Original Article
The French SF-36 Health Survey: Translation, Cultural Adaptation and Preliminary Psychometric Evaluation

https://doi.org/10.1016/S0895-4356(98)00093-6Get rights and content

Abstract

This article reports on the main developmental stages and on the preliminary psychometric assessment of the final French version of the SF-36. A standard forward/backward translation procedure was followed. When translating survey items, the emphasis was placed on conceptual equivalence. When translating response choices, we attempted to select a set of response choices that replicate the U.S. version. The distance between the response choices was checked using visual analogue scales (N = 30). The adaptation procedure also included formal ratings of the difficulty of the translation, of the quality of the translation, and of the equivalence between the American source version and the French target version. The face validity was checked during lay panel sessions at which the translated questionnaire was administered to subjects from the general public, hospital employees, and subjects with a low level of education. Standard psychometric techniques were used to evaluate the cultural adaptation of the SF-36, using data from a general population survey. The main objective of this analysis was to determine how well the scaling assumptions (summated rating or Likert-type scaling construction) of the SF-36 were satisfied. The results support the claim that the scaling properties of the French version of the SF-36 are adequate and that health outcomes may be reliably assessed using this version of the instrument.

Introduction

In matters of health, the point of view of the patient is gaining importance in decision-making procedures. Thus, decision makers require indicators that will provide information about the way in which patients see their own health. The SF-3 Health Survey was designed to meet this need [1]. The adaptation into French of the SF-36 that is presented here is part of the International Quality of Life Assessment (IQOLA) project. The project aims to develop a validated instrument for measurement reflecting the patient’s point of view and enabling international comparisons of health outcomes. The IQOLA project research team laid out a standardized translation and adaptation procedure that has been followed by the French scientific team. The main objective of IQOLA is to adapt the SF-36 into more than 15 languages for use in international studies of health outcomes [2]. There are two main reasons behind enterprises of this sort: the first is that adaptation provides a very cost-effective access to state-of-the-art quality of life (QoL) measures in the target language or culture; the second is that if the adaptation is successful, such translated instruments can be used in international comparative studies. These benefits are, however, conditioned by a certain number of constraints specific to the cross-cultural procedure that must be respected.

The SF-36 had previously been translated into French by several research teams. The Canadian version [3] could not be used directly in France owing to linguistic differences in Canadian French. The psychometric properties of another pre-IQOLA French (France) version of the SF-36 have been described by Bousquet et al. [4] and Bullinger et al. [5] from results obtained from asthmatic patients and rhinitis patients, respectively. A Swiss French version using a relatively simple translation procedure has been published by Perneger et al. [6].

This article describes the successive stages in the translation and adaptation procedure used to develop the final French version of the SF-36 within the IQOLA project and provides a preliminary analysis of the psychometric properties of this final French version (version 1.3), which has been administered to a sample drawn from a representative panel of the French population. The factorial structure of scores is also examined and compared with the American version.

Section snippets

The SF-36

The SF-36 is a generic health status measurement instrument. It can be used to assess health status independent of which diseases or illnesses affect the population under study. It is made up of 36 questions divided into 8 scales: physical functioning (PF1 to PF10), role limitations relating to physical health (RP1 to RP4), bodily pain (BP1 and BP2), general health perceptions (GH1 to GH5), vitality (VT1 to VT4), social functioning (SF1 and SF2), role limitations relating to mental health (RE1

Translation and Cultural Adaptation of the SF-36 into French

The main translation problems encountered in the course of the development of the French version are described next. Appendix 1, Appendix 2 provide a comparison of the content of the American and French forms.

It was intended that the overall presentation of the questionnaire not include any sort of ambiguity. Thus the translation of your health (introductory sentence) gave rise to some discussion. In French, in the perspective of an instrument measuring perceived health, it was possible to opt

Translation

The most apparent “alterations” to the American version are in fact an integral part of the process of translation into another language and culture. For instance, it is extremely common for a word in English to have an equivalent in French in terms of form (being from the same root) but for the two words to cover different areas of meaning, following divergent evolution from the historical root. These areas of meaning frequently overlap to some extent, which can lead to the wrong assumption

Acknowledgements

We acknowledge the pioneering work of Denis Bucquet, who initially headed the French team of the International Quality of Life Assessment (IQOLA) project. This endeavor would not have been possible without the continuing help and advice of Barbara Gandek and John Ware from the New England Medical Center. We also acknowledge the useful comments of the following individuals: Ann Smet (Glaxo Belgique), Jean Pierre Dreyfus (Sofres Medicale), Patrick Marquis and Catherine Acquadro (Mapi, études

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