Linguistic translation and cultural validation of the COST-FACIT-V2 questionnaire in Odia to measure financial toxicity in India

Abstract Background Cancer treatment can be associated with numerous direct and indirect financial burdens. These burdens, described as financial toxicity, can often affect care-based decision making of cancer patients. Breast cancer is the leading cause of cancer death of women in India, who often face the detrimental effects of financial toxicity. Measuring financial toxicity can be assessed through the COST-FACIT-V2 questionnaire, yet it is only available in limited languages. This study aimed to translate the widely used COST-FACIT-V2 tool used for assessing financial toxicity in Odia, one of India’s most commonly spoken regional languages. Methods We followed the prescribed linguistic translation guidelines for the 12-item COST-FACIT-V2 developed by the tool developers. This entailed a forward translation and back translation, facilitated by artificial intelligence (AI), confirmed by human validation, and pilot testing with 10 native Odia speakers at a comprehensive cancer center in Odisha, India. Results The AI forward and back translations demonstrated accuracy with human validation. Minor changes were needed to enhance contextual accuracy and consistency with previous FACITtrans key phrases such as “paid work at home”, which were not well understood by the pilot sample group, leading to culturally adapted modifications in the final translated version. Discussion The findings of this paper support the linguistic validity and cultural appropriateness of the Odia COST-FACIT-V2 and highlight the importance of rigorous translation methods to enable equitable measurement of financial toxicity and inform financial protection efforts in diverse cancer care settings. The use of AI represents an important innovation to support translation of standardized tools used in health systems research.