Translation, Cultural Adaptation, and Mixed-Methods User Feedback of the SelfBack App to the Arabic Language (Preprint)

Abstract

Low back pain (LBP) is a significant global health concern, adversely impacting affected individual’s quality of life. Effective self-management strategies, including digital interventions, are critical to enhancing LBP patients’ adherence to treatment regimens. The SelfBack smartphone app exemplifies such digital innovations, with clinical evidence of effectiveness and a focus on personalised user experiences.

This study describes the translation of the SelfBack app from the English language to the Arabic language, its cultural adaptation into the Saudi context, and an evaluation of the app’s perceived usability in a Saudi cohort.

Five comprehensive stages were used to ensure the quality of the adaptation process of the SelfBack app from the English to the Arabic language. The first stage was the exchange phase where the self-assessment scales, completed at initial registration and weekly update sessions which are used by the app to tailor treatment, were changed from English to validated Arabic language versions. The second stage was the translation and cultural adaptation phase which translated the content of the patient self-management plan and adapted it for cultural relevance. The third stage was the audio conversion phase which translated the English audio educational materials to Arabic. The fourth stage was a laboratory usability testing phase which integrated the new Arabic content across all app features, ensuring the interface accommodated the new language format. The fifth stage was a field usability testing phase which used the Arabic version of the System Usability Scale (A-SUS) and participant interviews to evaluate the Arabic SelfBack app’s performance using a sample of 11 participants with non-specific LBP.

The stages of translation and cultural adaption are reported in detail and the expert panel members reported no misunderstandings and a few minor discrepancies in the Arabic version of the SelfBack app’s content or software interface. The SUS score was 70% for the participants in the field usability testing, reflecting a good level of usability. Interview responses were consistent with these SUS results, suggesting the app was clear and easy to use. However, some negative feedback was received concerning the number of mandatory questions, lack of interaction, repetitive content and unmet expectations which could potentially be addressed in future updates.

High user satisfaction, ease of use, and interface efficiency were observed, with only minor criticisms encountered, for the newly developed Arabic version of the SelfBack app. These results suggest that the Arabic SelfBack app is ready for research testing in clinical practice involving Arabic-speaking participants.

The study was approved by the Institutional Review Board for Health Sciences Colleges Research on Human Subjects at the College of Medicine at King Saud University (# E-22-7106). All participants signed a consent form.