respondent selection within a household is a fairly well 

established technique. All of the translations included this technique to randomly select one adult from 

each household contacted. We have found, however, that this method is very difficult to use with the 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

9 

Vietnamese and Cambodian households, because birthdays are not celebrated in those countries. Thus, 

when the interviewer asks to speak to the person with the most recent birthday, this is generally 

misunderstood as the "person born most recently." As a result, the interviewer often ends up speaking 

with the youngest person in the household. In households where there are several eligible adults, one 

person often doesn't know the birth dates of everyone, since birth date has no special significance. 

Interviewers have had to ask the person they are speaking with to ask others in the household if they 

know the birth dates of eligible adults in the household. 

C. Preparing the Final Questionnaire for Use with a Computer Assisted Interview System (CATI) 

Creating the Interviewer's Notebook 

 The next task was to create a version of the translation the interviewer that could use while 

completing the interview. Not only did the survey need to be easily read, the interviewer needed to be able 

to follow the complicated skip patterns of the survey instrument.3 We decided the only way for this to 

occur was to have the interviewer use the CATI system being used for the English language version of the 

questionnaire. Interviewers would read the translated text from the paper version of the questionnaire, 

and enter the responses into a CATI system terminal as the interview was being conducted. By entering 

the data as the interview progressed the skip patterns would be calculated for the interviewer. 

 The translations were copied and placed into a two or three inch binder. The sections of the survey 

were separated by heavier gage colored paper with heavy gage tabs on the side to denote the 15 

sections. The sections were labeled using the terms shown in Figure 1. The interviewers also marked the 

translations with highlight pens in different ways they felt would help them to follow the skip patterns when 

completing the interviews. The interviewers were also responsible for assuring the translation matched 

the CATI system. Since the survey instrument had under gone six revisions while the survey was being 

translated --- questions were changed, added and deleted -- we were concerned that the skip patterns 

might have changed and not been corrected or that a question might need to be added or deleted from 

the translation. Matching the survey questions with the CATI system also gave the interviewers their first 

 

 3 One calculation takes the computer nearly a minute to process. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

10 

experience with the translated version of the questionnaire. In a few cases the interviewers worked with 

the translators to make a few edits to the translation that made the interviewers more comfortable with the 

translations, although we preferred to limit this as much as possible. We told the interviewers to wait until 

after the pretest to edit the translation. However, to avoid mutiny, the survey was edited in a few places in 

order for some of the interviewers to agree to do the pretest. Once the process of matching the 

translation to the CATI system was completed we began the pretests. 

D. Pretesting the Translated Questionnaires

Methodology

 By the time we were ready for the pretest of the translations, the survey instrument was in use with 

the general population. It was timed to take from 20 minutes to one hour, and sometimes as long as one 

and one half hours to complete. The time variation depends on how many sections the respondent might 

skip over within the 15 part survey. For example, if respondents answers "no" to alcohol use, they skip out 

of a rather long section on alcohol use. If they also say "no" to all eight of the drug use screening 

questions the respondent skips out of the questions about use for each of these drugs and jumps over the 

DIS Diagnosis Section and three sections dealing with different treatment issues. The same holds true for 

the four sections on mental health and for a large part of the section regarding health and disability 

assessment. The only sections of the survey where everyone completes the full section are the 

introduction, demographics, and risk factors for alcohol and drug abuse. This allows for great variation in 

the time an interview will take. Recognizing this we designed a pretest that would test the entire 

questionnaire. 

 We did this using "role play" where participants completed different sections of the survey 

instrument. We would have preferred to test the entire survey with each role-play participant. However, 

this was too taxing for both the interviewer and the role-play participant. Instead the survey was broken 

down so that three role players, person one, two or three, knew what sections he or she was supposed to 

say "yes" to when the question was asked. Figure 2 gives a break down of how that worked. Having 

these participants role play the different sections at least provided a test of the entire survey instrument. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

11 

All of the pretest interviews were monitored by one of the translators who noted any problems with the 

translations as the pretest progressed. Each role-play participant was paid a twenty dollar stipend. 

 The translators and interviewers found volunteers who spoke the target language. This method 

required the role-play participants to respond "yes" to behaviors and disorders whose conceptionalizations 

were largely western in orientation and foreign to many of the role-play participants. The person that 

contacted the participant explained that "role playing" required the participant to say "yes" to behaviors or 

psychological disorder questions that was not part of their normal behavior. The participants also received 

a letter that briefly explained what was required of the role-play participant and what questions they would 

be asked to say "yes" to in order to role-play through the related questions. Just prior to beginning the 

pretest, we would call the participant and go through what we had asked them to do again. Fortunately 

most of the role-play participants were college students who had learned about some of the psychological 

disorders and drug use problems in introductory courses they had completed in college. Some of the roleplay participants, however were family members of the translators or interviewers who had less knowledge 

of the conditions they were asked to portray. This resulted in a less-than-perfect pretest because the 

interviewer would have to stop and remind the respondent he or she was role-playing and that they were 

supposed to say "yes" to certain questions. 

 The merit of this pretest was that the interviewer was at least able to go through all of the survey's 

sections and test the full translation. In addition, it was sometimes the first time the interviewer had been 

able to practice the survey! Unlike the typical setting where the interviewers practice the survey 

instrument calling each other, our interviewers had no one available to call to practice the interview. 

Instead, they read the interview out loud to practice saying the interview and entered made-up data into 

the CATI system to get used to doing both at the same time. 

 In addition to the role-play pretest, each interviewer completed two random calls to respondents we 

had found in the English pretest that spoke the target languages. As we had anticipated, these calls went 

very quickly with the respondents skipping out of most of the sections. However, this pretest allowed us to 

note where refusals occurred or areas where the respondent seemed offended by the wording of the 

questions. Once the pretest was completed any problem areas were corrected by once again going 

through the negotiation process. 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

12 

Pretest Results 

 Literal translation proved to be a problem when the translations were pretested. Spanish, 

Japanese, and Vietnamese translations were the first three translations to be completed, and these were 

literal translations (used the wording as close as possible to the original text). We learned that the 

interviewers found the literal translations difficult to say which made it difficult for the respondent to 

understand the questions. The literal translation disrupted the normal speaking pattern of the languages. 

As McKay and Lavallee (1993:6) state, the literal translation tends to make the translation 

"incomprehensible, or at least, stilted or awkward." In contrast, in the Cantonese, Cambodian, and 

Korean translations, which were completed somewhat later, the translators were allowed to negotiate to 

maintain the meaning of the question, but given permissible to state the question in a more normal 

conversational pattern for the language and use commonly used words rather than exact translations of 

the word. 

 Furthermore, we found that the deferments and formal apologies used in the other languages for 

asking personal and sensitive questions were missing and had to be added to the interview so that the 

respondent would not be offended and refuse to complete the survey. For example, the reference to "you" 

is not polite in Korean. We had to go back and delete the term to make the interview acceptable to the 

respondent. Also, the use of examples and modifiers added to the difficulty in translating the survey. 

Some examples tended to simply not translate, while others were at best foreign to the different cultures. 

The examples tended to get very long in the translation, which added to the length of an already long 

survey. While conceptual translation benefits comprehension, it adds to the length of the survey. Marin 

and Marin (1991) have an excellent discussion about the benefits and costs of "decentering" a survey 

(modifying the survey to accommodate both languages). However, decentering would have been difficult 

to accomplish in this instance given we had seven languages to deal with for this particular questionnaire. 

E. Conclusion 

 We have drawn five general conclusions from our experience with the translation of a survey 

instrument into six languages. First, the translation process takes time, so be sure to leave enough time 
 Translating a Survey on Alcohol and Drug Use 

Sangster, Reynolds, and Tarnai 

13 

for this process, after the English version has been finalized. Avoid translating a questionnaire that has 

not been completely written. Consider adapting the English version to the translation if necessary 

(decentering). Second, avoid the use of slang and technical terms that may not be possible to translate 

into other languages. Third, use questions, phrases, and examples that are culturally sensitive and that fit 

the life experiences of the people that are being interviewed. Keep modifiers and examples to a minimum. 

Fourth, avoid literal translations that, while being grammatically correct and closely following the wording 

of the original text, may be too formal for the average language speaker and may convolute the language 

to borderline incomprehensibility. Also be sure to ask the translators to point out where questions might 

be offensive or missing important polite phrases necessary to not offend the listener. Finally, as with any 

survey instrument, thorough pretesting of all aspect of a translated questionnaire is the only way to ensure 

that questions and instructions are being understood by respondents. 

F. References 

Bernard, Henry R. 1989. Research Methods in Cultural Anthropology. Newbury Park: Sage Publications. 

McKay, Ruth and Anita P. Lavallee 1993. "The Hispanic Version of the Redesigned CPS Questionnaire" 

Applying Sociolinguistic and Survey Research Methods to Translating Survey Questionnaires." A 

paper presented at the 1993 American Association for Public Opinion Research meetings, 

Pheasant Run, IL. 

Matsumoto, David. 1994. Cultural Influences on Research Methods and Statistics. Brooks/Cole Publishing 

Company. 

Marin, Gerardo and Barbara VanOss Marin. 1991. Research with Hispanic Populations. Applied 

 Research Methods Series, Vol 23, Sage Publications.