Original ArticleTranslation, Adaptation, and Validation of the SF-36 Health Survey for Use in Japan
Introduction
Studies of health status and quality of life in Japan have become increasingly common [1]. Of the health-status measures used in Japan, some were developed domestically and others are translations of instruments originally developed in other countries. Among those translated into Japanese are both disease-specific measures, including Zung’s Self-Rating Depression Scale [2] and the Chronic Respiratory Disease Questionnaire [3], and generic instruments, including the Sickness Impact Profile [4] and the Nottingham Health Profile [5].
The SF-36 Health Survey is a questionnaire used to measure health status in general. In the SF-36, one item is designed to assess perceived change in health status, and each of the remaining 35 items contributes to a score on one of eight scales: physical functioning (PF), role-physical (RP), bodily pain (BP), general health perception (GH), vitality (VT), social functioning (SF), role-emotional (RE), and mental health (MH). Scores on these eight scales can be used to compute a summary index of physical health and a summary index of mental health. This structure is referred to as the SF-36 measurement model [6].
The International Quality of Life Assessment (IQOLA) network was established to translate and adapt the SF-36 for use in languages other than U.S.-English [7]. The founding members of the IQOLA Project represented 14 countries and 16 languages. With one exception, all 16 languages are closely related—Japanese is the only one that did not develop from Indo–European. In addition, Japan is the only one of those 14 counties in which Western culture is not dominant. Against this backdrop of linguistic and cultural differences, we translated the U. S.-English version of the SF-36 into Japanese and adapted it for use in Japan.
Here, we document the translation and cultural adaptation of the SF-36 for use in Japan, and the results of the initial psychometric testing of the Japanese version. We describe the process in chronological order, for two reasons. First, the development of the Japanese version involved two phases, each with its own methods and results (Figure 1); and second, we want to emphasize the importance of the fact that translation, evaluation (both qualitative and quantitative), and revision were done iteratively. Part I of this article describes phase 1, which included most of the translation and adaptation, and the first quantitative test. Some results of that test were unexpected, which made phase 2 necessary. Part II of this article describes phase 2, which included qualitative reevaluation, the resulting revisions, and further quantitative tests.
Section snippets
Part i (phase 1)
Phase 1 comprised forward translation, back-translation, development of version 1.1, and initial psychometric testing.
Part II (phase 2)
Phase 2 comprised qualitative reevaluation of version 1.1, revisions (development of version 1.2), and psychometric testing of the revised version.
Methodological Lessons
Even though the guidelines for translation were carefully designed and structured, compliance with them did not ensure that the translation was adequate, which may reflect the magnitude of linguistic and cultural differences between Japan and the United States. We found the following four tactics to be crucial in minimizing linguistic and cultural difficulties, and in overcoming those that did arise:
- 1.
The translators were asked to provide all reasonable options before the group meeting. This
Acknowledgements
We are grateful to Kirin Brewery Co. Ltd. for assistance in psychometric testing of version 1.2, and to Mark Kosinski, Barbara Gandek, and John Ware for their helpful comments and suggestions on earlier versions of this manuscript.
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