Language barriers and qualitative nursing research: methodological considerations

Abstract

Aim

This review of the literature synthesizes methodological recommendations for the use of translators and interpreters in cross-language qualitative research.

Background

Cross-language qualitative research involves the use of interpreters and translators to mediate a language barrier between researchers and participants. Qualitative nurse researchers successfully address language barriers between themselves and their participants when they systematically plan for how they will use interpreters and translators throughout the research process. Experienced qualitative researchers recognize that translators can generate qualitative data through translation processes and by participating in data analysis. Failure to address language barriers and the methodological challenges they present threatens the credibility, transferability, dependability and confirmability of cross-language qualitative nursing research. Through a synthesis of the cross-language qualitative methods literature, this article reviews the basics of language competence, translator and interpreter qualifications, and roles for each kind of qualitative research approach. Methodological and ethical considerations are also provided.

Conclusion

By systematically addressing the methodological challenges cross-language research presents, nurse researchers can produce better evidence for nursing practice and policy making when working across different language groups. Findings from qualitative studies will also accurately represent the experiences of the participants without concern that the meaning was lost in translation.

During qualitative research, language helps participants represent their sense of self. Language allows them to communicate similarities and differences to others, including the researcher (Gee 1990; Temple & Young 2004). Through spoken interactions, the language of participants helps define and explain issues related to their ethnicity, heritage, gender and other components of their identity (Gee 1990; Hole 2007; Temple 2002).

For qualitative nurse researchers, when the participant speaks a different language than the researcher, ‘it is more appropriate for researchers to use the language of the informant to obtain an understanding of health experiences and perceptions of health care’ (Twinn 1997, p. 419). The term ‘cross-language research’ describes studies in which a language barrier is present between qualitative researchers and their participants (Larson 1998; Temple 2002).

Experienced cross-language qualitative researchers understand that when they conduct studies with participants who speak another language, they have a responsibility to maintain the integrity and credibility of translated qualitative data. Inexperienced cross-language qualitative researchers often wrongly assume that a translator or interpreter will resolve any methodological issues related to language barriers between qualitative study participants and researchers (Temple 2002; Temple & Young 2004; Yach 1992). With words as data, however, language barriers between nurse researchers and participants become a potentially formidable methodological challenge.

Translators and interpreters provide similar services to overcome language barriers between two or more people. Their roles in research, however, are distinct. An interpreter provides oral translation services during an interaction between two or more people who do not speak the same language. A translator provides services translating documents, including transcribed interviews. The distinct nature of their roles affects data quality and may influence responses of study participants and the research process. A central concern with using translators and interpreters is that the quality of data translation can affect the conceptual equivalence and accuracy of the study's findings (Fredrickson et al. 2005; Schultz 2004; Temple 2002). Therefore, a researcher's failure to systematically address language barriers during cross-language research threatens the credibility, transferability, dependability and confirmability of the findings.

With just these few methodological concerns, it is not surprising that many monolingual qualitative researchers may hesitate to pursue a cross-language qualitative study (Adamson & Donovan 2002; Esposito 2001; Lange 2002; Twinn 1997). Numerous individual articles describe the different methodological challenges that cross-language research presents. This article synthesizes the recommendations from the research methods literature addressing language barriers and qualitative research. It begins with a description of the basics of language competence and reviews the criteria for translator and interpreter qualifications. The succeeding section provides a discussion of translator and interpreter roles during various points in the research process, ethical considerations, and the use of translators and interpreters in the various qualitative research approaches. Qualitative nurse researchers seeking to expand their research to groups that speak a different language than themselves will find the content useful for developing a cross-language qualitative study.

The basics of language competence

Linguists define four levels of language competence: grammatical, discourse, sociolinguistic and strategic (Danesi 1996; Larson 1998; Savignon 1997). These levels represent four kinds of knowledge that a person must have to be linguistically competent in any language. Table 1 outlines the four levels of language competence. The language competence literature recommends that for research purposes, interpreters and translators must possess a minimum of sociolinguistic competence.

Table 1.

Four types of language competence

Type	Description	Expected competencies
Grammatical competence	The goal of most college-level language courses. The ability to appropriately use the common forms of comprising a language: sounds, words and sentence structures.	Persons are able to speak and write simple sentences.
Discourse competence	A more complex level of language competence. Person is able to converse and follow everyday conversations without difficulty.	Oral and written communication contains complex sentence structures sophisticated enough to facilitate story-telling or business letters.
		Demonstrates contextual understanding of how and when specific words and phrases are used in different situations.
Sociolinguistic competence	Overlaps with discourse competence but requires the ability to express and negotiate the meaning of words and phrases according to the culture using the language.	Oral and written communication functions on a sophisticated level. Integrates understanding of cultural norms into communication processes. Knows how and when, for example, to be polite and show respect in social situations.
Strategic competence	One can compensate for a lack of ability in other aspects of language competence by effectively communicating desires through the use of other vocabulary or physical signals. Non-native speakers generally adopt a number of strategies in order to be understood.	Example: if one does not know a word but can describe the word this is an example of strategic competence in languagesought in order for a native speaker to provide the correct term, this is an example of strategic competence in language.

Adapted from content in Danesi (1996) and Savignon (1997).

Grammatical competence is the goal of most university-level language courses. The speaker demonstrates the ability to appropriately use the common word forms comprising a language, like sounds, words and sentence structures. Individuals with grammatical competence possess the ability to speak and write simple sentences. They do not have the specialized vocabulary required for working in healthcare delivery systems.

Discourse competence represents a more complex level of language competence. The person demonstrates the ability to converse and follow conversations without difficulty. Written communication contains complex sentence structures with a level of sophistication that facilitates story-telling or business communication. Discourse competent individuals also demonstrate contextual understanding of how and when to use specific words or phrases in a variety of situations. Many South Asians, for example, may have discourse competence in several languages because of the number of languages spoken in that part of the world.

Sociolinguistic competence overlaps with discourse competence. The speaker converses technically well in the second language. He or she integrates the expressions and meanings of culturally specific terms and phrases. The spoken language ability demonstrates a combination of social, technical and cultural competence when interacting in their second language.

The fourth and final component of language competence is strategic competence. This compensatory skill allows the bilingual individual to adapt to situations where they encounter unfamiliar words or slang terms. As many bilingual individuals know, non-native speakers of a language adopt multiple strategies for effective communication in their second language. For example, if the speaker does not know a word in his/her second language, he/she describes the characteristics of the thing to the native speaker. If he/she is successful, the native speaker provides the word or phrase the second language speaker seeks.

Basic qualifications for translators and interpreters

Persons skilled in providing interpreter or translator services possess all four levels of language competence described in Table 1. These individuals can work in both translator and interpreter roles; thus, professional associations for translators refer to these people as professional translators. For clarity, the term translator will be used from this point forward to refer to both translators and interpreters, unless specifically discussing role differences.

The qualification and interpretive experiences of the translator are important because translators always influence the research process, whether or not researchers acknowledge their roles in the published results (Adamson & Donovan 2002; Temple & Young 2004). Many researchers use non-professional translators for the sake of convenience because they are unaware of how the quality of translation can affect qualitative research results. Translators, however, are the interpreters of a communication task in a cultural context (Gee 1990). The technical and conceptual accuracy of their work affects the credibility of the qualitative researcher's findings.

A professional translator demonstrates their language competency through a credentialing process designed by a translator's guild, like the American Translators Association (2005) or similar organization. Many countries or linguistic regions around the world have their own professional association that verifies the competence of translators. These professional organizations balance translator requirements with an educational and experiential credentialing process. For example, to become a certified translator, a person with a high school diploma (or equivalent) must provide documentation of his or her translation work and have at least 5 years of experience working in translator or interpreter roles. At the same time, an individual with a graduate degree may use only their educational credentials for certifications (American Translators Association 2005).

Professional translators will produce different qualitative results than informal or inexperienced translators. For example, a bilingual individual with a graduate degree in medical sociology can easily translate medical terminology. A lay person serving in a translator role, however, may be unfamiliar with medical terminology. Their lack of experience with medical terminology will affect how they translate the researcher's questions and the participant's responses.

Inexperienced cross-language researchers often do not realize that the primary role for the translator is not only the literal translation of language, but also the culturally informed conceptualization of the contextual meaning of the participant's words (Larkin et al. 2007). Translators consider the structure of words and phrases spoken by the participant and the context where the participant speaks them when performing a translation (Esposito 2001). Therefore, for ensuring the conceptual equivalence of the results, ‘the importance of choosing and evaluating qualified bilinguals for translation is critical’ (McDermott & Palchanes 1994, p. 114).

Achieving conceptual equivalence between two languages is a complex challenge. It requires a systematic method to ensure that concepts accurately translate across languages and take account of cultural differences (Fredrickson et al. 2005). Many terms from healthcare disciplines have no conceptually equivalent term in the participants’ language (Fredrickson et al. 2005; Schultz 2004). This will affect how the translator interprets data, both oral and written. For example, a non-healthcare Spanish-speaking person may translate the English word ‘self care’ in one of two ways: autocuidado (self-care) or cuidando para su mismo (caring for oneself). The researcher coding the data may develop different codes based on how the translator translated that concept. Consequently, the codes may not reflect what the participant communicated in the interview because of how the translator translated the word or concept.

Nonetheless, the reality for many nurse researchers is that sometimes hiring a professional translator is not feasible owing to the project's budget. When this happens, a sociolinguistically competent, bilingual native speaker from the same country of origin as the research participants is the best option for translator selection. If a native speaker is not available, a person who has pursued intensive study in language or lived in the country or region of the participant's language is the next best option. Usually in universities, foreign language and some social science masters and doctoral students can meet these requirements.

Types of translation services

Translation services function in three ways when conducting cross-language qualitative research: written, oral or simultaneous. Translators provide written translation services. Interpreters provide ‘live’ oral or simultaneous translation. The services provided by the translators or interpreters shape their roles and influence during the research process.

Written translation

Written translation transfers documents in the source language (SL) to written documents in the target language (TL). Researchers generally use translators in this capacity after qualitative data collection occurs. They may also use translators to help disseminate study results in professional publications outside their own country or linguistic region.

Sometimes, however, a monolingual researcher will need contextual or cultural interpretation of written data. This frequently occurs, for example, in historical research because language evolves over time. Familiarity with language use patterns common during the year of publication of the historical document will require a translator and researcher with high levels of language competence.

Oral translation

Oral translation relies on interpreters, so this section uses that term for the translator. With oral translation services, the interpreter is the mediator between the speakers of the SL and the speakers of the TL. Interpreters may conduct oral translation during an interview, other researcher–participant interaction, or while listening to audio recordings of an interview in the SL. The monolingual researcher will depend heavily on the interpreter's abilities to translate language in this scenario.

A key element in standard oral translation is interpreter objectivity. A non-objective translator could affect translated qualitative data collected in another language. Interpreters remain objective by only translating the words of the SL. They refrain from offering any additional interpretation or explanation of contextual or cultural meanings. Good interpreters will not modify participant responses to what he or she thinks the researcher wants to hear. In this scenario, the interpreter's role is an active but neutral one during the data generation process.

For example,a nurse caring for a patient who does not speak her language may rely on an interpreter hired by the hospital or use a family member of the patient for communication between him or herself and the patient. If the nurse uses the interpreter to ask the patient questions, the nurse knows that the interpreter will only translate exactly what the patient said. A family member, however, may modify the patient's responses intentionally or unintentionally. The family member may do this because they fear what the nurse's response would be to a negative comment or they do not want to embarrass the family (Mill & Ogilvie 2003). For research, this means that the person interpreting the words spoken by the participant is changing the meaning found in the qualitative data. That change will affect the findings of the cross-language qualitative study and should be acknowledged.

Researchers can use interpreters performing any kind of oral translation service to explain cultural or contextual meanings of words during the interview and data analysis processes. A common assumption of monolingual researchers, however, is that face-to-face communication allows the researcher to clarify data from an informant via the interpreter (Twinn 1997). If the interpreter clarifies statements objectively, the effect on data is minimal. When interpreters clarify culturally bound concepts or phrases, their role changes because they contribute a subjective interpretation of what the participant said. The quality of the interpreter's analysis, therefore, becomes an important methodological consideration for cross-language studies because it changes the level of involvement, or the role, the interpreter has in the research process.

For example, if a Mexican patient describes experiencing ‘susto’ – a word used in Mexican Spanish to describe experiencing fright and an illness that follows – the researcher might want to know why the patient used that word, but cannot ask the participant at the time. The interpreter would explain the cultural background of the word in the context of that passage in an interview. When interpreters contribute this kind of information to the analysis process, their roles change to active or interactive producers of research data because their interpretation informs the overall analysis of the results.

Simultaneous translation

Frequently, one thinks of simultaneous translation as that which occurs in a United Nations-like context, where professional translators are translating what various speakers are saying in ‘real time’. Simultaneous translation, however, is more complex than basic oral translation. The interactions between nurse researchers, participants and translators increase in intensity because all parties have to respond to each other in ‘real time’.

Researchers seeking active participation in group processes or interviews will find simultaneous translation ideal even though it is the most complex kind of translation a researcher can integrate into their study (Esposito 2001). During simultaneous translation, the risk for miscommunication between parties increases as interpretive tasks evolve in their complexity (Esposito 2001; Mill & Ogilvie 2003; Yach 1992). Careful planning for the use of interpreters and translators during simultaneous translation mediates these risks.

At the same time, interpreters used for simultaneous translation may evolve into interactive producers of research. In this scenario, interpreters not only provide technical translation, but add cultural or interpretive insights into the dynamics of the interview process. In conclusion, regardless of the roles of translators and interpreters in their studies, investigators analysing translated qualitative data would be well-served to remember that a single sociocultural interpretation of translated data does not necessarily represent a whole community or a culture (Adamson & Donovan 2002; Temple 2002).

The ethics of translation

Much like nurses, professional translators have a code of ethics to guide their behaviours when providing their service (American Translators Association 2005). Most importantly, when adhering to the code of ethics, a translator will inform the researcher if he or she is not qualified to perform the translation.

Translator neutrality is an important component of ethical behaviours for translators. When a translator performs their service objectively, they adhere to the ethical guidelines recommended by a professional translator association. To translate the responses of a participant inaccurately and with deliberate bias violates the code of ethics.

In addition, an ethical translation considers the identity of the translator in relation to the participant (Temple 2002). For example, if the translator and participant come from the same country but have very different class backgrounds, the translator will not allow this difference to interfere in communications with the participant. A translator who treats a participant poorly because of class, ethnic, tribal or racial differences violates the ethics of professional translation.

Finally, the same confidentiality requirements healthcare providers use also bind translators. Revealing identifiable personal information about a participant outside of study is an ethical violation on the part of the translator (American Translators Association 2005).

Research designs and the roles of translators and interpreters

How the researcher integrates the translator into the research design is a key component of a cross-language qualitative study. The researcher's approach to cross-language qualitative research affects how the investigator integrates translators’ roles into the research process and their effects upon the results (Adamson & Donovan 2002; Esposito 2001; Kapborg & Berterö 2002; Temple 2002; Temple & Young 2004; Twinn 1997). For example, translator roles will be different in grounded theory studies than in historical research.

Although quantitative researchers have widely discussed translation and language equivalence in literature about quantitative research (McDermott & Palchanes 1994; Maneesriwongul & Dixon 2004), researchers publishing in nursing and the social sciences infrequently address the issue of language or the use of translators during the qualitative research process (Larkin et al. 2007; Wallin & Ahlström 2006). Researchers also tend to present findings as though the participants are native speakers of the researcher's language (Adamson & Donovan 2002; Temple 2002; Temple & Young 2004; Twinn 1997). This minimizes the roles translators and interpreters play in the research process and consequently, their effects on the findings (Temple & Young 2004; Wallin & Ahlström 2006).

The goal of most researchers using translators for their studies is to obtain the most technically correct translation (Temple 2002; Wallin & Ahlström 2006). Therefore, when presenting the findings of cross-language studies, researchers usually discuss translator roles from a functional perspective, rather than epistemologically (Temple & Young 2004). Translators have an epistemological role in research when their role includes producing research data and informing the analysis of the results (Temple 2002; Temple & Young 2004). Temple & Young (2004) stressed that qualitative researchers should acknowledge the epistemological role of the translator in the conduct of research. They proposed that a qualitative researcher's failure to recognize the epistemological role of the translator in the research process can introduce bias into the results because it does not account for the translator's potential effects on data. When publishing the findings of a cross-language study, a full description of translator roles during research verifies the epistemologic role of the translator. This is especially important when the translator contributed to data analysis.

When researchers choose to have an epistemologic role for a translator in their study, their philosophic perspective may also influence how, where and when they use the translator. For example, a researcher functioning from a positivistic perspective for knowledge creation considers the translator to be a fully objective transmitter of the facts gathered by the researcher. Researchers assume data translation as an unproblematic process and the single interpretive view receives no challenge when they require translation (Temple 2002); language is something that transfers easily from one point of view to another (speaker to listener).

In contrast, social constructionist, non-positivist or interpretive approaches to research adhere to the tenet that the social world influences a translator's perspectives and consequently, how translators translate qualitative data (Temple 2002; Temple & Young 2004; Yach 1992). These perspectives take account of the influence of gender, social class and other demographic characteristics of the translator on how they translate qualitative data (Temple 2002). This type of integrative approach eliminates the assumption that the translator role is functionally objective and the translator becomes part of the knowledge production process.

Developing interview questions and guides

As researchers develop the questions they will ask participants, those intending to translate questions must first evaluate whether or not the question accurately represents the meaning or construct within the participant's culture (Lange 2002). This helps qualitative research questions align with the culture of the participants in the study. It also increases the likelihood that researchers will obtain responses relevant to the study.

Experienced cross-language researchers also recommend pilot testing the translated research questions before undertaking a full qualitative study (Adamson & Donovan 2002; Esposito 2001; Hole 2007; Temple 2002; Twinn 1997). Authors that report pilot testing the questions prior to implementing the main study enhance the credibility of their findings in cross-language studies.

When writing interview questions, researchers start by writing the SL version in the simplest form possible. That way slang phrases, colloquialisms or complex sentence structures do not interfere with the conceptual equivalence of the translation. For multi-language studies, the research team selects a SL to develop the questions for the interview guide. Once the team finalizes the questions for the guide, then translation to other languages occurs. Independent bilingual consultants can confirm if the phrasing in the translation will function in the target language (Adamson & Donovan 2002; Lange 2002). All of these steps help ensure that the questions read the same way in both languages (Fredrickson et al. 2005; Hole 2007; Lange 2002).

Data collection, transcription and translation

With role and other technical considerations accounted for, researchers then need to plan to recruit interpreters and translators before the start of the study (Adamson & Donovan 2002; Lange 2002). In the author's professional experience, one complaint frequently reported by translators is that the time expected for translation services is too short because monolingual speakers expect translation to occur rapidly. Translators, however, may require 1−2 h per transcribed page to translate an interview. For a 10-page, single-spaced interview, this is 10−20 h worth of work for the translator.

For consistency, Twinn (1997) recommends the use of a single, dedicated translator for all written translations in a study. In this case, a single translator ensures translation consistency and improved conceptual congruency in the overall translation process, be it oral or written (Larkin et al. 2007; Twinn 1997). Overall, however, the type of qualitative method will determine if a single translator is appropriate.

Sometimes, studies require multiple translators, such as with focus groups. In all cases where researchers need multiple translators, it may prove valuable to discuss with them their perceptions of what occurred during specific points in data collection to enhance the conceptual and contextual trustworthiness of the translations (Temple & Young 2004). Esposito's (2001, 2005) work provides excellent examples of the use of real-time translators when conducting focus groups. Translators used for focus group work have an epistemologic role (a data-generating role) in the research process.

Finally, to the inexperienced cross-language researcher, bilingual research assistants may seem ideally suited for the translator role, even if they have no experience with performing translation. According to Mill & Ogilvie (2003), however, research assistants conducting and translating interviews can decrease the auditability of the research (Mill & Ogilvie 2003). They described how research assistants used as data collectors and translators for a study in Ghana altered their written translation of interviews. The research assistants’ interview interactions with study participants affected how they translated the written transcripts from the interview. Then, during data analysis, the research assistants assigned meanings to words or phrases used by research participants to clarify culturally derived concepts expressed in the interviews. Mill & Ogilvie (2003) described having no way to verify if the participants intended those kinds of meaning when answering interview questions. Consequently, the research assistants became interactive translators, thus changing the author's original assumption that their role in translation was objective.

Method-specific challenges

Several other methodological considerations for addressing language barriers in each type of qualitative research method emerged from the literature review. Table 2 outlines methodological considerations for each type of qualitative approach.

Table 2.

Qualitative research approaches and translator roles

Type of research	Type of translation required	Researcher's language ability	Possible roles for translators
			Passive/neutral	Active	Interactive
Case study research	Document translation; participant interviews.	All four levels of language competence; proficient navigating in different culture.	X	X
Ethnography	Conducting participant interviews; transcribing and/or translating interviews; interpretation of cultural statements by participants.	Moderate competence levels; proficient navigating through a different culture and working as an 'outsider'.		X	X
Focus groups	Conducting participant interviews with simultaneous translation; conducting focus groups in language of participants; transcription and/or translation of interviews; interpretation of cultural statements by participants.	Minimal to none.	X	X	X
Grounded theory	Conducting participant interviews; transcribing and/or translating interviews.	Minimal to none.	X	X
Historical	Document translation, informal interviews possible.	All four levels of language competence and extensive background knowledge of country's history.	X
Narrative analysis	Conducting participant interview; transcribing and/or translating interviews.	Minimal to none.	X	X
Phenomenology	Conduct research, analysis and dissemination in participant's language only.	Native speaker or language equivalent w/years spent living in the culture of research participants.	N/A	N/A	N/A

Generally, researchers can successfully conduct cross-language research with most qualitative research methods. Experienced cross-language qualitative researchers, however, indicated that this approach is not suitable for phenomenological studies (Larkin et al. 2007; Temple 2002). The importance of the exactness of language used to understand the lived experience of the phenomenon elevates the risk of losing conceptual equivalence and altering the interpretation of the results (Temple & Young 2004; Twinn 1997). Translation processes change the language used by the participant; therefore, researchers cannot complete credible phenomenologic studies in more than one language unless they are fluent in the languages involved. Researchers who desire to publish the results of their phenomenologic studies in international journals may opt to complete the analysis entirely in the language of the participants and then publish the completed results in another language. In this case, it becomes critical for the researcher to acknowledge the translated presentation of the results as a study limitation and carefully consider publishing translated participant quotes.

For historical or country-level case study research, experts also indicated that researchers themselves must possess at least socio-linguistic language competence along with sociocultural competence. Significant background knowledge of the country of study owing to the large volume of document review and analysis is also required (Yin 2003). Finally, researchers familiar with managing cross-language issues in qualitative research recommended that all those conducting their own translations should have their work checked for technical and conceptual accuracy by a well-educated, native speaker.

Data analysis and dissemination of results

For data analysis, researchers need to decide in what language the coding process will take place: the researcher's or the participant's. Most likely, financial and time resources will dictate the choice of language for the coding process. Researchers can guide the incorporation of translators into the data analysis process by considering what their role was in the overall study. How researchers approach this is a decision for the primary investigator or team involved in the study.

For multi-language studies, researchers may also find it useful to develop a translation lexicon. A lexicon ensures the conceptual equivalence of translated words or themes by creating a consistent resource for the translator. Researchers and translators would work together before and during the research process to develop the lexicon. For example, if the primary investigator develops a code book for the analysis process, the translator would have the code book in both the TL and SL.

When disseminating results, the methods literature encourages researchers to include a detailed description of how they used interpreters during the data collection process in the methods section. If the translator had a role in data analysis, the literature advises researchers to describe it in any final product of the research project, including reports and manuscripts for publication. If problems occurred with translation during the research process, researchers would address that in the limitations section. Most importantly, translated data are always a limitation of any cross-language study.

Some researchers may raise the issue of back translating translated interviews as a way to validate the translation. Given the volume of qualitative data in a single study, back translation can add additional time and costs to a study. Back translation does not necessarily enhance the trustworthiness of the results anymore than a critical review by a bilingual independent consultant. A qualified bilingual individual competent in the professional terminology of the qualitative researcher's discipline can easily validate the quality and conceptual equivalence of the translation. The core issue here is that the researcher had an independent source to validate the conceptual equivalence of the translation.

Finally, while pressure for publishing research studies in international journals is great, results published in the same language as the participants help ensure the integrity and trustworthiness of the data. This is especially true for phenomenological studies, so the lived experiences of the participants are not lost in translation.

Finally, English-speaking researchers, in particular, would benefit from a greater awareness of the linguistic imperialism imposed upon the non-English speaking research participant. Linguistic imperialism means that speakers of one language expect all others they interact with to learn their language. This also holds true, however, for researchers living in countries where research participants may not speak the official national language as their first language. Mexico illustrates this example well. The official language is Spanish, but the indigenous population in the country speaks one or more of at least 15 recognized languages, such as Nahuatl or Zapotec. Allowing participants in these situations to respond in their primary language will increase participant comfort level with the data collector or their participation in the study. The researcher may also obtain richer data from first language responses.

Conclusion

This article demonstrates that the use of translators during cross-language studies requires strategic advanced planning on the part of the researcher. A nurse researcher's failure to address the roles of translators and interpreters during a qualitative study can compromise the credibility, transferability, dependability and confirmability of the findings to the global audience. A lack of a translation plan, or a flawed one, may result in treatment plans and care delivery methods that are not consistent with cultural norms of foreign, immigrant or minority populations in any country. Qualitative nurse researchers can prevent this from happening by systematically addressing the roles and use of translators in cross-language studies.

More than ever before, nurse researchers can contribute to a deeper understanding of health-related phenomena across cultures, regardless of the presence of language barriers (Schultz 2004). The 21st century paradigm requires ‘that regardless of language barriers, researchers produce culturally sensitive qualitative research better than the research produced in the past’ (Esposito 2001, p. 578). Therefore, language barriers should not hinder opportunities for nurses to develop and improve upon the services they provide. Utilizing the recommendations from this paper will help qualitative nurse researchers ensure that the words of their participants do not create evidence that misinterprets or misrepresents a phenomenon. In effect, their findings do not end up lost in translation.