Translation, linguistic validation, and cultural adaptation of the COST-FACIT-V2 to measure financial toxicity in Odia-speaking populations in India

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, to be used for assessing financial toxicity in Odia, one of India’s most commonly spoken regional languages. Methods We followed the tool-developer guidelines for translating, validating and culturally adapting the COST-FACIT-V2 tool for use in an Odia-speaking population in India. This entailed a forward translation and back translation, facilitated by artificial intelligence (AI), confirmed by human review, and pilot testing with four native Odia speaking breast cancer patients and six native Odia speaking healthcare workers at a comprehensive cancer center in Odisha, India. Results The AI forward and back translations demonstrated accuracy with human review. Minor changes were needed to enhance contextual accuracy and consistency. The key concept “paid work at home” was 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 accuracy 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 a potentially complementary tool for supporting translation of standardized instruments used in health systems research.