A systematic approach to cross-cultural adaptation of survey tools

  • Filipa A. Costa
  • Catherine Duggan
  • Ian Bates
Keywords: Cross-cultural adaptation, Information, Perception, Anxiety


Background: Involving patients in health care is increasingly acknowledged as the best way to empower patients to manage their illness. Whilst the involvement of patients is laudable and widely recognised, how much they want to be involved needs to be ascertained. Research has shown that inappropriate provision of information to patients can increase their anxieties towards illness and alter perceptions of medicines’ usefulness, consequently impacting on medicines’ taking behaviour. Tools have been validated in the UK to identify information desires, perceived usefulness of medicines and anxiety felt about illness. There is a need to adapt validated tools for use in other settings and countries. This paper is the first of a series describing the processes involved in the adaptation and validation of these.

Aim: to review and adapt the processes established to translate and back translate scales and tools in practice.

Methods: The survey tool was translated and back-translated according to published guidelines, subsequently tested in a sample of medical patients and further refined by seeking health care professionals’ perceptions and input from lay people.

Results: Data demonstrates the importance of including various perspectives in this process, through which sequential modifications were made to the original scales.  Issues relating to religious beliefs, educational and health literacy differences between countries highlight the relevance of taking cultural values into account. Some led to significant modifications, discussed in this first paper, and tested for validity and reliability in a second paper.


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1. Tully MP, Hassell K, Noyce PR. Advice-giving in community pharmacies in the UK. J Health Serv Res Policy 1997; 2(1):38-50.

2. Stevenson FA, Cox K, Britten N, Dunbar Y. A systematic review of the research on communication between patients and health care professionals about medicines: the consequences for concordance. Health Expect 2004; 7(3): 235-245.

3. Koo M, Krass I, Aslani P. Consumers opinions on medicines information and factors affecting its use - an Australian experience. Int J Pharm Pract 2002; 10: 107-114.

4. Duggan C, Bates I. Development and evaluation of a survey tool to explore patients' perceptions of their prescribed drugs and need for drug information. Int J Pharm Pract 2000; 8(1): 42-52.

5. Duggan C, Bates I, Sturman S, Andersson E, Astrom K, Carlsson J. Validation of a 'desire for information' scale. Int J Pharm Pract 2000; 10(1): 31-37.

6) Weinman J. Patients and doctors. An outline of psychology as applied to medicine. Butterworth-Heineman Ltd Oxford: 1987 (158-179). ISBN 0750620579.

7. PCNE. Pharmaceutical Care Network Europe. Available at www.pcne.org (accessed 11/12/2004).

8. Brislin RW. The wording and translation of research instruments. In Lonner, W.L. & Berry, J.W. Field Methods in Cross-Cultural Research. Sage Publications, Newbury Park: 1986 (137-164). ISBN 0803925492.

9. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidem 1993; 46 (12): 1417-1432.

10. MAPI Research Institute. 2005, "Linguistic Validation Process". available at www.mapi-research.fr (accessed 20/04/2004)

11. Brislin RW. Back-translation for cross-cultural research. J Cross-Cult Psych 1970; 3: 185-216.

12. Jones PS, Lee JW, Phillips LR, Zhang XE, Jaceldo KB. An adaptation of Brislin's translation model for cross-cultural research. Nurs Res 2001;50 (5): 300-304.

13. Small R, Yelland J, Lumley J, Rice PL, Cotronei V, Warren R. Cross-cultural research: trying to do it better. 2. Enhancing data quality. Austr N Zealand J Public Health 1999; 23 (4): 390-395.

14. Hilton A, Skrutkowski M. Translating instruments into other languages: development and testing processes. Cancer Nurs 2002; 25 (1): 1-7.

15. Bullinger M, Alonso J, Apolone G, Leplege A, Sullivan M, Wood-Dauphinee S, Gandek B, Wagner A, Aaronson N, Bech P, Fukuhara S, Kaasa S, Ware JE Jr. Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidem1998; 51 (11): 913-923.

16. Sperber AD. Translation and Validation of Study Instruments for Cross-Cultural Research. Gastroent 2004; 126(1): S124-S128.

17. Abraido-Lanza AF, Vasquez E, Echeverria SE. En las manos de Dios [in God's hands]: Religious and other forms of coping among Latinos with arthritis. J Consult Clin Psychol 2004;72(1):91-102.

18. Grimaldi A. L'acceptation de la maladie diabetique. Ann Endocr (Paris) 2003; 64 (3 Suppl): S22-S26.

19. Baker LM. A new method for studying patient information needs and information-seeking patterns, Top Health Info Man 1995; 16 (2): 19-28.
How to Cite
Costa FA, Duggan C, Bates I. A systematic approach to cross-cultural adaptation of survey tools. Pharm Pract (Granada) [Internet]. 2007Sep.10 [cited 2021Sep.18];5(3):115-24. Available from: https://www.pharmacypractice.org/journal/index.php/pp/article/view/246
Original Research