CULTURAL ADAPTATION AND LINGUISTIC VALIDATION

All cultural adaptations and linguistic validations of our questionnaires have been done by the MAPI Research Institute, Lyon , France who are world leaders in this specialised work. http://www.mapi-research.com

Adapting quality of life questionnaires and health status questionnaires for another language and culture is a great deal more complicated than doing a simple translation. Although the quality of life problems that are important to asthma patients are fairly consistent across continents and cultures, there are occasionally minor differences that need to be taken into consideration. For instance, although ‘feeling frustrated’ is important to patients in most countries, Portuguese patients say they do not experience this emotion, they accept asthma and its effects on their day-to-day lives as something with which they have to live. Parents in North America feel ‘anger’ that their child has asthma whereas in the rest of the world ‘sadness’ is a more commonly identified emotion. Part of the adaptation process must ensure that the problems that are important to local patients are included in the new language (‘content validity’). It is also important to adapt the Asthma Control Questionnaire to the local culture using the words that patients themselves use to describe their asthma symptoms.

The process of cultural adaptation involves the local team of MAPI translators working closely with the developer (EFJ). Members of the MAPI team are not only medical linguists but also skilled in clinical measurement and scaling. There are usually two forward translations by independent translators whose primary language is the one into which the questionnaire is being translated. There is then a reconciliation of the two forward translations followed by two backward translations, ideally by people whose primary language is English. Probably the most important part of the whole process is the testing in patients (cognitive debriefing). This is done in a clinic with the assistance of a local leading asthma/rhinoconjunctivitis clinician. The purpose of this phase is to ensure that the words chosen by the translators are easily and accurately understood by patients and that all the important problems have been included. It is essential to use the words that patients themselves use to describe their symptoms and limitations, not the terms used by clinicians.

Ideally, every new cultural adaptation should undergo a complete measurement property validation. However, this is expensive and time-consuming. However, there is now good evidence that if the cultural adaptation is done to a high standard, the resulting questionnaire will have measurement properties very similar to those of the original. All the cultural adaptations of the AQLQ, done by MAPI, that have undergone complete validation studies have shown the same measurement properties and evidence of validity as the original instrument. This provides strong evidence that we can have confidence in the validity of all languages of our questionnaires. The MAPI Research Institute can provide certificates of linguistic validity for all languages of all our questionnaires

When a questionnaire is used in a multinational clinical trial, data from the various countries can be used to confirm the consistency of the measurement properties (usually responsiveness and construct validity) across languages. Cronbach’s alpha will provide evidence of the internal consistency of the items across the different languages but such analyses make the assumption that similar patients were enrolled in each country and that they have all responded in a similar manner to the intervention.

References

• Acquadro C, Conway K, Giroudet C, Mear I. Linguistic validation manual for patient-reported outcomes (PRO) instruments. 2004; MAPI Research Institute, Lyon , France .
• Juniper EF, Guyatt GH, Ferrie PJ, Griffith LE. Measuring quality of life in asthma. Am Rev Respir Dis 1993; 147: 832-838.
• Sanjuas C, Alonso J, Sanchis J, Casan P, Broquetas JM, Ferrie PJ, Juniper EF, Anto JM. The quality of life questionnaire with asthma patients; the Spanish version of the Asthma Quality of Life Questionnaire. Archivos de Bronconeumologia 1995; 31: 219-226.
• Rutten-van Molken MPMH, Clusters F, Van Doorslaer EKA, Jansen CCM, Heurman L, Maesen FPV, Smeets JJ, Bommer AM, Raaijmakers JAM. Comparison of performance of four instruments in evaluating the effects of salmeterol on asthma quality of life. Eur Respir J 1995; 8: 888-98.
• Stahl E, Postma DS, Juniper EF, Svensson K, Mear I, Lofdahl C-G. Health-related quality of life in asthma studies. Can we combine data from different countries? Pulmonary Pharmacology and Therapeutics 2003; 16: 53 -59.

ASTHMA QUALITY OF LIFE QUESTIONNAIRES

ASTHMA QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

STANDARDISED ASTHMA QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

MINI ASTHMA QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

ASTHMA QUALITY OF LIFE QUESTIONNAIRE FOR 12 YEARS AND OLDER

Original language : English for North America

ACUTE ASTHMA QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

Canada : French
Thailand

[Top of AQLQ List]

PAEDIATRIC ASTHMA QUALITY OF LIFE QUESTIONNAIRES

PAEDIATRIC ASTHMA QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

STANDARDISED PAEDIATRIC ASTHMA QUALITY OF LIFE QUESTIONNAIRE

Original language : English for UK

MINI PAEDIATRIC ASTHMA QUALITY OF LIFE QUESTIONNAIRE

Original language : English for UK

Belgium : Dutch (Flemish)
USA : English

PAEDIATRIC ASTHMA CAREGIVERS QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

[Top of PAQLQ List]

RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRES

RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

STANDARDISED RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRE  

Original language : English for North America

MINI RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

NOCTURNAL RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

[Top of RQLQ List]

PAEDIATRIC RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRES

ADOLESCENT RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRE

Original language : English for NorthAmerica

Germany
Netherlands : Dutch

[Top of PRQLQ List]

PAEDIATRIC RHINOCONJUNCTIVITIS QUALITY OF LIFE QUESTIONNAIRE

Original language : English for North America

ASTHMA CONTROL QUESTIONNAIRES

ASTHMA CONTROL QUESTIONNAIRE

Original language : English for North America

ASTHMA CONTROL QUESTIONNAIRE

INTERVIEWER-ADMINISTERED FOR CHILDREN 6 – 10 YEARS

Original language : English for UK

ASTHMA CONTROL DIARY

Original language : English for North America