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DI-041 Design of a methodology for cultural translation and adaptation of the adherence to refills and medications scale (ARMS)
  1. J González-Bueno1,
  2. E Calvo-Cidoncha2,
  3. MR Cantudo-Cuenca3,
  4. A Rodríguez-Pérez4,
  5. MD Toscano-Guzmán4,
  6. B Santos-Ramos3
  1. 1Consorci Hospitalari de Vic., Pharmacy Unit, Barcelona, Spain
  2. 2Dirección General de Farmacia., Área Sanitaria Barcelona, Barcelona, Spain
  3. 3Área Sanitaria Sur de Sevilla, Pharmacy Unit, Sevilla, Spain
  4. 4Hospital Universitario Virgen Del Rocío, Pharmacy Unit, Sevilla, Spain


Background The Adherence to Refill and Medications Scale (ARMS) is a tool for measuring adherence validated in an English speaking setting. The application of this scale into a different clinical practice setting requires a cross cultural translation and adaptation process.

Purpose To design a methodology to translate and adapt the ARMS Scale to a non-English speaking culture ensuring cross cultural equivalence.

Material and methods A symmetrical translation approach was selected for ensuring a semantic, conceptual and content equivalence between the source language (SL) and the target language (TL). This approach was structured on three steps: forward translation, blind back translation and synthesis adaptation. Translators involved in steps 1 and 2 had to rate (0–10 scale) the difficulty they found assuring cross cultural equivalence of every translated item. Difficulty rating was expressed as mean and SD. Correlation analysis between the scores of each translator was performed using Pearson´s correlation coefficient.


  1. Forward translation: the 12 item ARMS scale (SL) was forward translated to the TL by an independent bilingual and bicultural translator whose mother language was the TL.

  2. Blind back translation: the preliminary translated version was back translated into the SL in a blinded fashion by another independent bilingual and bicultural translator whose mother language was the SL. Both translators were healthcare professionals knowledgeable about compliance terminology. The score for translation difficulty was 2.7 (SD 1.5) in both cases. A non-significant correlation between translators was observed: 0.475 showing a specific difficulty for each language and translator.

  3. Synthesis and adaptation: items of the back translation were compared with the original scale regarding format, wording, grammatical structure, similarity in meaning and relevance. This step was performed by a third independent bilingual and bicultural translator whose mother language was the TL and by a methodologist and healthcare professional. The translated scale was modified by consensus in case of discrepancies between the original and the back translated scale.

Conclusion The proposed methodology might be robust enough to provide a reliable and cross cultural translated tool to be applied into clinical practice.

References and/or Acknowledgements

  1. Kripalani et al. Value in health, 2009

References and/or AcknowledgementsNo conflict of interest.

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