Early Community Engagement

We worked with the Seniors Advisory Council (SAC) for four years, including more than a year before we commenced the study. We developed a close working relationship with the SAC, which had staff and volunteers who represented several ethno-cultural minority groups in South Vancouver. For more information on our collaboration with the SAC, see Tong et al. (Reference Tong, Sims Gould and McKay2018). In a series of approximately 20 in-person meetings, we worked with volunteers from the SAC to determine study objectives, apply for funding, and design the study. Prior to commencing data collection, volunteers from the SAC played a vital role in ensuring that our study was culturally and linguistically accessible and tailored to the anticipated participants. It was the SAC that selected the five languages, given their knowledge of local FBOA residents. Volunteers from the SAC recommended translation agencies and interpreters that they had worked with previously. They also reviewed the recruitment materials (consent forms, posters, and letters of introduction) to provide feedback on the translation. The SAC encouraged us to simplify the documents, to make the language less academic and more accessible. We incorporated their feedback prior to submitting materials for ethics approval and final translation. The SAC also cautioned us that some potential participants may not read or may have a very low level of comprehension of their first language in the written format; having this knowledge ahead of time allowed us to plan study documents and data collection accordingly.

Ethics and Recruitment

The first translation task was submitting English and translated versions of the consent forms to our university behavioural research ethics board. Our ethics board requires all consent forms to be professionally translated, even if the study investigators can conduct translations themselves. Professional translation is costly, especially when one document must be translated into five different languages. Most organisations charge by the word for professional translation, so we endeavoured to keep the consent forms as complete yet succinct as possible. Per the guidance of the SAC, we also endeavoured to make the language of the consent form’s English version as simple as possible, prior to translation. We emphasised to the translators that our objective was to keep the consent forms at an accessible reading level. Volunteers from the SAC reviewed the translated versions of the consent forms before we commenced recruitment. The SAC volunteers highlighted several instances in which the language of the consent form needed to be simplified.

Upon receipt of ethics approval, peer volunteers from the SAC introduced the study and collected the names of individuals interested in the study. Volunteers shared information about the study at the South Vancouver Neighbourhood House, community centres, ESL and computer classes, places of worship, and culturally specific social groups and gatherings. These were the same volunteers who helped conceive of and design the study. Recruitment sheets included name, phone number, preferred time of call, and preferred language of communication. Some participants spoke numerous languages (e.g., English, Hindi, Punjabi and Urdu, or English, Mandarin, and Vietnamese), and it was therefore important to ask them which language they would prefer. Multilingual research assistants then followed up with this list of names to confirm eligibility and to further describe the study.

Translation and Data Collection Team

Team members who worked with participants, including the research assistants (RAs) and interpreters were all women with prior experience working with older adults and vulnerable populations. The team members’ roles, education and experience, and languages are summarised in Table 1. It was cost-effective and efficient to hire RAs who spoke multiple languages (for example, one RA spoke Mandarin and Cantonese; another spoke Hindi and Punjabi). We knew that it was vital to create a direct line of communication between the RAs and research participants; we never wanted a situation whereby an older adult telephoned our team and was misunderstood or unable to communicate. On study documents we highlighted and repeated the one telephone number that would directly connect study participants to the research assistant who spoke their language. This process included removing our general office telephone number from letterhead and stationery to avoid any potential confusion or miscommunication. We budgeted for cellular phones for RAs and planned for overtime hours so that participants could reach RAs outside regular business hours on these phones.

Table 1:

Multilingual data collection team

FBOAs = Foreign-born older adults

Our consent forms also included the contact information for the university research board; this is a standard requirement of most research boards to protect participants. If a participant telephoned this number, the university official answering the phone likely would have answered and communicated in English. To support this potential communication, we provided every participant with an English language consent form, with the hope that participants could and would share this form with a trusted family member or other English-speaking individual who could speak to the university board on their behalf. During data collection, we saw many adult children reviewing our English version of the consent forms.

Data Collection – Wave 1: Surveys, Accelerometers, and GPS Units

Data collection took place from May through June 2013. Data collection for both waves occurred in quick succession, enabling us to capitalise on the multilingual research team that we had in place for both components of the study. Wave 1 consisted of 2-hour survey sessions in large rooms at local community centres and neighbourhood houses. After the survey session, participants were asked to wear an accelerometer and GPS unit for one week to track both the intensity and location of their movement.

Organisational Considerations. Data collection for Wave 1 revealed several organisational considerations. First, we were not sure if we could conduct survey sessions in multiple languages in the same room at the same time. Being mindful of noise and privacy, we scheduled only two participants in the room for each appointment time. One-on-one measurement sessions were conducted at the South Vancouver Neighbourhood House for those who requested it. We also quickly learned that we needed additional items, not just study documents, translated – for example, wayfinding signage (see Figure 1) and labels on envelopes that said “please open and read”. We also required English labels to guide our research staff: for example, the research coordinator could not distinguish between Hindi and Punjabi script. We added English labels as “footers” to all study documents to indicate the version/language being used. In an English language study, we would typically assign and label participant IDs in advance (e.g., providing booklet 102 to participant ID 102); however, this was not possible when using documents in multiple languages. Accordingly, we took enough booklets in each language, and then assigned IDs as participants arrived and indicated their language preference. Many participants spoke several languages, and it was important not to make assumptions about which language they would prefer to use in a research setting. Using this method, we might assign ID 102 to a Mandarin-language participant package, and ID 103 to a Punjabi-language package.

Figure 1:

Multilingual wayfinding signage

Survey Administration and Vocabulary Cards. We did not translate the survey booklet. Professionally translating the entire booklet, which was 60 pages, into five languages would have been cost-prohibitive. We also knew that some participants would have limited literacy, even with translated documents. Consequently, for each language, we had one RA consistently administer the survey sessions verbally. Each RA piloted their translation of the survey booklet prior to data collection by administering a copy of the booklet to an older adult volunteer who was not part of the study. After these pilots, we reconvened as a team to review any issues that arose related to translation. Two issues were raised by both research assistants. First, the term “walkable” did not readily translate. We decided as a team to use and translate the English phrase “a good place to walk” to replace “walkable”. Many participants, however, readily understood the concept of “walkable” in English, and translation was not necessary.

The second issue was that many built environment terms were difficult to translate. One example is “curb cut”. According to the Merriam-Webster Dictionary, a curb cut is “a ramp cut into a street curb at a corner for wheelchair access or at a driveway for vehicular access” (“Curb cut”, 2018). Of the surveys that we administered (see Tong et al., Reference Tong, McKay, Martin-Matthews, Mahmood and Sims-Gould2019), the Neighbourhood Environment Walkability Survey was the most difficult to translate, as it included many built-environment terms that are not necessarily part of everyday conversation. Problematic vocabulary included “curb cuts”, “cul-de-sacs”, and statements such as “There is a grass/dirt strip that separates the streets from the sidewalks in my neighbourhood.” To aid in the translation of this survey, we created visual vocabulary cue cards (see example in Figure 2). A professional photographer, who was also part of our research team, travelled to South Vancouver to take photos of the concepts to which these questions referred.

Figure 2:

Sample vocabulary cue card

Take-home Booklets and the Role of Family Assistance. Of the 49 participants who completed the survey sessions, 48 agreed to take home an accelerometer and GPS unit to measure their physical activity and spatial mobility. We asked participants to wear these units for one week, during waking hours. Along with the units, we sent a take-home booklet that included instructions, visuals, and a daily log to track their wear time and pertinent notes (e.g., if they took a nap and removed the units mid-day; if they removed the units for swimming, etc.). We knew in advance that some participants would have limited literacy, even with translated booklets; however, we also knew that many of these participants co-resided with family members who could assist. To facilitate a role of family support, we typically sent home two versions of the take-home booklets, one in the participant’s first/preferred language, and one in English. We knew from our work with the SAC that some second- and third-generation relatives would be willing to help, and these individuals might have spoken Punjabi, Cantonese, and so on, but would not have been able to read or write in these scripts. Providing materials in multiple languages allowed family members to be of assistance when needed and desired by the participants.

Communication with the Research Team. Participants were keen to wear their accelerometers and GPS units correctly. With the aforementioned direct line of communication to RAs’ cellular phones, RAs received daily calls from participants. These telephone calls were often queries on how to correctly wear the accelerometers, what the lights on the units indicated, if they should still be wearing the units, how we wanted the units returned, and so on. This line of questioning led to a very high level of compliance, as reported in Tong et al. (Reference Tong, McKay, Martin-Matthews, Mahmood and Sims-Gould2019).

Data Collection — Wave 2: Interviews and Walking Interviews

Wave 2 consisted of in-depth interviews with 18 participants, and optional walking interviews with 13 participants. For more information on the interACTIVE interpreted walking interview method, see Tong et al. (Reference Tong, Sims-Gould and McKay2016).

Working with Professional Interpreters. In a multilingual study with limited resources, we chose to prioritise the cost of professional interpretation. Colleagues and peers who had conducted research with FBOAs advised us to employ professional interpreters if and when possible. Also, the SAC advised us to avoid the use of peer and/or volunteer interpreters, citing privacy concerns for participants. We worked with a local interpretation agency to contract two women – one who spoke English, Hindi, and Punjabi, and one who spoke English, Cantonese, and Mandarin – each with 10 years of experience. Although professional interpreters are expected and trained to insert themselves into interviews without preparation, we provided copies of the consent form, interview guide, and a summary of study objectives one week prior to our first interviews. Interpreters were allocated one hour of paid time to review materials prior to commencing data collection. We also met with interpreters one hour prior to the first interview, to review any questions, comments, or concerns.

Including the Interpreters as “Co-researchers”. In the interACTIVE walking interviews, the interpreter’s role evolved from that of translator to that of co-interviewer. In the seated interviews, the interpreters maintained their formal interpretation role. Both interpreters had experience working in health care and legal settings and were accustomed to scenarios in which their primary role is to find approximate word equivalence between two languages. The interACTIVE interviews, however, provided a less-prescribed format, and allowed the interpreters the opportunity to contribute to the discussion in different ways. In the dynamic mobile interviews, interpreters posed their own questions, initiated conversations, and contributed to group discussions. As often happens in multilingual contexts (Myers-Scotton, Reference Myers-Scotton1993), these conversations were typically conducted in several languages, sometimes combining English and the participant’s other languages in a single sentence. Participants’ English language abilities were highly varied; consequently, the role of the interpreter varied from interview to interview. For participants with very limited English, the interACTIVE interview still required thorough translation. Participants with stronger English skills were able to combine physical and visual cues in the environment – some English words or sentences, and some verbally translated discussions to convey their impressions of the local environment and their interactions with said space.

After each interview, the interpreter and interviewer had a 15- to 20-minute debriefing. In the debriefing, the interpreter and interviewer verbally reviewed the verbal content of the interACTIVE interview, co-reviewed the rough field notes for completeness, and the interpreters then offered their impressions of the interview. The content of the debriefing was added to the field notes that we took throughout Wave 2. As the interpreters became more accustomed to this method, and more familiar with our research objectives, they increased their level of participation beyond that of translator. At the end of the study, both interpreters expressed their appreciation for the opportunity to add their voices and their own questions to the interview.

Data Transcription and Analysis. Our research team had an established relationship with a reliable and efficient professional translation agency, but the transcribers worked only in English. The transcriber was instructed to transcribe only sections of the audio file that we had recorded in English. Professional interpreters translated both the interviewer’s questions and participants’ responses into English. This process relied on complete and faithful interpretation into English.

To ensure the quality of the transcribed interviews, multilingual RAs who were not present during the interviews were asked to review a random selection of transcripts (five interviews per assistant). Research assistants listened to the original audio files and compared them to final interview transcripts to ensure both faithful translation of the interview and faithful transcription of the English text. No major issues were reported. Minor omissions were recorded on the checked transcripts, and largely consisted of a missing word. One lengthy discussion about the divorce of one participant’s daughter was not fully translated. At the time, this was discussed with the interpreter who felt that the information was sensitive and not pertinent to the research questions. This was the only noted significant omission from interpretations and transcriptions. In short, when employing high-quality professional interpreters, it was possible to work with a monolingual, English-only transcriber.

Sharing the Results: A Multimodal Approach

At one of our first interviews, a participant expressed her frustration with previous research studies that she had participated in. She explained that her community had “been researched a lot”, but she didn’t feel that she ever received enough feedback from previous research teams. She felt that her community had been “used”. It was a priority of ours to ensure that participants felt that their involvement was valuable, appreciated, and would have an impact. We mailed a personalised, handwritten thank-you card to each participant immediately following data collection; RAs assisted with these notes. Within approximately four months, each participant received a personalised “mobility and physical activity report”. They received a full-colour copy in English, and a translated version in their preferred language. This report included their personal physical activity report from the accelerometers, a map of their mobility based on their GPS outputs, and a more global summary of high-level study findings. We produced a higher-level summary of the studying findings in English for the SAC and neighbourhood stakeholders.

Finally, approximately eight months after data collection we also held a half-day community forum at the South Vancouver Neighbourhood House, in which we shared study findings. Presentations were made in English, whereas work and discussions in smaller groups at tables were conducted in multiple languages, with the assistance of peer volunteers from the SAC translating as needed. The community forum was attended by approximately 40 stakeholders, including study participants and partners from the SAC and South Vancouver Neighbourhood House. In Figure 3, we have provided an overview of the project timelines and the documents and resources required at each phase to implement this mixed-methods, multi-language study.

Figure 3:

Study overview: Roles and multilingual materials