Italian translation and cultural adaptation of health literate organisation self-assessment tool

BACKGROUND: The International Working Group Health Promoting Hospitals and Health Literate Healthcare Organizations has developed an English-language self-assessment tool for Organizational Health Literacy of Hospitals, designed to quality managers of healthcare organizations. It aims to diagnose strengths and weaknesses of the organization's health literacy, and our goal is to translate and culturally adapt it for Italy. METHODS: We have been following the Translation, Review, Adjudication, Pretesting, and Documentation team model for cross-cultural translation of questionnaires. Initially, two separate teams of translators worked independently to translate the tool from English to Italian. Next, the national coordinator organised six meetings to discuss, integrate, and unify the two versions, and any translation difficulties and suggested solutions were reported in the supporting tool that will be sent along with final agreed version of the tool to the International Coordination Centre. Finally, two experts will review the translation for the cultural adaptation. RESULTS: Difficulties related to comprehension in translation can arise from ambiguity in word choice, the need for contextual precision, and a lack of cultural appropriateness. The translation of English words that have become part of Italian language (e.g. ‘feedback', ‘stakeholder', ‘management', ‘standard') was also hugely discussed between the teams. Finally, to categorize the information entered into the supporting tool, 50% pertains to adaptation to context, 30% to simplification or clarification, and 20% to non-applicable items. CONCLUSIONS: Cultural adaptation will improve the translation by reducing ambiguities, providing contextual clarifications, and rephrasing items to make them more appropriate for Italy. The Italian version of the tool will be piloted in local hospitals to support healthcare operators, patients, and the community in better managing the complexities of healthcare organizations. KEY MESSAGES: • Translation of health literacy self-assessment tool for Italian hospitals, aiming to reduce ambiguity and increase appropriateness for local context. • Culturally adapted tool to diagnose organizational health literacy in Italian hospitals will help healthcare organizations deal with complexity of healthcare and improve patient outcomes.