Cross-cultural comparisons of the content of SF-36 translations across 10 countries: Results from the IQOLA Project

Anita K. Wagner, Barbara Gandek, Neil K. Aaronson, Catherine Acquadro, Jordi Alonso, Giovanni Apolone, Monika Bullinger, Jakob Bjorner, Shunichi Fukuhara, Stein Kaasa, Alain Leplège, Marianne Sullivan, Sharon Wood-Dauphinee, John E. Ware

Research output: Contribution to journalArticlepeer-review


Increasingly, translated and culturally adapted health-related quality of life measures are being used in cross-cultural research. To assess comparability of results, researchers need to know the comparability of the content of the questionnaires used in different countries. Based on an item- by-item discussion among International Quality of Life Assessment (IQOLA) investigators of the content of the translated versions of the SF-36 in 10 countries, we discuss the difficulties that arose in translating the SF-36. We also review the solutions identified by IQOLA investigators to translate items and response choices so that they are appropriate within each country as well as comparable across countries. We relate problems and solutions to ratings of difficulty and conceptual equivalence for each item. The most difficult items to translate were physical functioning items that refer to activities not common outside the United States and items that use colloquial expressions in the source version. Identifying the origin of the source items, their meaning to American English-speaking respondents and American English synonyms, in response to country-specific translation issues, greatly helped the translation process. This comparison of the content of translated SF-36 items suggests that the translations are culturally appropriate and comparable in their content.

Original languageEnglish
Pages (from-to)925-932
Number of pages8
JournalJournal of Clinical Epidemiology
Issue number11
Publication statusPublished - Nov 1998


  • Cross-cultural comparisons
  • Health status
  • Health-related quality of life
  • SF-36 Health Survey
  • Translations

ASJC Scopus subject areas

  • Medicine(all)
  • Public Health, Environmental and Occupational Health
  • Epidemiology


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