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Illustration of Backtranslation Process with heading Managing Back TranslationBack Translation is the process of translating a translated document back into the original language of the source content. The goal of managing this process is to ensure that the target and source language accurately match. This process is often required by law in pharmaceutical marketing or with clinical trials. Translation Accuracy is of utmost importance in these cases as the risk of invalidating a study or legal ramifications can be very costly.

Back Translation is often described as simply “adding steps” to the quality process. However, this is a process that needs careful planning and can be challenging. Areas where back translation can hold up the process:

  • Concepts not matching
  • Grammatical Incompatibilities
  • Stylistic Preferences

Another challenge is not inherent to the differences in languages, but rather the process itself. In certain situations, back translations can provide a forum for discussion whether there is any agreement over the original content of the message. We also see this with in-country client review of the translation where reviewers make changes that go against the original source content.

Some of the following issues may also increase that chance of debate and increase timelines:

  • Concepts not matching

There are many concepts that need either a localized approach or explained differently to mean the same thing. One example is the concept of treatment, as in “treatment for a disease or illness”. There is no direct Spanish equivalent of the concept of sticking to treatment. Cumplir as in complying may read inaccurately in English but is conceptually the closest translation. Another example is the term empowerment, which translates back differently in Chinese because the literal translation would render awkward sentences. Rather, it’s translated back as “giving you the ability to” (让您可以).

If healthcare translations are evolving to a more localized and culturally competent communication field, the back translation requirement will have to define what accuracy is in the context of cultural appropriation. There may be more suitable ways in which comprehension is tested. Some of these testing methods are already put in place in Health Literacy writing and usability testing that the medical field is familiar with.

  • Grammatical Incompatibilities

Grammatical incompatibilities will also show up in back translation. For instance, the use of phrasal verbs for simplicity in English. They don’t translate well into Spanish. Examples in English like “goes up” instead of “increase” or “help bring it down” instead of “decrease” in Spanish translation will provide a slightly different English translation, but with similar intent.

This process should always be a “blind” process where the translator does not see the original source language. These issues may come up without having any effect on the quality and accuracy. Some of these issues may be resolved in reconciling results from the back translation with the original source content.

  • Stylistic Preferences

One example is the use of repetition in the following:

Original Source Content: How long can it take between getting HIV and when HIV can be detected by a test?

Spanish Translation: ¿Cuánto tiempo puede pasar entre el momento de contraer el VIH y el momento en que el virus se pueda detectar con una prueba?

Back Translation: How much time can pass between the time of contracting HIV and the time the virus can be detected with a test?

Repetitive content may be avoided in another language because it reads more natural that way. Strict guidelines may prohibit translators to provide a good translation that reads well if there are no provisions for language-specific style preferences.


Back translation has proven to be a valuable step in ensuring translation process. It puts clients at ease when they can read back the translation in their own language. Plus, it often satisfies regulatory needs. However, there are a few things to keep in mind:

  • This is a literal process to evaluate translations that may not be so literal. Discrepancies may occur but do not automatically assume it is a mistake that needs to be fixed.
  • It is not the process by which you evaluate branding and messaging. This process should happen before you start translating by identifying and sharing key brand messaging. Understand that key messaging may translate differently than the literal back translation may reveal. More information may be needed emphasize the message in a similar fashion.
  • The process ideally should be done by the same language service provider (LSP) as they can manage discrepancies between this process and the translation process. There is nothing wrong with having a Language Service Provider (LSP) work together with the back translation team to work out any discrepancies ahead of time and reduce the burden on the client review team before they go into the review. The process should be transparent to meet the requirements of objectivity.
  • Consistency in the process will go a long way. This means not only demanding consistent and regular teams from your translation provider, but also having a consistent process on your end. As we learn with in-country review, it takes time to get reviewers and translators attuned to each other’s style and preferences. Over time, a consistent approach reduces the need for intervention and reduces your cost and time to market.
  • Consider adding in a Translation Quality Model that will be used during the review process to evaluate the feedback. Our quality process has a modified quality standard based on the ASTM J4250 standard. Using a model like this with set guidelines provides a structure to the review process that can help to reduce the back and forth that jeopardizes the timelines and increases costs.

Back translations are nothing controversial in our industry anymore. It’s been a proven and often required process in the medical industry. What we want you to take away from this is that like any process, the back translation process needs to be well-managed and consistent in order for it to be efficient.