The Process and Challenges in the Translation of World Health Organization Quality of Life (WHOQOL- BREF) to a Regional Language; Malayalam

By Aswathy, S.; Cherkil, Sandhya et al. | Indian Journal of Psychological Medicine, April-June 2012 | Go to article overview
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The Process and Challenges in the Translation of World Health Organization Quality of Life (WHOQOL- BREF) to a Regional Language; Malayalam

Aswathy, S., Cherkil, Sandhya, Menon, Bindu, Rajani, G., Unnikrishnan, A., Indian Journal of Psychological Medicine

Byline: S. Aswathy, Sandhya. Cherkil, Bindu. Menon, G. Rajani, A. Unnikrishnan

A lot of research has been directed on wellbeing and disability in many non-communicable disease conditions. In this context, health-related aspects of life and quality of life (QOL) are receiving a lot of focus. Many Quality of Health measures are available, of which World Health Organization Quality of Life (WHOQOL-BREF) is one of the most popular. Translating and adapting this tool is useful in view of research happening in a multicultural arena. Though translations into Hindi and other Indian languages including Tamil and Kannada have been done, a Malayalam version is not available. This paper discusses the steps adopted in this exercise and the challenges in translating WHOQOL-BREF to Malayalam from the original English version.


There has been an increase in the number of multinational and multicultural research projects, and with it the need to adapt health status measures for use in other than the source language has also grown rapidly. [sup][1],[2],[3],[4] Most questionnaires are developed in English speaking countries [sup][5] and hence there is a dearth of culturally validated health measures - both physical and psychological. This hampers meaningful research in many instances, especially for studies that assess health care utilization or QOL. [sup][5],[6]

The term quality of life is used to describe the general well-being of individuals and societies. The term is used in a wide range of contexts, including the fields of international development, healthcare and politics. QOL is defined as individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns [sup][7] The definition focuses on the impact of disease and effect of interventions on the QOL, rather than on the diseases and their associated symptoms. Standard indicators of the QOL include not only wealth and employment, but also the built environment, physical and mental health, education, recreation and leisure time and social belonging. [sup][8]

Investigations into HRQL (Health-related Quality of Life) have led to instruments suitable for detecting minimally important effects in clinical trials, for measuring the health of populations and for providing information for policy decisions. [sup][9] Widely valued aspects of life exist that are not generally considered as "health," including income, freedom, and quality of the environment. Although low or unstable income, the lack of freedom, or a low-quality environment may adversely affect health; these problems are often distant from a health or medical concern. Clinicians focus on HRQL, although when a patient is ill or diseased, almost all aspects of life can become health related. [sup][8]

HRQL serves as an index for the impact of the chronicity of a given health condition. [sup][10] The health condition itself is less distressing for patients as compared with the loss of functional capacity it produces. This in turn drastically reduces the sense of well-being, affects the interpersonal relations resulting in further reduction in well-being, leading into depression and exacerbation of existing health condition. This explains why lot of interest is taken in the QOL of the patient. We (the authors) decided to translate QOL-BREF into a regional Indian Language; Malayalam, because there are very limited instruments available in Malayalam to measure the QOL.

The first and major step in the process of cultural equivalence is the translation, which determines the usefulness, reliability and validity of the instrument in the new cultural context. In order to validate health status measures for cross-cultural use a number of criteria are required [sup][2],[11] namely content equivalence; semantic equivalence; technical equivalence; criterion equivalence and conceptual equivalence.

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The Process and Challenges in the Translation of World Health Organization Quality of Life (WHOQOL- BREF) to a Regional Language; Malayalam


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