Translation, adaptation and validation of instruments or scales for use in cross‐cultural health care research: A clear and user‐friendly guideline
Abstract
RATIONALE, AIMS AND OBJECTIVES: The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research. METHODS: A review of highly recommended methodological approaches to translation, adaptation and cross-cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven-step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described. CONCLUSIONS: Translation, adaptation and validation of instruments or scales for cross-cultural research is very time-consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.
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The study followed the back-translation procedure recommended for cross-cultural adaptation of research instruments.
“We followed the back-translation procedure recommended for cross-cultural adaptation of research instruments (Sousa & Rojjanasrirat, 2011).”
From Perceived Search Overload, Generative AI Credibility, and Comparative Usefulness: A Channel Complementarity Approach to Health Information Seeking (2025) · cites this paper as Sousa & Rojjanasrirat, 2011
The original EQ was independently translated into French by two research groups following guidelines for translation and cultural adaptation, including forward translation, back-translation, expert review, and harmonization.
“The original instrument was independently translated into French by two research groups in France and a French part of Switzerland. Both groups followed the guidelines for this type of procedure (Sousa & Rojjanasrirat, 2011): Items were translated into French by two bilingual individuals, and an initial version was elaborated after a discussion between the translators. Furthermore, two bilingual”
From Measuring Decentering – Development and Validation of the French Version of the Experiences Questionnaire (EQ-F) (2024) · cites this paper as Sousa & Rojjanasrirat, 2011
The translation and adaptation of the instrument could have benefited from extra methodological aspects in accordance with specialized guidelines.
“the translation and adaptation of the instrument could have benefited from considering extra methodological aspects in accordance with specialized guidelines”
From Psychometric properties of the engaged living scale (ELS) Spanish version in a large sample of Spanish pilgrims (2023) · cites this paper as Sousa & Rojjanasrirat, 2011
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- Authors
- Sousa, V. D., & Rojjanasrirat, W.
- Affiliations
- University of Kansas (US)
- Graceland University (US)
- Corresponding author
- Sousa, Valmi D.
- Venue
- Journal of Evaluation in Clinical Practice
- Publisher
- Wiley
- Published
- 2010-09-28
- Volume
- 17
- Issue
- 2
- Pages
- 268-274
- ISSN
- 1356-1294 (ISSN-L)
- 1365-2753
- OpenAlex
- W1851740361
- Cited by
- 3,322
- References
- 35
- Citations by year
- 2026: 454 · 2025: 503 · 2024: 436 · 2023: 387 · 2022: 416 · 2021: 313 · 2020: 221 · 2019: 167 · 2018: 120 · 2017: 92 · 2016: 86 · 2015: 59 · 2014: 37 · 2013: 13 · 2012: 11
- FWCI
- 43.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Evaluation in Clinical Practice (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Education › Health Education and Validation
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Sociology and Political Science › Cultural Competency in Health Care
- Keywords
- cross-cultural validation, psychometric validation, validation guidelines, reliability and validity, patient-reported outcome measures
- MeSH terms
- Cross-Cultural Comparison, Female, Health Services Research, Humans, Male, Psychometrics, Surveys and Questionnaires, Translating, Guidelines as Topic
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