Promoting Public Health >>Promoting Public Health among the general public. >> Development of Guides, Manuals and Pamphlets for the Prevention of Back Problems>> Cross Cultural Adaptation of The Back Book

CROSS CULTURAL ADAPTATION OF THE BACK BOOK

Background.

A multidisciplinary team in Britain has prepared a text aimed at the general public to provide the most up-to-date information on the attitudes which reduce the risk of back problems and the possibility of their becoming chronic.

The text, entitled "The Back Book", does not focus on aspects of healthy posture, although it includes a brief section on it, rather it redirects mistaken beliefs which have been shown to have a damaging effect on the evolution of back pain and it encourages an active attitude towards pain, which speeds the process of recovery and prevents relapses. The Back Book was prepared by a team in which psychologists and experts in communication took part, in addition to the relevant medical specialists. The text is based on the information contained in the Guidelines for Clinical Practice for back pain published by the British Royal College of General Physicians.

While there are many texts on back problems for the general public, the Back Book is the only one that has been scientifically tested by means of controlled clinical trials, and shown that its mere distribution improves patients' evolution and reduces their degree of disability.

However The Back Book was not available in Spanish, thereby preventing its use in the Spanish-speaking world.

Objective.

To develop a cross-culturally adapted version of The Back Book.

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Description.

Given that The Back Book is a document aimed at changing beliefs, it was important to ensure that the Spanish version maintained the elements that supported and proved the efficacy shown by the original version. Thus, it wasn't only a matter of making a literal translation of the text; a cross-cultural adaptation was needed to guarantee its comprehension and validity, both in the text and the illustrations.

To this end, the Kovacs Foundation reached an agreement with the publisher of the British version (the Royal Stationary Office of the United Kingdom). The Foundation set up a multidisciplinary and international team of Spanish-speakers that included experts in various clinical specializations relevant to back problems (internists, primary care physicians, traumatologists, neurosurgeons, etc), experts in communication, the general public and patients in Spain, Colombia, Cuba and Argentina. The team led by the Foundation translated the British version into Spanish, then translated the Spanish back into English and compared it with the original, in order to detect differences in nuance which may have passed unnoticed.

Finally, the text was adapted cross-culturally and each difference in regard to the English version was debated thoroughly with the authors of the original. Thus a final Spanish version of The Back Book, entitled "El Manual de la Espalda"(The Back Manual), was written.

The Foundation has received the exclusive publication rights of the Spanish version in Spain (and of the possible future editions in the other languages of the different Spanish Autonomous Regions), and has ceded free of charge the texts developed in Spanish to the publisher for their publication throughout the American continent.

Given that the Foundation must pay the British publisher a certain amount for each copy it distributes, its diffusion is relatively limited due to the cost. In the health care setting, the Manual is distributed to patients at the Kovacs Back Units who request it and it is also used in the context of the campaigns to promote public health (for example, among senior citizens, school children and the working population).

The simple distribution of the Manual has been shown to be effective in transmitting clear and understandable information to the general population and patients and thus reduce patients' level of disability, so that the Foundation encourages its use by insurance companies, mutual workman's compensation insurance and Public Health Services.

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Along with the Kovacs Foundation, the following have participated in this project.

A team of 20 people including doctors in all specializations related to back problems, experts in communications and publishers.

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Status.

The Manual de la Espalda has been available since September 2002. That year a first edition of 2,000 copies was printed and new editions will be published as necessary. It is anticipated that throughout 2004, copies will be published in Latin America.