Translation procedure
The English version was translated to Hindi by two bilingual experts separately, and version 1 and version 2 were developed. Each item in these two versions was discussed by the translators until a consensus was reached and a third version was developed. This version was back-translated to English by two different bilingual experts, resulting in version 4 and version 5. Discrepancies, if any, between these two versions were discussed and a final back-translated version, version 6, was developed and compared with the original scale. The back-translated version (version 6) was brought as close as possible to the original scale. Corresponding changes were made in version 3, and it was stored as version 7.
A pilot study was conducted by using version 7, and the subjects participating in the pilot study were asked to point out the difficulties they faced in comprehending the items on the scale. The suggestions made during the pilot study were taken into account and another version, version 8, was developed. This version 8 [] was used in the current study.
The translation being a cross-cultural one, various difficulties were faced and certain modifications in the wordings had to be made, but the contextual meaning of the original version was retained.
The literal meaning of ‘insomnia’ in Hindi is anidra and that of ‘problem’ is paresani, and hence the term anidra ki paresani was used in the column depicting the nature of sleep problems in the first three questions. The original version graded the severity of the first three questions as ‘none’, ‘mild’, ‘moderate’, ‘severe’, and ‘very severe’, whose equivalent in Hindi were chosen as ‘bilkul nahi’, ‘lagbhag nahi’, ‘madhyam’, and ‘gambhir’ and ‘ati gambhir’, respectively, after discussing it with patients.
The first question of the original questionnaire was initially translated as ‘Nidra shuru karne me paresani’. However, the participants of the pilot study had difficulty in comprehending the exact meaning of the question and suggested that it be changed to ‘neend aane me paresani’, ‘neend’ being another word for ‘sleep’ and is more commonly used. The contextual meaning of the original question ‘Difficulty in falling asleep’ remained unchanged.
The second question enquired whether the subjects had any difficulty in the maintenance of their sleep and was translated as ‘soye rahne me paresani’, ‘soye rahne’ denoting ‘sleep maintenance’. However, a few patients failed to understand it, and hence, it was changed to ‘neend ka baar-baar tootna’ in the final version after the pilot study.
The third question of the Insomnia Severity Index was framed as ‘Problem waking up too early’ in the original version, and this was initially translated as ‘neend ka jaldi khul jana’. However, the subjects of the pilot study had difficulty comprehending the difference between the second and the third question. After the difference between these two questions were explained to the subjects, they suggested that it be changed to ‘neend ka jaldi khol jana evam uske bad nahi ana’, which meant ‘waking up earlier than the usual waking time and inability to fall asleep again’.
The fourth question of the Insomnia Severity Index measured how satisfied or dissatisfied the subjects were with their present sleep pattern and the answers were graded as ‘very satisfied’, ‘satisfied’, ‘moderately satisfied’, ‘dissatisfied’, and ‘very dissatisfied’. These were translated as ‘bilkul santusht’, ‘santusht’, ‘madhyam santusht’, ‘asantusht’, and ‘bilkul asantusht’. The main question was translated as ‘in dino aap apni nindra se kita santust/asantust hai?’
The fifth question intends to ask about the impairment in quality of life owing to insomnia, as perceived by persons close to the sufferer. However, literal translation of quality of life was difficult to understand by our subjects and they suggested a simplified language. Hence, we changed it to ‘anidra ki wajah se aapke dainik jeevan menin aane wali pareshaniyaan’, that is, ‘impairments that the sufferer is facing in daily activities because of insomnia’.
The sixth question enquired how worried/distressed the subject was about his current sleep problems. This was translated as ‘aap apne nidra ke paresaniyo se kitna chintit hai’, ‘kitna’ meaning the ‘magnitude’ and ‘chintit’ meaning ‘worried/distressed’. The responses in the original questionnaire were graded as ‘not at all worried’, ‘a little’, ‘somewhat’, ‘much’, and ‘very much worried’, the equivalent of which in Hindi were ‘bilkul chintit nahi’, ‘bahut kam’, ‘kuch had tak’, ‘adhik’, and ‘bahut adhik chintit’.
The seventh question enquired how adversely the subject's daily functioning (e.g., daytime fatigue, mood, ability to function at work/daily chores, concentration, memory, and mood) has been interfered with by his current sleep problems. The responses were graded as ‘not at all interfering’, ‘a little’, ‘somewhat’, ‘much’, and ‘very much’.
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