Accurate Translation, Accurate Outcomes: The Risks of Inadequate PROM Translation in Wales

Abstract

In Wales, Patient-Reported Outcome Measures (PROMs) are used across the health service (NHS Wales) as part of Value-Based Healthcare initiatives. PROMs must be translated into Welsh for use across Wales to meet legal requirements. However, traditional translation methods, such as producing single forward-translations, risk producing suboptimal PROM translations. Drawing on work to translate over 50 PROMs into Welsh for national use across Wales, this manuscript discusses the consequences of inadequate PROM translations on understanding patient outcomes. Informed by feedback from over 350 qualitative interviews, we discuss observed behaviours amongst Welsh-speaking patients when met with inaccurate or overly complex translations such as responding despite a lack of understanding, skipping questions and requesting to complete a different language version, and the implications on PROMs data accuracy. These data discrepancies pose the risk of misdiagnosis and ineffective treatment for individual patients and can more broadly lead to misinformed healthcare policies in Wales. Recommendations are made to follow multi-step frameworks to produce robust Welsh PROM translations that enable accurate and equivalent data to be collected.