OBJECTIVES:  The Zarit Burden Interview (ZBI) is a caregiver self-report measure, developed in US English, specially designed to reflect the stresses experienced by caregivers of dementia patients. Caregivers are asked to respond to a series of 22 questions about the impact of the patient’s disabilities on their life. For each item, caregivers are asked to indicate how often they felt that way (never, rarely, sometimes, quite frequently, or nearly always). The objectives of this study were to present the challenges of the translation of the ZBI-22 into 95 languages and the importance of developing a conceptual definition for each item.

METHODS: In most languages, the standard translation process consisted of: 1) Concept definition with the developer 2) Forward/backward translation step including a review of the backtranslation by Prof. Zarit; 3) Clinician review; and 4) Cognitive interviews with five caregivers. RESULTS:  No cultural issues were identified during the process. Most of the challenges were semantic. One of the greatest challenges was in finding the most appropriate words for the description of the feelings of the caregivers (i.e., do you feel stressed, embarrassed, angry, uncomfortable, afraid); each word representing a specific concept needing a clear differentiation. Items 7 and 13 raised queries given their idiomatic nature (7. Are you afraid of what the future holds for your relative?; 13. Do you feel uncomfortable about having friends over?). The interventions of Prof. Zarit helped the teams in finding appropriate translations. Examples of solutions found are presented. CONCLUSIONS:  The input of the developer in providing conceptual definitions and clarifications during the process was key in developing translations of the ZBI-22 conceptually equivalent to the original.