The validity of clinical psychological tests remains a challenging issue, especially when the tests are applied in cultural groups other than those for which they were originally developed. Notwithstanding impressive developments over the past few decades in the field of clinical cross-cultural psychometric test development--reaching a high point in the International Test Commission (ITC) Guidelines on Adapting Tests--several authors point out the difficulties in obtaining validity or equivalence for adapted measures, particularly construct validity. (1-6)
With regard to terminology, validity usually refers to a test's ability to measure what it is supposed to measure and to capture the true meaning of the concept. It includes construct-, content- and criterion-related validity. (1,7) The term equivalence indicates whether an adapted or translated test reliably measures what the original version measured and in the same way. (2,3,8,9) A related term, test fairness, refers to the comparability of score meanings across individuals, groups or settings. (10) Closely linked to the issue of validity is the issue of bias that detracts from the validity or equivalence of an adapted test. (3,4) Societal values are also argued to underpin validity. (1)
This article focuses on the question of how to enhance validity in clinical cross-cultural psychometric test development, and explores a possible solution based on systems theory by building on the work of Kitayama.12 The scope of the article is limited to the field of clinical psychology, and excludes other fields where cross-cultural psychometric testing is used, e.g. industrial psychology or the human resources context. In the present scope, psychological or psychometric tests are taken to include measures of intelligence, personality inventories, projective tests, and self-report measures of various psychological variables such as anxiety and others.
We track some of the progress in the field of clinical cross-cultural psychometric test development before and since the appearance of the ITC Guidelines. We then propose a systems-informed paradigm shift and suggest that qualitative research designs might be used more frequently in clinical cross-cultural psychometric test development.
Before the ITC Guidelines
Until the early 1990s the adaptation of tests for cross-cultural use was characterised by a relatively low level of methodological sophistication in comparison with the sophisticated test-development, validation and norming techniques used for the original monolingual tests. (8) In cross-cultural test development various combinations of approaches have been used to adapt tests, including translation, back-translation, decentring, adaptation of test content or administration procedures, and establishing culture-specific norms. (6,9,10,13-20) Notwithstanding the value offered by the previous main test-developmental approaches, certain limitations remain. Translation or linguistic equivalence does not necessarily guarantee cultural equivalence, since culture is not constituted by language only. In some previous test-development studies respondents' cultural contexts were not taken into consideration, whereas in others constructs were not clearly defined. (10) Some studies fail to account for the effects of confounding variables such as gender, sexual orientation, religion, ethnicity, or educational and socio-economic factors. (21,22) More importantly, there appears to have been hardly any attempt to address issues relating to societal bias and value judgements in clinical cross-cultural test adaptation, e.g. crosscultural differences in the evaluation of sensitive topics such as honesty, work ethic, aggression, immorality, or sensitivity to gender-specific experiences.
The work of the ITC has aimed to reduce the impact of some of these limitations, mainly by drawing attention to the need to establish the equivalence of …