Translating patient reported outcome measures: Methodological issues explored using cognitive interviewing with three rheumatoid arthritis measures in 6 European languages

摘要

Objectives: Cross-cultural translation of patient-reported outcome measures (PROMs) is a lengthy process, often performed professionally. Cognitive interviewing assesses patient comprehension of PROMs. The objectives were to evaluate the usefulness of cognitive interviewing to assess translations, and compare professional (full) to non-professional (simplified) translations processes.udMethods: A ‘full’ protocol used for the Bristol RA Fatigue Multi-dimensional Questionnaire and Numerical Rating Scale (BRAF-MDQ, BRAF-NRS) was compared with a ‘simplified’ protocol used for the RA Impact of Disease scale (RAID). RA patients in UK, France, the Netherlands, Germany, Spain and Sweden completed the PROMS during cognitive interviewing (BRAFs in UK omitted as performed during development). Transcripts were deductively analysed for understanding, information retrieval, judgement, and response options. Usefulness of cognitive interviewing was assessed by the nature of problems identified, and translation processes by percentage of ‘consistently problematic items’ (>40% patients/country with similar concerns). udResults: 60 patients participated (72% women). For the BRAFs (full protocol) one problematic item was identified (of 23 items x 5 languages, 1/115=0.9%). For the RAID (simplified protocol) two problematic items were identified (of 7 items x 6 languages, 2/42=4.8%), of which one was revised (Dutch). Coping questions were problematic in both PROMs.udConclusions: Conceptual and cultural challenges though rare, were important, as identified by formal evaluation, demonstrating that cognitive interviewing is crucial in PROM translations. Proportionately fewer problematic items were found for the full than the simplified translation procedure, suggesting that whilst both are acceptable, professional PROM translation might be preferable. Coping may be a particularly challenging notion cross-culturally.