Translation with ongoing adaptation and improvement (ToAI) framework: A community-informed, structured, iterative approach to culturally adapting cognitive assessment tools

Abstract

INTRODUCTION: Alzheimer's disease (AD) and related dementias (ADRD) are increasing globally, including in the United States, but the fast-growing Vietnamese American population remains understudied, with a significant lack of culturally adapted neuropsychological assessment tools. The Vietnamese Insights into Cognitive Aging Program (VIP) addresses this gap as the first longitudinal cohort study focused on this community. METHODS: This paper (1) describes the assessment instruments, including a neuropsychological battery selected for the VIP, and (2) introduces the Translation with Ongoing Adaptation and Improvement (ToAI) framework, an innovative and practical method for culturally informed translation and adaptation. RESULTS: The ToAI framework followed a nine-step process: preparation, translation, native-speaker review, VIP team review, external panel review, pilot testing, proofreading, final formatting, and ongoing review and improvement. DISCUSSION: The ToAI framework was efficient, and the ongoing improvement component was particularly beneficial. It is recommended for inclusion in future cross-cultural research involving translation and adaptation processes. Highlights: The Translation with Ongoing Adaptation and Improvement (ToAI) framework. Cross-cultural translation and adaptation of psychological assessment instruments. Neuropsychological assessment for Vietnamese American older adults. The Vietnamese Insights into Cognitive Aging Program (VIP).