Introduction
Assistive technology (AT) encompasses various products, systems, and supports that individuals use to enhance their functioning and independence, ultimately improving their overall wellbeing. These devices can vary from simple to complex, such as wheelchairs, hearing aids, white canes, pill organizers, walkers, robots, rehabilitation tools, cognitive rehabilitation software, and text-to-speech software. As the global population continues to age and the prevalence of non-communicable diseases and disabilities rises, the demand for ATs is increasing, especially among individuals with disabilities, older people and those with chronic illnesses. Access to appropriate AT is crucial as it enables individuals to achieve independence, take charge of their care, and reduce the strain on healthcare services. Unfortunately, it is estimated that only 10% of the global population has access to the AT they require. Addressing this significant gap in access to AT is essential for attaining universal health coverage, meeting responsibilities outlined in the UN convention on the rights of persons with disabilities (UNCRPD), and ensuring inclusivity in reaching sustainable development goals [1-7].
In 2014, World Health Organization (WHO) started the global cooperation on assistive technology (GATE) initiative to enhance worldwide access to high-quality and affordable AT [8]. To assess access to AT, the GATE team created the rapid assistive technology assessment tool (rATA) survey tool for countries to identify AT needs, barriers to access, and user satisfaction. rATA is a survey tool based on population, with seven parts covering demographics, needs, demand and supply, user satisfaction, and optional recommendations. While the global deployment plan offers detailed guidance on implementing the rATA in national surveys, it can also be adapted for specific populations, integrated into other surveys, and administered in various ways [9].
Reports indicate that over 11 million people with disabilities live in Iran. This number is anticipated to rise due to population growth, aging demographics, higher rates of chronic illnesses, natural disasters, and traffic accidents [10]. However, the health challenges experienced by people with disability in Iran are not receiving adequate attention from policymakers due to factors such as limited influence, lack of a unified voice, and being in the minority [11]. Despite the potential of AT to empower individuals with disabilities and improve access to their fundamental human rights, there is limited data on this issue. To accurately assess the need for AT among different countries, gathering more comprehensive data at the national level is crucial. A national deployment plan has been created to address this data gap based on the “WHO’s global deployment plan for measuring access to AT.” This study aims to report the steps taken to translate and assess the face validity of the rATA for use in Iran. 

Materials and Methods
After receiving authorization from WHO, English to Persian translation of the rATA tool was done accurately by two independent Farsi native-speaking translators. Both translators were fluent in English, too. Since the translators should be familiar with the terminology used in rehabilitation and AT, one translator was an orthosis and prosthesis assistant professor and had prior experience translating quantitative survey tools. The other translator was an associate professor in occupational therapy with experience in translation. Both translators knew AT-related concerns. The translators used known local translations of technical terms during the entire translation process. The product list was also carefully translated, and common Farsi product names were used. Discrepancies between the two translators were discussed and controversial issues were resolved among the research team members, including the national data coordinator, an epidemiologist, and a member of the Rehabilitation Affairs office, to achieve reconciliation. Careful consideration was staged to avoid potentially pejorative or harmful words during the whole process of translation. There was generally a reasonable consensus for most items. The team discussed words and phrases that could be interpreted in multiple ways, and the most appropriate meanings were selected. The research team decided to keep the English name of a few items from the product list that are not currently used in the country.
To get a sense of how effective the translation was and to ensure the accuracy of the translation, a back-translation of the reconciled version of the questionnaire was carried out (translated back from the Farsi language into the English language). Two independent translators (an occupational therapist and a general physician) who were not involved in step A carried out the back translation. Both translators were native Farsi speakers fluent in the English language. The back translators had access to the reconciled version of the two forward translations only, and they were not given access to the two forward translations nor to the original English items.
An expert committee was formed to approve the final Farsi version of the translation. The committee members included experts familiar with the construct of interest (a physiotherapist, a nurse, an occupational therapist, a health policy expert, two mental health specialists, an orthosis and prosthesis expert), translators and the research team. The expert committee reviewed both versions of the translations to ensure that words accurately reflect their intended meaning in Farsi, maintaining the meaning and intent of the items in the original questionnaire. The other issue discussed among this group concentrated on clarifying the Farsi translation of the rATA questionnaire and determining whether the translated and original versions achieve semantic, idiomatic, experiential, and conceptual equivalence. Members of the expert committee reached a consensus on all items. Because of the different sampling processes in Iran, the expert committee added an item to preliminary information/administrative survey data regarding location (Table 1). In addition, since there are several crucial AT providers in the public sector in Iran, the expert committee decided to add their names to the questionnaire (Social Welfare Organization, Red Crescent Organization, and Imam Khomeini Relief Foundation). The remaining discrepancies were resolved, and a pre-final version of the translated questionnaire was prepared. WHO country office, as the professional support, was requested to review the report on the translation process of the rATA questionnaire.

Results 
The Persian version of the tool, similar to the English version, has 7 sections. The first section is preliminary information/administrative survey data, which includes 11 questions about information related to the Interviewer’s ID, location, date, and time of the questioning. The second section is related to demographic information and includes 2 questions to determine the age and gender of the interviewee. The third part concerns needs and questions about challenges a person might encounter when doing specific activities due to a health condition. The fourth part asks about the AT supply and demand (AT use, source, payer, distance to facility, unmet need, and barriers to access). The fifth section has 6 questions and measures the users’ satisfaction with AT. The final sections also include 3 questions for recommendations and 3 about the surveyor’s comments and post-survey administration. The changes that were made as a result of the translation and face validity stage in the Persian version are shown in Table 1.

Discussion
AT is an ignored area that governments have not prioritized in low- and middle-income countries. Collecting data in this sector and knowing the size and scope of the AT market is essential to attract investment and without valid data, prioritization, assessment, and comparison of access to AT will be challenging [12, 13].
Currently, several methods to collect AT-related data can be classified into two general categories: Collecting primary data and using secondary data sources. The primary data collection methods are cross-sectional, key informant, and longitudinal studies. Although these methods can provide accurate data about the need and access to AT, they are time-consuming and require a lot of resources. 
Using secondary data sources (analysis of preexisting datasets such as censuses and national health surveys) is another method to collect AT-related data, which, despite being quick and lower cost, has limitations such as extrapolating findings across populations.
rATA was developed to collect primary data related to AT and has been translated into 28 languages, including Chinese, French, Russian, Arabic, Spanish and Portuguese [9]. To gather data on participants’ functioning, rATA uses an adapted version of WGSS.
WGSS is a well-known survey that includes six questions about individuals’ difficulties in daily activities such as seeing, hearing, mobility, communication, memory and self-care. One of the key strengths of the WGSS is its alignment with the biopsychosocial model of disability, which emphasizes functional limitations over physical structure or health conditions [14]. This approach makes the WGSS ideal for comparing disability data across different countries. It is increasingly seen as the preferred method for censuses to estimate the population of individuals with functional difficulties who may require AT [15].
Assessing supply and demand for AT in mobility, vision, hearing, cognition, communication, and self-care is a crucial aspect of rATA. This part involves identifying the usage of AT, the sources and funding for assistive devices, the distance traveled to obtain them, unmet needs, and barriers to access. This section offers a comprehensive overview of the AT landscape in various countries [16]. Another critical rATA component is evaluating user satisfaction with assistive devices and services for assessment, maintenance, and follow-ups. It is essential to address this issue as simply providing devices does not ensure their practical use, and many users abandon them due to dissatisfaction with design and functionality [17].
Despite providing valuable and comparable data on the AT population, the rATA may result in underestimation and overestimation of need. Underestimation could be due to a lack of awareness about AT or low expectations of its benefits. At the same time, overestimation may result from poor understanding of the underlying causes of impairment or functional limitations [18-19]. Due to time constraints in conducting the rATA survey in Iran, it was impossible to assess the content validity and reliability of the Persian version of the rATA. Therefore, it is recommended that its content validity and reliability be evaluated before using it in similar studies.

Conclusion
Ensuring access to AT is not just a human right but also has significant socioeconomic advantages and can contribute to achieving universal health coverage and preventing marginalization. The government and other stakeholders must prioritize access to AT as critical to meeting sustainable development goals. The Persian version of rATA appears to be a reliable tool for gathering population-level data on AT. Utilizing rATA can offer a thorough assessment of the present condition of AT and assist decision-makers, policymakers, and stakeholders in enhancing equitable access to AT.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Tehran University of Medical Sciences, Tehran, Iran (Code: IR.TUMS.SPH.REC.1399.292).

Funding
This article was extracted from the PhD dissertation of Hossein Gerivani, approved by Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Authors' contributions
Conceptualization and methodology: Amirhossein Takian, Mohammad Taghi Joghataei and Marzieh Shirazikhah; Research and analysis: Hossein Gerivani, Haniye Sadat Sajadi, and Marzieh Shirazikhah; Writing the initial draft and sourcing: Hossein Gerivani and Haniye Sadat Sajadi; Review and editting: Hossein Gerivani, Amirhossein Takian and Haniye Sadat Sajadi; Supervision: Amirhossein Takian, Mohammad Taghi Joghataei and Marzieh Shirazikhah.

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors appreciate and thank Azam Raoofi.


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