Here we present a summary of the linguistic issues and problems encountered during the linguistic validation processes and the necessary measures taken to resolve them. Grammatical and spelling errors corrected during proofreading of the third reconciled version of the translated questionnaire are not presented here.
Title of the instrument: "Wisconsin Smoking Withdrawal Scale (WSWS)"
The title of the source instrument was "Wisconsin Smoking Withdrawal Scale (WSWS)". In Malay language, the term "withdrawal" literally translates to "penarikan" ("to pull something"). The term withdrawal which is more of a technical term is not easily understandable in spoken Malay language. Therefore, the literal translation of the instrument's title was not possible in Malay; thus, the whole title was rendered by a culturally acceptable linguistic equivalent. The translation committee agreed to use the phrase 'gejala penarikan' instead of 'penarikan', which means 'withdrawal symptoms'. The term 'selepas berhenti merokok' was further added to make the term withdrawal more meaningful and understandable for the Malay respondents. Consequently, the title was rendered to "Skala Wisconsin Untuk Gejala Penarikan Selepas Berhenti Merokok" (Wisconsin Scale for Withdrawal Symptoms after Quitting Smoking), which was more acceptable in Malay.
The first instruction sentence: "Please answer the following questions based on how you have felt or what you have noticed [over the last 24 hours/over the last week]".
The second instruction sentence: "Answer based on how you have felt in general during this time".
The second sentence of the instructions was completely deleted, because translation of this sentence tended to make users confused especially in Malay. Users would generally assume that the item questions about their feelings "at the present moment", rather than over the stated period, as emphasized in the sentence preceding that (i.e. over the last 24 hours/over the last week). Furthermore, during the cognitive testing, respondents were generally confused about two phrases used in the first sentence of the instructions which were "bagaimana perasaan anda" (how you have felt) and "apa yang anda sedari" (what you have noticed). They were not sure whether these phrases were referring to their feelings during the process of quitting smoking or in natural behaviors. Owing to the persistent misconceptions and concerns raised by the cognitive debriefing subjects regarding the two phrases in the first sentence, we introduced a new sentence "Jawapan anda mestilah berdasarkan pengalaman anda berhenti merokok", which translates to "Your answer should be based on your quitting experience". Therefore, the instructions were rendered to Sila jawab soalan-soalan berikut berdasarkan "bagaimana perasaan anda" atau "apa yang anda sedari" (dalam tempoh 24 jam yang lalu/dalam tempoh seminggu yang lepas). Jawapan anda mestilah berdasarkan pengalaman anda berhenti merokok, which carry the meaning Please answer the following questions based on "how you have felt" or "what you have noticed" (over the last 24 hours/over the last week). Your answer should be based on your quitting experience. These changes were made after pertinent consultations with the developers of the original instrument.
No issues arose or problems encountered regarding the response choices throughout the linguistic validation process.
Idiomatic expressions and terms within the items
Culturally acceptable equivalents had to be found for the following terms and expressions within the items:
▪ irritability → easily angered (mudah marah)
▪ nibbling on snacks or sweets → urge to snack or have sweets (hendak mengunyah snek atau gula-gula)
▪ upbeat → joy (gembira)
Furthermore, the literal translation of some expressions within the items was not possible in Malay and they had to be rendered by culturally acceptable linguistic equivalents.
▪ Item 1: Food is not particularly appealing to me → I have no interest in food. (Makanan bukanlah sesuatu yang menarik minat saya)
▪ Item 14: I want to nibble on snacks or sweets → I feel the urge to snack or have sweets. (Saya terasa hendak mengunyah snek atau gula-gula)
▪ Item 26: I have trouble getting cigarettes off my mind → It is difficult for me to forget about cigarettes. (Saya mempunyai masalah untuk melupakan rokok)
During the pilot testing, the Malaysian Malay speakers more readily understand the meaning of the above expressions when they are rendered as the phrases following the arrows.
The Malay translated second reconciled version of WSWS was tested on seven Malay respondents with a mean age of 29.6 years, who were in the process of quitting smoking or had prior experience of quitting. Respondents took an average of about 14 minutes to complete the questionnaire.
In general, the respondents did not encounter problems with understanding the contents of the Malay version of the WSWS. The instrument was found to be easily comprehensible, clear and appropriate for the smoking withdrawal symptoms intended to be measured. However, the subjects raised a concern on the first sentence of the instructions, which created some misconceptions. They provided some suggestions, a consensus was reached and we retained the item by providing a supplementary explanatory sentence. This issue has been previously discussed under the "instructions".
Furthermore, three of seven subjects involved in the cognitive debriefing raised a concern that Item 20: "I have thought about smoking a lot", sounds not specific to them (whether it was referring to smoking and health, frequency of smoking or the urge to smoke). Based on the discussions during the cognitive debriefing, the committee agreed to modify the item from "Saya sering terfikir tentang merokok sejak akhir - akhir ini" to "Saya sering terfikir untuk merokok sejak akhir-akhir ini" which means "I think about smoking a lot". The word "tentang" was replaced with "untuk" to strengthen the meaning of the sentence, which was meant to ask about the respondent's urge to smoke cigarettes. The subjects were satisfied with the questionnaire and provided favorable feedbacks. The cognitive debriefing process was therefore successful.