Translation and cultural adaptation of health questionnaires.

BACKGROUND: Health research in Pakistan often requires questionnaires in English language developed in the West to be translated into the local language. Many of the factors measured by these questionnaires are complex and apply to a different culture. Simple translations may lead to problems of validity and reliability in the Pakistani setting. This paper describes the strategies adopted for the translation and cross-cultural adaptation of the Self-Reporting Questionnaire (SRQ), a screening questionnaire for mental health developed by the World Health Organisation.
METHODS: A general protocol was developed for translation of questionnaires into Urdu, describing each step in the translation procedure. Key informant interviews were carried out to obtain better cultural understanding of difficult concepts. The translation was tested and disputed items discussed in a focus group in a structured manner.
RESULTS: Modifications were made to the questionnaire in light of the target population's culture and language.
CONCLUSION: Simple translations are often insufficient for complex questionnaires. Key informant interviews and focus groups are useful to address conceptual and construct issues in such questionnaires.