Language Access in Healthcare
EvidenceE-0376Initial AI draft

75% of bilingual readers preferred the functionalist over the word-for-word survey translation

2026-06-052 out · 0 in

Source

Colina (2022). Research Documents for Populations with Limited English Proficiency: Translation Approaches Matter. Ethics Hum Res.

Description #

When asked which of two Spanish translations of the Perceived Stress Scale they preferred overall, 15 of 20 bilingual participants (75%) chose the version produced with a functionalist (reader-oriented) approach ("translation B") over the version produced with a literal, word-for-word approach ("translation A"). The two translations were of the same source survey, so the preference reflects the translation approach rather than the underlying instrument.

"Seventy-five percent (n = 15) of the participants preferred the translation that used a functionalist approach (B) over the word-for-word one (A)." (Colina, 2022, p. 33)

Methods Context #

What? #

The observable: each participant's stated overall preference between the two translations, elicited at the end of the interview.

"At the conclusion of the interview, participants were asked to indicate which survey they preferred overall and why (see appendix B, "Sample Questions for Semistructured Interviews")." (Colina, 2022, p. 33)

How? #

Participants reviewed two translations of the same survey — a published literal translation ("A") and a newly drafted functionalist translation ("B") — then answered semistructured interview questions and stated a preference.

"we used a published translation of the Perceived Stress Scale (see appendix A, available online, along with appendix B and table 1; see the "Supporting Information" section below), a patient-reported outcome measure that reflects a literal translation approach ("translation A," in appendix A) and drafted a new one ("translation B" in appendix A) using the functionalist approach described by Colina et al." (Colina, 2022, p. 32)

Who? #

Twenty English-Spanish bilingual adults (ages 19-39; 11 Spanish-dominant, 1 balanced, 8 English-dominant) recruited at and around the University of Arizona in Tucson.

"We recruited 20 bilingual participants at the campus of the University of Arizona and in its surrounding community using flyers written in English and Spanish and by word of mouth." (Colina, 2022, p. 32)

Other Notes #

Both translations were from English into Mexican Spanish. Translation A was a published, real-world translation used in the field; translation B was drafted for the study using the functionalist approach.

Caveats #

  • Study measured only perceived difficulty not actual reading comprehension of the translations The study captured only participants' perceptions of difficulty and their stated preferences; it included no reading-comprehension test or readability instrument, so the findings speak to perceived difficulty and preference, not to objectively measured comprehension. The authors caution that translation B might be only perceived as more formal or difficult and note that future studies should test actual difficulty.
  • Spelling errors in the literal translation could have influenced participants perceptions Translation A (the literal version) was a real published translation that contained spelling errors, which the authors retained because their interest was the translation approach rather than spelling. However, those spelling errors are a confound: they could independently have depressed participants' evaluations of translation A, so part of the observed preference and issue-count gap may reflect spelling rather than the literal-versus-functionalist approach. The authors recommend using an error-free text in future studies.
  • Sample size of 20 is too small to statistically confirm the main effects The study enrolled only 20 participants. The authors acknowledge that a larger sample is needed to statistically confirm the main effects from the t-tests; the small n is also why the logistic-regression language-dominance trend reached only p = 0.058 rather than conventional significance. The authors frame the current findings as sufficient illustration rather than definitive confirmation.
  • Sample was bilingual not monolingual LEP limiting generalizability to true limited-English readers All 20 participants were bilingual to some degree rather than monolingual or truly limited-English-proficient, because recruiting participants with no English skills in Tucson, Arizona was difficult. Their knowledge of English could make them more accepting of English-influenced, literal renderings than a genuinely LEP reader would be, which limits how far the preference and comprehension findings generalize to the target population — the authors call for a future study recruiting monolingual speakers.