Culturally Congruent And Linguistically Correct Translations Of Proms As A Basis For Communication In Healthcare

Lise-Merete ALPERS (1) , Ingrid Hanssen (2)
(1) VID Specialized University, Postboks 184, 0319 Oslo, Norway , Norway
(2) Lovisenberg Diaconal University College, Lovisenberggata 15 B, 0456 Oslo, Norway , Norway


Patient-reported outcome measures (PROMs) are questionnaires used in clinical settings to provide information of a patient’s health status. In encounters with ethnic minority patients, translations of these are needed. However, producing linguistically correct and culturally congruent translations of PROMs is complicated. The aim of the study was to investigate the challenges of translating PROMs according to standard translatory rules. The methods were literature research, forward-and-back translations, discussions with those doing the translations, and in-depth interviews with other translators. Thematic analysis. The findings showed that forward-and-back translation was not found to result in meaningful translations for patients. One key issue was poor/incorrect translations; this often occurred due to translators being unfamiliar with biomedical terminology, the exact concepts do not exist as such in the target language, the professional terms are not used in every day/oral language, and/or the patient's level of education made understanding the PROMs difficult. Successful medical treatment depends on PROMs being understood and correctly filled in. Poor/incorrect translations may cause important background information to be missed, which can potentially result in insufficient treatment or even misdiagnosis.

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ACSQHS. (2022). Patient-reported outcome measures: Australian Commission on Safety and Quality in Health Care. Retrieved from, 23.09.2022

Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2021). The patient’s culture and effective communication. Retrieved from, 22.09.2022

Bird, C. M. (2005). How I stopped dreading and learned to love transcription. Qualitative Inquiry, 11(2), 226-248. DOI:

Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology(2), 77-101. doi: DOI:

Braun, V., & Clarke, V. (2013). Successful qualitative research: a practical guide for beginners. Thousand Oaks: Sage Publications.

Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic Analysis. In P. Liamputtong (Ed.), Handbook of Research Methods in Health Social Sciences (pp. 843-860). Singapore: Springer. DOI:

Brislin, R. W., Lonner, W. J., & Thorndike, R. M. (1973). Cross-Cultural Research Method. NY, USA: Wiley.

Brooks, R. (1996). EuroQol: the current state of play. Health Policy, 37(1), 53-72. doi: DOI:

CCHI. (2021). Certification commission for healthcare interpreters: National, accredited, inclusive Retrieved from, 14.06.2022

Cha, E.-S., Kim, K. H., & Erlen, J. A. (2007). Translation of scales in cross-cultural research: issues and techniques. J Adv Nurs, 58(4), 386-395. doi:10.1111/j.1365-2648.2007.04242.x DOI:

Chang, C. D. (2019). Social Determinants of Health and Health Disparities Among Immigrants and their Children. Current Problems in Pediatric and Adolescent Health Care, 49(1), 23-30. doi: DOI:

Colina, S., Marrone, N., & Ingram, M. (2017). Translation Quality Assessment in Health Research: A Functionalist Alternative to Back-Translation. Evaluation & the Health Professions, 40(3), 267-293. doi:10.1177/0163278716648191 DOI:

Djuve, A. B., Sandbæk, M. L., & Lunde, H. C. (2011). Likeverdige tjenester? Storbyens tjenestetilbud til en etnisk mangfoldig befolkning [Equal healthcare services? The city's service to an ethnically diverse population. Norwegian]. Fafo-report. Retrieved from, 22.09.2022

EuroQol Research Foundation. (2020). EQ-5D-5L. Self-complete version on paper. Retrieved from, 22.09.2022

Flores, G. (2005). The impact of medical interpreter services on the quality of health care: a systematic review. Medical Care Research and Review, 62(3), 255-299. doi:10.1177/1077558705275416 DOI:

Hanssen, I., & Alpers, L.-M. (2010). Interpreters in Intercultural Health Care Settings: Health professionals’ and professional interpreters’ cultural knowledge, and their reciprocal perception and collaboration. Journal of Intercultural Communication, 23.

IASP. (2020). IASP Announces Revised Definition of Pain. Retrieved from, 22.09.2022

Juckett, G., & Unger, K. (2014). Appropriate Use of Medical Interpreters. American Family Physician, 90(7), 476-780.

Khalaila, R. (2013). Translation of Questionnaires into Arabic in cross-cultural research: Techniques and equivalence issues. Journal of Transcultural Nursing, 24(4), 363-360. doi:10.1177/1043659613493440 DOI:

Maneesriwongul, W., & Dixon, J. K. (2004). Instrument translation process: a methods review. J Adv Nurs, 48(2), 175-186. doi:10.1111/j.1365-2648.2004.03185.x DOI:

NIPH. (2018). Helse i innvandrerbefolkningen [Health in the immigrant population]. Retrieved from, 25.09.2022

Phongphanngam, S., & Lach, H. (2019). Cross-cultural Instrument Translation and Adaptation: Challenges and Strategies. Pacific Rim Int Nurs Res, 23(2), 170-179.

Polit, D. F., & Beck, C. T. (2021). Nursing Research. Generating and Assessing Evidence for Nursing Practice (11 ed.). Philadelphia: Wolters Kluwer.

Sperber, A. D. (2004). Translation and validation of study instruments for cross-cultural research. Gastroenterology, 126(1 Suppl 1), S124-128. doi:10.1053/j.gastro.2003.10.016 DOI:

Statistic Norway. (2020). Befolkningens utdanningsnivå [The educational level of the population. Norwegian]. Retrieved from, 22.09.2022

Statistic Norway. (2022a). Immigrants and Norwegian-born to immigrant parents. Retrieved from, 22.09.2022

Statistic Norway. (2022b). Population. Retrieved from, 24.09.2022

Terry, G., Hayfield, N., Clarke, V., & Braun, C. (2017). Thematic analysis. In C. Willig & W. Stainton-Rogers (Eds.), The SAGE handbook of qualitative research in psychology (2 ed., pp. 17-37). London: Sage Publications. DOI:

The Municipality of Oslo. (2021). Befolkningens landbakgrunn [The inhabitants’ countries of origin]. Retrieved from, 23.09.2022

Wahl, A. K., Rustoen, T., Rokne, B., Lerdal, A., Knudsen, O., Miaskowski, C., & Moum, T. (2009). The complexity of the relationship between chronic pain and quality of life: a study of the general Norwegian population. Qual Life Res, 18(8), 971-980. doi:10.1007/s11136-009-9515-x DOI:

WHO. (2021). Process of translation and adaptation of instruments. Retrieved from, 21.09.2022

Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., & Erikson, P. (2005). Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health, 8(2), 94-104. doi:10.1111/j.1524-4733.2005.04054.x DOI:

Zidan, A., Awaisu, A., Hasan, S., & Kheir, N. (2016). The Living with Medicines Questionnaire: Translation and Cultural Adaptation into the Arabic Context. Value in Health Regional Issues, 10, 36-40. doi:10.1016/j.vhri.2016.07.001 DOI:


Lise-Merete ALPERS (Primary Contact)
Ingrid Hanssen
ALPERS, L.-M., & Hanssen, I. (2022). Culturally Congruent And Linguistically Correct Translations Of Proms As A Basis For Communication In Healthcare. Journal of Intercultural Communication, 22(4), 14–21.

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