Sweni S1, Prakash V1, Hariohm K2
1CHARUSAT, Ashok & Rita Patel Institute of Physiotherapy, Changa, India, 2The Centre for Evidence Based Neuro-Rehabilitation (CEBNR), Chennai, India
Background: Cross cultural adaptation (CCA) is viewed as a simple and easy solution to address the problem of non-availability of relevant and valid patient reported outcome measures (PROM) within target culture. The majority of PROMs which are typically in English had originated from the USA and the UK for use within their health and socio-cultural contexts. Researchers from non-English speaking regions of the world such as Europe, South America, Asia, Africa when faced with a predicament of unavailability of PROM developed within their cultural context, prefer to adapt an existing instrument rather than develop a new instrument. The decision on need for adaptation should take into consideration how much can be gained from the cultural adaptation and how much will be lost in terms of generalization and comparability. Yet, there are no clear guidelines available for researchers delineating the circumstances when it is appropriate to adapt an existing outcome measure or develop a new culture specific outcome measure applicable to local population.
Purpose: The aims of this review are to critically review the contemporary cross cultural adaptation methods and guidelines and recommend guidelines for researchers to assist in making decision on whether to adapt an existing measure or to develop a new tool.
Methods: A systematic search using Medline database was conducted to identify all studies describing cultural equivalence, methods and guidelines of cross cultural adaptation was conducted. We identified potentially relevant articles on concept and theoretical framework and methodological approaches to cultural equivalence.
Results: Majority of available guidelines on CCA methodological approaches are based on the absolutist perspective which emphasize designing translations and adaptations of existing instruments to replicate the originals as closely as possible that capture the content of the original, with all its nuances of meaning. These methodologies are predominantly expert-based; not scrutinized for its adequacy in controlling for biases such as construct bias and item bias that are prevalent in cross-cultural research; do not insist on an initial investigation of the relevance of the concepts measured by a questionnaire to the target culture. Based on results of review, we recommended a decision guide for researchers contemplating adapting an existing measure developed elsewhere for use into their context.
Conclusion(s): To produce a culturally equivalent version of the original instrument in the target culture comprehensive understanding of conceptual and theoretical framework underlying the measurement construct and in-depth knowledge of intricacies of cross-cultural differences between source and target culture is critical, but are often overlooked in the process of translation and cultural adaptation of patient reported outcome measures.
Implications: Cultural adaptation of patient reported outcome measures often creates more problems than it solves. When prospects of cross cultural adaptation producing a culturally valid and appropriate measure is significantly limited, development and validation of new instrument within the context of target culture should be considered necessary and unavoidable.
Keywords: Patient reported outcome measures, Cross cultural adaptation, Conceptual equivalence
Funding acknowledgements: N/A
Purpose: The aims of this review are to critically review the contemporary cross cultural adaptation methods and guidelines and recommend guidelines for researchers to assist in making decision on whether to adapt an existing measure or to develop a new tool.
Methods: A systematic search using Medline database was conducted to identify all studies describing cultural equivalence, methods and guidelines of cross cultural adaptation was conducted. We identified potentially relevant articles on concept and theoretical framework and methodological approaches to cultural equivalence.
Results: Majority of available guidelines on CCA methodological approaches are based on the absolutist perspective which emphasize designing translations and adaptations of existing instruments to replicate the originals as closely as possible that capture the content of the original, with all its nuances of meaning. These methodologies are predominantly expert-based; not scrutinized for its adequacy in controlling for biases such as construct bias and item bias that are prevalent in cross-cultural research; do not insist on an initial investigation of the relevance of the concepts measured by a questionnaire to the target culture. Based on results of review, we recommended a decision guide for researchers contemplating adapting an existing measure developed elsewhere for use into their context.
Conclusion(s): To produce a culturally equivalent version of the original instrument in the target culture comprehensive understanding of conceptual and theoretical framework underlying the measurement construct and in-depth knowledge of intricacies of cross-cultural differences between source and target culture is critical, but are often overlooked in the process of translation and cultural adaptation of patient reported outcome measures.
Implications: Cultural adaptation of patient reported outcome measures often creates more problems than it solves. When prospects of cross cultural adaptation producing a culturally valid and appropriate measure is significantly limited, development and validation of new instrument within the context of target culture should be considered necessary and unavoidable.
Keywords: Patient reported outcome measures, Cross cultural adaptation, Conceptual equivalence
Funding acknowledgements: N/A
Topic: Outcome measurement
Ethics approval required: No
Institution: N/A
Ethics committee: N/A
Reason not required: Narrative review which did not involve human participants.
All authors, affiliations and abstracts have been published as submitted.
