Response to "Pretesting and cognitive interviewing are integral parts in translation of survey instrument".

Sir,

Having read the correspondence regarding the description and adaptation of the survey used in the article contributed by Zieger I would like to take the opportunity to respond on behalf of all the authors and provide some clarification. In the study, we sought to assess the perception of stigma regarding mental illness in two Indian cities, Chennai and Kolkata. In response to each of the points raised:

While the survey was developed in English, it was translated directly into the respective local languages before the participants were interviewed. This included Tamil for Chennai and Bengali for Kolkata. Each questionnaire contained the questions printed in both English and the respective language, providing a basis of accuracy and consistency for the interviewer. All participants included in the study were fluent in English or one of the regional languages (Bengali/Tamil). No participants were included or excluded based on the linguistic criteria.

In case participants were unsure of questions or contexts and needed more information and clarification, further information was provided to them after the initial interview, at which time questionnaire was then completed. Our impression was that during the interview if any issues arose due to some participants being unfamiliar with the context of mental illness, it was helpful that we allowed them to take their time and instructed them that they had the chance to respond to that question later. This procedure may not necessarily be a weakness of the questionnaire and facilitated a higher completion rate.

We agree et al.,[12] that in our study we did not fully follow the outlined WHO translation method, especially in terms of cognitive testing. We, thus, acknowledge the suggestion for future studies, given sufficient funding, and accept a potential inadequacy of equivalence as a limitation of our study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.