CHALLENGES IN TRANSLATING THE EPWORTH SLEEPINESS SCALE (ESS) INTO 66 LANGUAGES

Piero Bindi1, Ana Bayles2, Catherine Acquadro1, Murray Johns3

1Author Collaboration Unit, Mapi Research Trust, Lyon, France; 2Mapi Languages Services, Lyon, France; 3Epworth Sleep Centre, Melbourne, Australia

For more information, please contact:

Piero Bindi, pbindi@mapigroup.com; www.mapigroup.com

In each country, the linguistic validation was conducted with the author of the

ESS, using either the standard forward/backward methodology or the adjusted

process, with reviews by the author and cognitive interviews with 5 patients. See

Figure 1 for the standard process.

The basis for discussion was the list of concepts elaborated with the author. For

each country, the history grid of the translation process was analyzed.

The Epworth Sleepiness Scale (ESS) is a self-administered questionnaire with

eight questions, providing a measure of a person’s general level of daytime

sleepiness, or their average sleep propensity in daily life. The ESS asks people

to rate, on a 4-point scale (0 – 3), their usual chances of dozing off or falling

asleep in eight different situations or activities that most people engage in as

part of their daily lives (e.g., sitting, reading, watching TV, etc.). Situations differ

in their somnificity, or sleep-inducing characteristics. See Table 1.

© MW Johns, 1990-97

The objective of this study is to present the challenges faced during the

translation of the ESS (originally developed in Australian English) into 66

different languages representing nine language families. See Table 2.

Most of the situations or activities described in the ESS were easily translated

and culturally relevant.

Only item 7 (Sitting quietly after a lunch without alcohol) raised a lot of

discussion in 46 languages*, either for cultural or syntactic/semantic or for all

reasons. Most of the discussions has been around the translation of “without

alcohol”:

- In three countries, representing eight languages, i.e., India (English, Hindi,

Telugu, Urdu), Israel (Hebrew, Russian) and Malaysia (English, Malay),

“without alcohol” was put between brackets since consumption of alcohol is

not encouraged for cultural reasons.

- In 29 languages, verbs or periphrasis clarifying the meaning of “without

alcohol” were used (e.g., without drinking alcohol , without using alcohol,

without taking alcohol, or “during which you do not drink alcohol”). See

examples in Table 3.

- “Alcohol” was replaced by equivalents meaning “alcoholic beverage(s)” or

“wine, beer or other alcoholic beverages” or “alcoholic drinks” in 11

languages [i.e., Arabic, Czech, German (Austria, Germany, Switzerland),

Italian, Kannada, Portuguese, Russian (Russia, Ukraine), Slovak].

- The 20 languages for which no difficulties were encountered are listed in

Table 4.

Table 2. Language families and branches of the 66 target languages

into which the ESS was translated

The Epworth Sleepiness Scale was translated in 66 languages with no major

difficulties.

The rigorous methodology used was essential in producing ESS translations

conceptually equivalent to the Australian English original.

Table 1. The Epworth Sleepiness Scale

Objectives

Methods

Results

Conclusion

Table 3. Item 7 – Examples of periphrasis clarifying meaning

Family Branch Sub-branch Language (Country)

Afro-Asiatic Semitic Central Semitic

Southwest

SemiticArabic (Israel)

Northwest

SemiticHebrew

AustronesianMalayo-

polynesianFilipino, Malay

Dravidian Southern Kannada, Malayalam, Tamil, Telugu

Indo-

European

Balto Slavic

Baltic East Baltic Latvian

Slavic

East SlavicUkrainian, Russian (Israel, Russia,

Ukraine)

South Slavic Bulgarian, Croatian, Serbian, Slovenian

West Slavic Czech, Polish, Slovak

Germanic

North Germanic Danish, Swedish

West Germanic

Afrikaans, Dutch (Belgium, The

Netherlands), English (Canada, India,

Israel, Malaysia, New Zealand, Singapore,

South Africa, UK, USA), German (Austria,

Germany, Switzerland)

Hellenic Greek

Indo-

IranianIndo-Aryan Gujarati, Hindi, Marathi, Urdu

Italic Romance

Gallo-RomanceFrench (Belgium, Canada, France,

Switzerland)

Ibero-Romance

Portuguese (Brazil), Spanish (Argentina,

Chile, Colombia, Mexico, Peru, Spain,

USA)

Italo Dalmatian Italian

Romanian Romanian

Japonic Japanese

Koranic Korean

Sino-Tibetan Sinnitic ChineseCantonese (Hong Kong), Mandarin

(China, Malaysia, Singapore, Taiwan)

TurkicCommon

TurkicOrghuz Turkish

Ural-Altaic UralicHungarian

Finnic Finnish

Figure 1. Standard Linguistic Validation Process

Language

(Country)

Translation Backtranslation into

English

Croatian (Croatia) 7. Sjedim mirno nakon ručka, a

nisam pio alkohol

7. Sitting quietly after lunch

and did not drink alcohol

English (UK) 7. Sitting quietly after a lunch

without having drunk alcohol

Finnish (Finland) 7. Rauhallisesti istuskellessa

lounaan jälkeen ilman, että on

nautittu alkoholia

7. Sitting quietly after lunch

and alcohol is not

consumed

Latvian (Latvia) 7. Klusām sēžot pēc pusdienām,

kurās nav lietots alkohols

7. Sitting quietly after lunch,

without using alcohol

Mandarin

(Singapore)

7. 午餐后静静地坐着，没有喝酒时 7. Sitting quietly after lunch,

when not drinking

Spanish (Spain) 7. Sentado/a tranquilamente

después de la comida sin haber

tomado alcohol

7. Sitting quietly after lunch

without having taken

alcohol

Ukrainian

(Ukraine)

7. Сидячи спокійно після обіду,

під час якого Ви не вживали

алкоголь

7. Sitting quietly after lunch,

during which you do not

drink alcohol

Table 4. List of languages for which Item 7 was not an issue

Afrikaans (South Africa), Danish, Dutch (Belgium, The Netherlands),

English (Canada, New Zealand, South Africa, United States), French

(Belgium, Canada, France, Switzerland), Greek, Hungarian, Japanese,

Malayalam, Polish, Spanish, Swedish, Tamil

*Some languages have cumulated translating issues. Therefore, the number of languages listed may excess

the number of 46.