Arabic Translation and Cultural Adaptation of the Quality Maternal and Newborn Care Framework In

10 Apr 20264 min read0 viewsJournal Feed

GIST

by Khadeja Zaza, Andrew Symon, Sahar Hassan, Hadil Ali-Masri, Jenny McNeill, Janine Stockdale, Weam Alhulaibi, Berit Mortensen Background The Quality Maternal and Newborn Care Framework index (QMNCFi) is a validated English-language instrument developed to assess women’s experiences during pregnancy, childbirth, and the postnatal period. These experiences include respect, dignity, communication, continuity of care, and involvement in decision-making.

Despite Arabic being spoken in 22 countries, substantial variations exist in dialects, terminology, and healthcare practices. Because maternity care models, communication styles, and clinical terminology vary across Arabic-speaking contexts, ensuring semantic and experiential equivalence is essential when adapting the QMNCFi for use in Middle Eastern settings.

This study aimed to translate and culturally adapt the QMNCFi into Arabic and to document the international collaborative methodological process supporting this adaptation. Methods We followed an internationally recognized six-stage approach for translation and cultural adaptation (forward translation, synthesis, back translation, expert committee review, pre-final testing, and finalization).

Two research teams, representing institutions across five countries, collaborated under a unified protocol. Cognitive interviews were conducted with 48 postpartum participants in Palestine and the Kingdom of Saudi Arabia.

Clinical Editorial

A multi-country translation effort: study design and objectives

The QMNCFi is a validated English instrument designed to assess women’s experiences across pregnancy, childbirth, and the postnatal period, covering domains such as respect, dignity, communication, continuity of care, and involvement in decision-making.
The study objective was to translate and culturally adapt the QMNCFi into Arabic and to document the international collaborative methods supporting this adaptation, recognizing linguistic and healthcare practice variation across Arabic-speaking contexts.

Methodological framework and collaborative process

A six-stage international translation and cultural adaptation approach was employed: forward translation, synthesis, back translation, expert committee review, pre-final testing, and finalization.
Two research teams from institutions in five countries collaborated under a unified protocol to ensure methodological consistency during adaptation.
Cognitive interviews were conducted with 48 postpartum participants in Palestine and the Kingdom of Saudi Arabia to evaluate comprehension and contextual relevance.

Key refinements and contextual tailoring

Demographic items were refined by adding a country identifier to distinguish data collection sites.
Demographic categories (education and income/currency) were aligned to reflect context-appropriate classifications.
Items were clarified with context-relevant examples to improve interpretability.
A “not applicable” response option was added where appropriate.
Importantly, these refinements maintained the original item order and scoring framework, preserving the structural integrity of the instrument.

Psychometric and operational considerations

Inter-rater agreement in their processes reached 99.1%, surpassing the pre-specified benchmark of 80%.
The authors acknowledge substantial operational challenges: ethics approvals, data-sharing restrictions, supervision structures, and cross-site coordination.
Challenges were mitigated through structured mentorship, version-controlled documentation, and regular joint meetings to sustain alignment across sites.

Conclusions and implications for practice

The study demonstrates that even with a shared language, semantic and experiential equivalence is not guaranteed; practical and regulatory factors substantially influence adaptation.
Addressing institutional, regulatory, capacity, and linguistic factors is essential to produce a usable Arabic QMNCFi.
The work provides a transparent methodological blueprint for same-language, multi-country adaptation of health measurement tools.
The Arabic QMNCFi is positioned for psychometric validation and future implementation in Arabic-speaking maternity care settings.

Limitations and open questions

The source notes uncertainties related to broader applicability across diverse Arabic dialects and healthcare systems beyond Palestine and Saudi Arabia.