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Cognitive Debriefing in Linguistic Validation

When researchers are working on a new study, experiment, medicine…etc their work is never theoretical. It depends on the people this study is concerned with. Let’s say there is a new medication for ADHD, the team of researchers has written down a questionnaire and given it to linguists to translate, but how can they be sure that the translated one matches exactly the source questionnaire before they proceed with it?

How do they know that the questionnaire is clear enough for participants? Is there any ambiguity or possibility of misunderstanding? Are there any offensive words or implications? 

These questions are more are answered by a method called ‘cognitive debriefing’.

Sounds like a big word? Stick around to learn more about cognitive debriefing the easy way.


What Is Cognitive Debriefing?

Cognitive debriefing is a part of the linguistic validation process (we will explore what that means in a minute) It helps to understand how a translated survey or document is received cognitively by people from different demographics. 

It’s a qualitative research technique often used in the development and validation of patient-reported outcome (PRO) measures, such as questionnaires or surveys. It involves interviewing individuals who have completed the measure to understand their thought processes while answering the questions.


Goal of Cognitive Debriefing

  • To ensure the target recipients find no difficulty, nor ambiguity in understanding the survey.
  • After debriefing, the document has the same context/meaning/and understanding in both the source and target languages.
  • The document/survey is culturally relevant to the target audience.
  • Identifying terms that are considered confusing or offensive for the target reader.
  • Solve any issue with document interpretation

We mentioned linguistic validation, well…what is it and how is it different from cognitive debriefing?


Linguistic Validation

linguistic validation is a complicated process that follows the methods of the International Society for Pharmacoeconomics & Outcomes Research (ISPOR) and the Food & Drug Administration (FDA).

It’s used in translation to make sure that the translated text is very faithful to the original one and accurately conveys its meaning without a chance of ambiguity or confusion.


Goals of Linguistic Validation

  • The target text is accurately translated, resembling the source.
  • The translation is culturally relevant.
  • The intended patient population can fully understand and comprehend the text.
  • Find accurate equivalents for words that don’t exist in the target language.

Linguistic validation refers to the overall process, but cognitive debriefing is just one step of linguistic validation. Other steps of linguistic validation include back translation and conciliation.

Read more: Difference between In house, Outsource, and Freelance translators


Importance of Cognitive Debriefing

We all know that medical translation is one of the most sensitive types of translation out there. There is no room for errors, or ambiguities because the risk is too high. 

This is where the importance of cognitive debriefing comes in; it aids in collecting information for several medical purposes like research studies, experiments, clinical trials, interviews, and plenty of other medical purposes. It gets medical professionals and scholars as accurate translations as possible that are free from linguistic errors. It removes language and cultural barriers that might stand in the way.

The bigger picture of cognitive debriefing is assisting the research to reach more accurate and realistic results. Simply, when the patients answer the survey with a full understanding of the subject matter and what it wants to communicate, the more realistic and accurate answers they will give will push the research forward in the right direction.


The Main Purpose of Cognitive Debriefing

Making medical surveys accessible to different demographics (age, gender, race, language, ethnicity…) 

Linguists and researchers do their best to find any errors or possibilities for improvement in the translation of these surveys before they officially use them in their research process.

Improvement of questionnaire translation based on the feedback of the participants.


Examples of Cognitive Debriefing

Cognitive debriefing is commonly used for:

Patient Reported Outcomes (PROs)

 When the patient himself reports symptoms of their health, like the measure of pain they are feeling. 

Clinician Reported Outcomes (ClinROs)

It refers to symptoms that are clinically identified and measured. It could be noticeable changes in their quality of life that require medical judgment.

Observer Reported Outcomes (ObsROs)

When someone other than the patient or their doctor (maybe a parent, or a partner) reports symptoms about them; like sudden changes in behaviors, or worrisome behaviors like vomiting, having nightmares, or self-harming…etc.

Quality of Life (QOL)

When measuring an individual’s quality of life, medical professionals look at things like physical and mental well-being, education, social status…etc.

You can check NIH’s definition of PROs, ClinRo, ObsRO, and QoL for more insight.


General Steps Involved With Cognitive Debriefing



Before interviewers execute the cognitive debriefing, they should have a clear idea of the questions. Researchers guide them through which questions to ask. Simply they outline the entire procedure. 

Wherever the interview will take place, it’s best to hire native psychologists or social workers who live in the same country. This way you make sure they know all the nuances when interacting with the native patients or subjects. Ideally, they also need to have a background in the healthcare field.

This process also involves training the interviewees so that they are more than prepared when they execute the cognitive debriefing with the target population in real life. The job requires not only language skills but also social ones like the ability to pick up on the interviewee’s emotions or body language during the questionnaire, or more importantly, how to ask them the correct questions.


Deciding who to interview in a cognitive debriefing

Participants’ “diversity” is key in many cases, the interview tries to cover as many different demographics as possible. The samples should be diverse in age groups, genders, social classes…etc) it depends on the goals of the research. 



The final step is obviously to put this knowledge into practice!

The protocol is followed as outlined in the preparation and training stages. The interview takes place physically, where interviews can best describe what each translated word means for them and if anything in the translation is confusing.

They take note of any interesting or significant information relevant to the survey. This information could be anything from interviewees’ responses, confusion, or inconsistency of reactions.


Harmonization of Cognitive Debriefing

In this stage, researchers make sense of all the information collected from the interviews, and based on them they ask questions like:

Is the collected information from the cognitive debriefing sufficient?

Do we need to conduct any further linguistic validation or cognitive debriefing?

Do we need to ‘retranslate’ the survey to achieve better results? 


Summarizing results of debriefing

The objective of summarization is to keep all team members satisfied, from translators, and researchers to project managers and linguists. 

A summary is written to document the entire process and its outcomes. It includes information like participants’ age, medical condition along with other demographic details.

It includes other things like: 

  • How many people (subjects) participated?
  • How old are they?
  • How hard was it for them to complete the survey
  • How long it took them to complete the survey?
  • What are the difficulties that came up when answering it?
  • What are recommendations or solutions for the survey? 


Best Practices for Conducting Cognitive Debriefing

The process of cognitive debriefing requires a variety of skills, and best practices to help the translators and research experts get the best outcome from the resources, below are the most important practices to follow

Participants Variety

 it’s important to select participants who represent the target patients at large. This means the participants have different ages, medical conditions, social status, education levels…etc.


Relaxed Interview environment

This one can make a huge difference. Participants should have a free space to answer the survey and voice any confusion or concern without being pressured or rushed through the process.

This involves being empathic towards patients when it comes to sensitive topics. The interviewer should offer quick solutions when a patient shows discomfort or fear of vulnerability. 

Ask Open-ended questions

Interviews that are based on yes or no questions miss out on valuable information the participant can add. Therefore, a skilled interviewer will ask open-ended questions to make space for participants to voice what’s on their mind, also known as the “think aloud” method.

Read more: How to choose the right language service provider?


Fast Trans Linguistic Validation Services is the best

Fast Trans is a leading translation company in the MENA region. We set the gold standard for accuracy and efficiency by hiring certified translators who can get you the best of two worlds; translation quality and second-to-thing price.

We offer 20+ kinds of translation services. When it comes to linguistic validation we make sure to hire linguists who have a solid background in the medical and healthcare field. In short. We know what it takes to provide impeccable linguistic validation services that shortcuts your research process and get you closer to accurate results!

Looking for quality linguistic validation services? You’ve come to the right place.

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