A checklist for translating and adapting questionnaires (CTAQ) in healthcare research: insights from a Delphi method approach

Abstract

Abstract Purpose Accurate translation and adaptation of survey questionnaires are essential for ensuring validity and reliability in cross-cultural healthcare research. Despite the global expansion of healthcare studies, standardized guidelines for the translation process are limited. Methods To address this gap, we developed the Checklist for Translating and Adapting Questionnaires (CTAQ). A three-round Delphi survey was conducted to refine and validate the CTAQ. An international panel of experts in survey methodology, cross-cultural research, and healthcare participated in the study, providing iterative feedback to achieve consensus on checklist items. The development of the CTAQ involved: (i) drafting an initial checklist based on a comprehensive literature review and expert insights; (ii) rating the importance and relevance of each item using an 80% consensus threshold; and (iii) revising items through successive Delphi rounds until consensus was reached. Results The finalized CTAQ comprises eight stages: defining the target audience and objectives; forming a translation team; forward and backward translation; comparing versions; reconciliation; pretesting and evaluation; final review and proofreading; and post-survey evaluation. This structured approach, informed by expert consensus, integrates best practices and addresses cultural nuances, thereby enhancing the accuracy and reliability of translated survey instruments. Conclusions The CTAQ offers a systematic, consensus-based framework that enhances the linguistic and cultural accuracy of translated survey instruments in healthcare research. Practice implications Adopting the CTAQ standardizes translation workflows and promotes the production of valid, reliable, and culturally appropriate questionnaires. This contributes to greater rigor and quality in international and cross-cultural healthcare studies.