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Table 1 Translation and adaptation process of the instrument

From: Translation and cross-cultural adaptation of the European Health Literacy Survey Questionnaire, HLS-EU-Q16: the Icelandic version

Original HLS-EU-Q16 English version

STEP 1 TRANSLATION

Forward translation: April 2016

Two translators, fluent in both source and target language with the target language as their native tongue, familiar with both cultures, and having some knowledge in the content of the instrument made two independent forward translations, versions T-1 and T-2.

Integration I: April 2016

Versions T-1 and T-2 were merged into a single version by authors 1 and 2, version T-1.2.

Specialists´ committee review I: May 2016

The multi-disciplinary specialist committee consisted of six members with a PhD in health or social sciences at two public universities in Iceland and most were experienced researchers. Review of the committee reflected on translations and critical decisions. Authors 1 and 2 reached a consensus on any discrepancy and versions T-1.2.1 was made.

Back translation: June–July 2016

Two translators, fluent in both source and target language with the source language as their native tongue, familiar with both cultures but unfamiliar with the content of the instrument made two independent back translations, working with T-1.2.1 version.

Integration II: August 2016

Two independent back translations were merged into a single version T-2 by authors 1 and 2.

Specialists´ committee review II: December 2016

Review of all translations by the specialists’ committee and critical decisions. Authors 1 and 2 made a Pre-final version T-2.1 to be used for cognitive interviewing.

STEP 2 PRE-TESTING I

Cognitive interviewing I: January–February 2017

Twelve interviews taken by author 1 and a research assistant (RA) with the pre-final version T-2.1. Comments made on nine questions.

Consultation and integration I: February 2017

Summary of all item comments reviewed. Authors 1, 2 and RA made version T-2.2.

Cognitive interviewing II: February 2017

Five interviews conducted by RA with people that volunteered participation with the pre-final version T-2.2. Comments made on five questions.

Consultation and integration II: February 2017

Summary of all item comments reviewed. Authors 1, 2 and RA made version T-3 for use in pre-testing II.

STEP 3 PRE-TESTING II

HLS-EU-Q16-IS questionnaire: March 2017

An intended cross-sectional sample of 1200 people provided by the Icelandic national registry was sent an introduction letter, the HLS-EU-Q16-IS and 11 background questions by mail. The actual sample consisted of 251 individuals who completed the HLS-EU-Q16-IS. Data was analysed for internal consistency using Cronbach’s α, and construct validity was examined using exploratory factor analysis.

Final version of the HLS-EU-Q16-IS