[Cross-cultural adaptation difficulties in health quality of life scales for developing countries: example of St-George respiratory questionnaire validation in Morocco].

BACKGROUND: In developing countries, quality of life (QoL) is becoming an increasingly relevant question. The use, in these countries, of the validated English scales could resolve an important problem of a lack of QoL tools noted in southern countries. However, this approach raises methodological problems of cross-cultural adaptation. This paper underlines the principal difficulties related to cross-cultural adaptation of QoL measurement scales based on the example of St-George Respiratory Questionnaire (SGRQ) translation from English to the Moroccan Arabic language.

METHODS: The SGRQ, initially designed in English, was translated into dialectical Arabic by four translators following the recommended stages of translation and cultural adaptation: translation with conceptual and linguistic evaluation, back translation, comparison of the source and target versions and verification of the new instrument.

RESULTS: During this cross-cultural adaptation process, some items were modified to adapt the original questionnaire to the Moroccan culture. Because of the great diversity of the Moroccan dialectal language, some words were, sometimes, translated into two or more equivalents which were put in the brackets in the final version of the SGRQ(m). Some questions were not applicable to all the Moroccan population such as a question about sports that did not concern women. On the other hand, some questions involving the same items posed differently in different dimensions, gave rise to confusion or the impression of repetition in the Moroccan Arabic version.

CONCLUSION: The cross-cultural adaptation process, even if carried out in a rigorous way, does not always lead to the best target version and suggests it would be useful to develop new scales specific to each culture and at the same time, to think about the Trans cultural adaptation.