Herdman M, Fox-Rushby J, Badia X
Catalan Institute of Public Health, Universitat de Barcelona, Spain.
Qual Life Res. 1998 May;7(4):323-35. doi: 10.1023/a:1024985930536.
The health-related quality of life (HRQoL) literature presents a confused picture of what 'equivalence' in the cross-cultural use of HRQoL questionnaires means and how it can be assessed. Much of this confusion can be attributed to the 'absolutist' approach to the cross-cultural adaptation of HRQoL questionnaires. The purpose of this paper is to provide a model of equivalence from a universalist perspective and to link this to the translation and adaptation of HRQoL questionnaires. The model evolved from reviews of the HRQoL and other literatures, interviews and discussions with researchers working in HRQoL and related areas and practical experience in the adaptation and development of HRQoL instruments. The model incorporates six key types of equivalence. For each type of equivalence the paper provides a definition, proposes various strategies for examining whether and how types of equivalence can be achieved, illustrates the relationships between them and suggests the order in which they should be tested. The principal conclusions are: (1) that a universalist approach to the cross-cultural adaptation of HRQoL instruments requires that six types of equivalence be taken into account; (2) that these are sufficient to describe and explain the nature of the cross-cultural adaptation process; (3) that this approach requires careful qualitative research in target cultures, particularly in the assessment of conceptual equivalence; and (4) that this qualitative work will provide information which will be fundamental in deciding whether to adapt an existing instrument and which instrument to adapt. It should also result in a more sensitive adaptation of existing instruments and provide valuable information for interpreting the results obtained using HRQoL instruments in the target culture.
与健康相关的生活质量（HRQoL）文献对于HRQoL问卷在跨文化使用中的“等效性”意味着什么以及如何进行评估呈现出一幅混乱的图景。这种混乱很大程度上可归因于对HRQoL问卷进行跨文化改编时采用的“绝对主义”方法。本文的目的是从普遍主义视角提供一个等效性模型，并将其与HRQoL问卷的翻译和改编联系起来。该模型源于对HRQoL及其他文献的综述、与从事HRQoL及相关领域研究的人员进行的访谈和讨论，以及在HRQoL工具改编和开发方面的实践经验。该模型包含六种关键类型的等效性。对于每种等效性类型，本文给出了定义，提出了各种用于检验是否以及如何实现等效性类型的策略，阐述了它们之间的关系，并建议了检验它们的顺序。主要结论如下：（1）对HRQoL工具进行跨文化改编的普遍主义方法要求考虑六种等效性类型；（2）这些类型足以描述和解释跨文化改编过程的本质；（3）这种方法需要在目标文化中进行细致的定性研究，尤其是在概念等效性评估方面；（4）这种定性工作将提供信息，这些信息对于决定是否改编现有工具以及改编哪种工具至关重要。它还应能使对现有工具进行更灵活的改编，并为解释在目标文化中使用HRQoL工具所获得的结果提供有价值的信息。
