Cross-cultural comparisons of the content of SF-36 translations across 10 countries: results from the IQOLA Project. International Quality of Life Assessment

UMMS Affiliation

Department of Quantitative Health Sciences

Publication Date


Document Type



*Cross-Cultural Comparison; Developed Countries; *Health Status Indicators; Humans; *Quality of Life; Questionnaires; Reproducibility of Results; *Translating; Translations


Biostatistics | Epidemiology | Health Services Research


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.

DOI of Published Version



J Clin Epidemiol. 1998 Nov;51(11):925-32. Link to article on publisher's site

Journal/Book/Conference Title

Journal of clinical epidemiology

PubMed ID


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Link to Article in PubMed