Are the instruments for quality of life assessment comparable between cultures? No
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EDITORIAL
Are the instruments for quality of life assessment comparable between cultures? No Swagata Tripathy1* and Sheila Nainan Myatra2 © 2020 Springer-Verlag GmbH Germany, part of Springer Nature
The concept of quality of life (QOL) goes beyond health. The WHO definition of QOL includes six domains of which four are related to health status and two are personal (environment, personal values/beliefs) [1]. Being objective, the first four are considered easier to assess and quantify. They are often the focus of health-related quality of life (HRQOL) questionnaires. The last two domains are affected by culture and change with age, time and situations, thus raising the question whether QOL assessments are comparable between cultures (Fig. 1) [2]. Most instruments of QOL are developed in the USA or the UK in English and need cross-cultural adaptation (CCA) to various European, Asian or other languages and cultures [3]. CCA of instruments needs to consider myriad attributes of quality of life important to people: income and family relations, appreciation for and utility of life, religious beliefs regarding karma, life after death, etc. The main questions that arise regarding cross-cultural QOL adaption are: Is the concept of QOL identical or equivalent across the cultures in question?; is it measurable across different cultures with the same QOL instrument?; and is the application of these instruments similar across cultures? The concept of equivalence of various domains of QOL across cultures is debated, with Herdman et al. finding 19 different interpretations [4]. The ‘particularists’ consider the implication and interpretation of a disease state intensely culture bound, precluding QOL application outside cultural boundaries. The ‘absolutists’ oppose this—health is the same across humanity, and culture has no effect on HRQOL perception. In between, are the *Correspondence: [email protected] 1 Department of Anesthesia and Intensive Care, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India Full author information is available at the end of the article
universalists who consider QOL domains to be uniform across humanity—careful linguistic translation may allow cross-cultural use of an instrument [5]. In spite of identifying thirty-one guidelines for CCA of questionnaires, Epstein et al. found no consensus in the methods of CCA. The use of focus groups and committees for CCA is common, but there is less evidence for back translation [6]. Studies have shown cross-cultural variations in response to such questionnaires. Cheung et al. [7] found that low ‘jingshen’ (Chinese for energy, but having connotations for spiritual vigour) used in a cancer therapy questionnaire was reported less frequently than low ‘energy’ used in the English version. Theuns et al. [8] found that only 11 of 24 constructs of the WHOQOLBref, an abbreviated version of the original WHO QOL questionnaire, had measurement equivalence when compared among Iranian and Belgian students. Psychological and physical constructs like sa
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