Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines
Abstract
Clinicians and researchers without a suitable health-related quality of life (HRQOL) measure in their own language have two choices: (1) to develop a new measure, or (2) to modify a measure previously validated in another language, known as a cross-cultural adaptation process. We propose a set of standardized guidelines for this process based on previous research in psychology and sociology and on published methodological frameworks. These guidelines include recommendations for obtaining semantic, idiomatic, experiential and conceptual equivalence in translation by using back-translation techniques and committee review, pre-testing techniques and re-examining the weight of scores. We applied these guidelines to 17 cross-cultural adaptation of HRQOL measures identified through a comprehensive literature review. The reporting standards varied across studies but agreement between raters in their ratings of the studies was substantial to almost perfect (weighted kappa = 0.66-0.93) suggesting that the guidelines are easy to apply. Further research is necessary in order to delineate essential versus optional steps in the adaptation process.
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The Portuguese version of the FAMCARE-Patient scale used in the study underwent translation, cultural adaptation, and pre-testing according to Beaton et al.
“The Portuguese version that was used in the study underwent translation, cultural adaptation, and pre-testing according to Beaton et al. [23].”
The DAP-R was translated into German following guidelines for cultural adaptation by Guillemin et al.
“The DAP-R was translated following the proposed guidelines for cultural adaption by Guillemin et al. [26].”
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The translation of the CPAQ into Spanish followed usual guidelines for cross-cultural adaptations.
“We have followed the usual guidelines for cross-cultural adaptations [19].”
From Veaselaircdhation of the Spanish version of the Chronic Pain Acceptance Questionnaire (CPAQ) for the assessment of acceptance in fibromyalgia (2010) · cites this paper as [19]
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- Authors
- Guillemin, F., Bombardier, C., & Beaton, D.
- Affiliations
- University of Toronto (CA)
- Venue
- Journal of Clinical Epidemiology
- Publisher
- Elsevier BV
- Published
- 1993-12
- Volume
- 46
- Issue
- 12
- Pages
- 1417-1432
- ISSN
- 0895-4356 (ISSN-L)
- OpenAlex
- W2150377764
- Cited by
- 6,060
- References
- 66
- Citations by year
- 2026: 208 · 2025: 262 · 2024: 300 · 2023: 307 · 2022: 312 · 2021: 360 · 2020: 379 · 2019: 344 · 2018: 325 · 2017: 306 · 2016: 263 · 2015: 301 · 2014: 305 · 2013: 270 · 2012: 262
- FWCI
- 41.45
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- DigitalGeorgetown (Georgetown University Library) (submittedVersion)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Education › Health Education and Validation
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- cross-cultural adaptation, health-related quality of life, back-translation, semantic equivalence, conceptual equivalence, idiomatic equivalence, adaptation guidelines, psychometric validation, reporting guidelines
- MeSH terms
- Cross-Cultural Comparison, Cultural Characteristics, Health Status Indicators, Humans, Language, Quality of Life, Surveys and Questionnaires, Guidelines as Topic
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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