Cultural adaptation process of six stigma assessment scales among Kannada speaking population in South India.

For several years stigma researchers in India have relied on Western instruments or semi-structured stigma scales in their studies. However, these scales have not been rigorously translated and adapted to the local cultural framework. In the current study, we describe the cultural adaptation of six stigma scales with the purpose of using it in the native language (Kannada) based on translation steps of forward translation, expert review and synthesis, cultural equivalence, back translation and cognitive interview processes. Several items were modified in the target language at each stage of the cultural adaptation process as mentioned in the above steps across all scales. Cultural explanations for the same have been provided. Concepts such as "community forest" and "baby sitting" was replaced with equivalent native synonyms. We introduced native cultural and family values such as "joint family system" and modified the item of housing concept in one of the tools. The concept of "privacy" in the Indian rural context was observed to be familial than individual-based and modification of corresponding items according to the native context of "privacy". Finally, items from each scale were modified but retained without affecting the meaning and the core construct.