Translation and Adaptation of the Revised Children's Anxiety and Depression Scale: A Qualitative Study in Belize

Background: Adapting data collection instruments using transcultural translation and adaptation processes is essential to ensure that respondents comprehend the items and the original meaning is retained across languages and contexts. This approach is central to UNICEF's efforts to expand the use of standard data collection tools across settings and close the global data gap on adolescent mental health. Methods: We conducted transcultural translation and adaptation processes in Belize using the Revised Children's Anxiety and Depression Scale (RCADS). Items from the original scale were translated into Belizean English and Kriol, reviewed by local mental health experts, and discussed in focus groups. Cognitive interviews were conducted with adolescents and parents. The information collected was analyzed with cultural equivalence domains: comprehensibility, acceptability, relevance, completeness, and technical equivalence. Bilingual discussions of findings informed the final item wordings, and the adapted tool was back-translated. Results: Adaptation of terms and specific expressions were done to improve comprehensibility and to ensure the appropriate clinical meaning. For example, the expression `feeling scared' was perceived to imply immaturity or threaten masculinity and was adapted to `feeling afraid.' Expressions like "shaky" were modified to "trimble" in Kriol. Statements were reworded as questions to enhance acceptability and comprehensibility. Discussion: A culturally adapted version of the RCADS was developed for use among adolescents in Belize in Belizean English and Kriol. The transcultural translation and adaptation procedure can be applied for other settings or tools to design contextual adaptations of mental health instruments prior to their validation or use in new settings.