A systematic survey instrument translation process for multi-country, comparative health workforce studies

Allison Squires, Linda H. Aiken, Koen van den Heede, Walter Sermeus, Luk Bruyneel, Rikard Lindqvist, Lisette Schoonhoven, Ingeborg Stromseng, Reinhard Busse, Tomasz Brzostek, Anneli Ensio, Mayte Moreno-Casbas, Anne Marie Rafferty, Maria Schubert, Dimitris Zikos, Anne Matthews

Research output: Contribution to journalArticlepeer-review


Background: As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. Objectives: To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. Design and settings: We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. Participants: Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. Methods: The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. Results: The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. Conclusions: The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation.

Original languageEnglish (US)
Pages (from-to)264-273
Number of pages10
JournalInternational Journal of Nursing Studies
Issue number2
StatePublished - Feb 2013


  • Content validity indexing
  • Cross-cultural research
  • Europe
  • Health services research
  • Instrument validation
  • Languages
  • Nurses
  • Nursing
  • Translation

ASJC Scopus subject areas

  • General Nursing


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