DEVELOPING AND EVALUATING CROSS-CULTURAL INSTRUMENTS FROM MINIMUM REQUIREMENTS TO OPTIMAL MODELS

In the age of increased international collaboration in medical researc h, the necessity of having at hand cross-culturally applicable instrum ents for the assessment of health-related quality of life (HRQL) in cl inical trials has been voiced. Several important theoretical bases lea ding to cultural bias in HRQL measurement include differences in defin itions of HRQL across national and cultural contexts, levels of observ ation relied upon to indicate HRQL states, and the significance or wei ght placed upon the various HRQL states or dimensions measured. Despit e a growing literature on the development and evaluation of existing H RQL measures in other cultures, comprehensive sets of procedures or re quirements for the international part of development and evaluation ar e lacking. This paper reviews major approaches to developing internati onal HRQL measures, and discusses various methods and criteria that ha ve been recommended for evaluating measurement equivalence in comparis ons of research across national and cultural contexts. A summary of re cent trends and advances in international HRQL assessment is presented .