Establishing a process to translate and adapt health education materials for natives and immigrants: The case of Mandarin adaptations of cardiac rehabilitation education

Heart Lung. 2021 Nov-Dec;50(6):794-817. doi: 10.1016/j.hrtlng.2021.06.002. Epub 2021 Jul 4.


Background: Cardiac rehabilitation (CR) is a proven model of secondary prevention in which patient education is a core component.

Objectives: to translate and culturally-adapt CR patient education for Mandarin-speaking patients living in China as well as immigrants, and offer recommendation for best practices in adaptation for both.

Methods: these steps were undertaken in China and Canada: (1) preparation; (2) translation and adaptation; (3) review by healthcare providers based on PEMAT-P; (4) think-aloud review by patients; and (5) finalization.

Results: Two independent Mandarin translations were undertaken using best practices: one domestic (China) and one international (immigrants). Input by 23 experts instigated revisions. Experts rated the language and content as culturally-appropriate, and perceived the materials would benefit their patients. A revised version was then administered to 36 patients, based on which a few edits were made to optimize understandability.

Conclusions: some important differences emerged between translations adapted for native versus immigrant settings.

Keywords: Asian Continental Ancestry Group; Cardiac Rehabilitation; Health Education; Patient Education as Topic; Translating.

MeSH terms

  • Cardiac Rehabilitation*
  • Emigrants and Immigrants*
  • Health Education
  • Humans
  • Language
  • Surveys and Questionnaires
  • Translations