Adaptation of the STRiDE dementia survey into the Indonesian context in North Sumatra

Background: North Sumatra is one of two provinces in Indonesia in which the prevalence and costs of care of dementia has been completed as part of the STrengthening Responses to dementia In Developing countries (STRiDE) program. The toolkit used in the study was developed in English and thus needed to be cross-culturally adapted into Bahasa Indonesia. Part of this process involved pre-testing as a way to maximize the cultural appropriateness of the toolkit, especially in a multi- ethnic province like North Sumatra. Here we report the adaptation process. Methods: The translated toolkit consisted of measures needed within the prevalence survey in North Sumatra. This included cognitive, functional and quality of life measures aimed at older adults and their informants (i.e., family member). The interviewer asked each component of the toolkit in full, making notes on certain questions or items that need to be clarified or rephrased for the participants. Any specific difficulty in understanding the translated sentence or any items that were culture inappropriate were also noted. Data included observation, interviews, verbatim quotes which were constructed in the form of field- notes. Results: Several questions and items needed to be paraphrased to achieve greater clarity and make sure that they were in line with the original meanings. This was mainly due to the translatability of the word from the source language to the target language with errors that could be linguistic or cultural. Translating a text from English to Bahasa Indonesia and vice versa may be affected because of the different ways of ellipsis, which is a phenomenon of missing phrasal components, operated in both languages. Although the respondents belonged to different ethnic groups, cultural background did not affect the way they responded to the questions. Conclusion: Cross-cultural adaptation and pre-testing process played an important role to ensure the toolkit measured and was interpreted as it was originally intended. The STRIDE toolkit was generally accepted and understood, although several items need further explanation or examples.