The challenge of cross-cultural quality of life assessment

As a result of an increased international cooperation in the health care field, the demand for cross-culturally applicable, patient-oriented instruments to assess the need for and to evaluate the outcome of medical interventions has also grown. However, basic problems exist in assessing health-related quality of life - one of the most prominent outcomes - across cultures. Conceptually it is unclear to which extent the quality of life construct is transferable from one cultural context to another. Methodologically, ways to assess the construct have to be sensitive to different cultures and practically, application of quality of life measures may be difficult. The current paper addresses these issues, presenting the current state of the art in cross-cultural development of health-related quality of life assessment instruments as well as a critical review thereof. Examples are provided from internationally active working groups in terms of the translation, psychometric testing and norming of quality of life questionnaires.