Research team and Forward translation

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Data collection and first Delphi round

In October 2016, the 24 experts received by separated email an individual form, where each item of the English version of the WAI SR was associated with its Spanish translation.
The experts were asked to evaluate the equivalence of translations using a Likert scale. The scale ranged from 1 (total disagreement) to 9 (full agreement). For each rating under 7, they had to explain it with a short commentary. Consensus was reached when at least 70% of the participants rated the items 7 or above.
If an item was considered as consensual, it was validated and no further work was needed on it. If an item was not consensual, the first team of 5 experts had to collect the comments and the other proposed versions and had to design a new item proposal to be submitted to the group of 24 experts. The process was continued until a final consensus was reached (38,39,40,41). The first team met at the reception of the forms in December 2016 and took into account the remarks to make changes on the Spanish version: they created a second Spanish version with the contributions of the participants.
The scoring sheet was not included in the form sent to the experts, the research team decided to send it after, in August 2017, with 4 questions to rank.

Backward translation

The consensual translation in Spanish was then submitted to a professional translator for a backward translation into English. The translator was not aware of the original version and was not trained on the subject of the study. His native language was English.

In the WAI SR Patient:

In the 7th, 9th and 10th question, the original English version used the expression “I Feel” whereas the backward translation used the expression “I think”. The sense was different, so the Spanish version was modified into “Siento que”.
The Research team considered that the discrepancies between “Seldom” and “Rarely” and “Fairly often” and “Often” came from the fact that there are many English terms to describe the frequency and that they were less numerous, or not used in Spanish. This did not change the Spanish version.

In the WAI SR Family Physician:

In the 2nd question, the original English version said “I am genuinely concerned for ___’s welfare.” Whereas the backward translation was “I am really worried about ___’s wellbeing.”. The sense was different, so the Spanish version was changed.
In the 4th question, the original English version said “ ___ and I collaborate on setting goals for my therapy.” While the backward translation said “ ___ and I trust that our present therapeutical activities are worthwhile.” The sense was not exactly the same, the Spanish version was changed. In the scoring sheet, the original English Version used the word “Bond” while the backward translation said “Relationship”. The sense was different, the Spanish word was changed.

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Implications for practice, further research, medical training:

The improvement of the communication techniques of the European general practitioners, with the aim of increasing patients’ adherence to treatment and more generally quality of care, depends in part on the improvement of their therapeutic alliance. Having a tool available to evaluate this working alliance on a daily practice will allow professionals to focus on their strengths and work on their shortcomings (29,30).
In the Barcelona Declaration of Patient Associations in 2003 (43), was proposed, among the main findings, a greater involvement of patients in clinical decision-making, improving the patient doctor relationship with mutual trust, more appropriate information, a longer time of attention to the patient and a better active listening of the physician. Methods of improvement and evaluation of the therapeutic alliance can be a part of a solution to these issues.
Using WAI SR will also improve the training of medical students in communication techniques with feedback on their evolution, with a view to enhance their future practice. It appears necessary to incorporate the communicational and relational competence in the training of the future doctors. In a book for the training of Spanish medical students published in 2007, the author notes that communication skills can and should be learned because although some professionals are naturally skilled in the domain of such skills, it is not the same with everyone. She provides a guide to communication techniques to improve patient doctor relationship in order to establish an adequate therapeutic alliance (44). WAI SR can be a good tool for improving communication skills of students. The effectiveness of the training will also be assessable. Comparative studies of patient satisfaction before and after the training of professionals and students throughout Europe may be useful.

Table of contents :

Abstract
Introduction
Material and Methods
Methodology
Ethics statement
Research team and Forward translation
Participant selection
Data collection and First Delphi round
Backward translation
Results
Forward translation and research team
Group of 24 experts
Backward translation and cultural check
Discussion
Main results
Limitation and bias of the study
Key points
Implications for practice, further research
Conclusion
Bibliography

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