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Year : 2017  |  Volume : 11  |  Issue : 5  |  Page : 80-89

Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine

1 Department of Epidemiology, Columbia University, New York, NY, USA
2 Department of Surgery, University of Melbourne, Melbourne; Department of Anesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia
3 Department of Anesthesiology, University of Virginia, Charlottesville, VA, USA; Department of Anesthesiology, King Fahad Medical City, Riyadh, Saudi Arabia; Outcomes Research Consortium, Cleveland, OH, USA, USA

Correspondence Address:
Siny Tsang
Department of Epidemiology, Columbia University, New York, NY
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sja.SJA_203_17

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Date of Web Publication25-May-2017


The task of developing a new questionnaire or translating an existing questionnaire into a different language might be overwhelming. The greatest challenge perhaps is to come up with a questionnaire that is psychometrically sound, and is efficient and effective for use in research and clinical settings. This article provides guidelines for the development and translation of questionnaires for application in medical fields, with a special emphasis on perioperative and pain medicine. We provide a framework to guide researchers through the various stages of questionnaire development and translation. To ensure that the questionnaires are psychometrically sound, we present a number of statistical methods to assess the reliability and validity of the questionnaires.

Keywords: Anesthesia; development; questionnaires; translation; validation

How to cite this article:
Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth 2017;11, Suppl S1:80-9

How to cite this URL:
Tsang S, Royse CF, Terkawi AS. Guidelines for developing, translating, and validating a questionnaire in perioperative and pain medicine. Saudi J Anaesth [serial online] 2017 [cited 2021 Nov 30];11, Suppl S1:80-9. Available from:

  Introduction Top

Questionnaires or surveys are widely used in perioperative and pain medicine research to collect quantitative information from both patients and health-care professionals. Data of interest could range from observable information (e.g., presence of lesion, mobility) to patients' subjective feelings of their current status (e.g., the amount of pain they feel, psychological status). Although using an existing questionnaire will save time and resources,[1] a questionnaire that measures the construct of interest may not be readily available, or the published questionnaire is not available in the language required for the targeted respondents. As a result, investigators may need to develop a new questionnaire or translate an existing one into the language of the intended respondents. Prior work has highlighted the wealth of literature available on psychometric principles, methodological concepts, and techniques regarding questionnaire development/translation and validation. To that end, this article is not meant to provide an exhaustive review of all the related statistical concepts and methods. Rather, this article aims to provide straightforward guidelines for the development or translation of questionnaires (or scales) for use in perioperative and pain medicine research for readers who may be unfamiliar with the process of questionnaire development and/or translation. Readers are recommended to consult the cited references to further examine these techniques for application.

This article is divided into two main sections. The first discusses issues that investigators should be aware of in developing or translating a questionnaire. The second section of this paper illustrates procedures to validate the questionnaire after the questionnaire is developed or translated. A model for the questionnaire development and translation process is presented in [Figure 1]. In this special issue of the Saudi journal of Anesthesia we presented multiple studies of development and validation of questionnaires in perioperative and pain medicine, we encourage readers to refer to them for practical experience.
Figure 1: Questionnaire development and translation processes

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  Preliminary Considerations Top

It is crucial to identify the construct that is to be assessed with the questionnaire, as the domain of interest will determine what the questionnaire will measure. The next question is: How will the construct be operationalized? In other words, what types of behavior will be indicative of the domain of interest? Several approaches have been suggested to help with this process,[2] such as content analysis, review of research, critical incidents, direct observations, expert judgment, and instruction.

Once the construct of interest has been determined, it is important to conduct a literature review to identify if a previously validated questionnaire exists. A validated questionnaire refers to a questionnaire/scale that has been developed to be administered among the intended respondents. The validation processes should have been completed using a representative sample, demonstrating adequate reliability and validity. Examples of necessary validation processes can be found in the validation section of this paper. If no existing questionnaires are available, or none that are determined to be appropriate, it is appropriate to construct a new questionnaire. If a questionnaire exists, but only in a different language, the task is to translate and validate the questionnaire in the new language.

  Developing a Questionnaire Top

To construct a new questionnaire, a number of issues should be considered even before writing the questionnaire items.

Identify the dimensionality of the construct

Many constructs are multidimensional, meaning that they are composed of several related components. To fully assess the construct, one may consider developing subscales to assess the different components of the construct. Next, are all the dimensions equally important? or are some more important than others? If the dimensions are equally important, one can assign the same weight to the questions (e.g., by summing or taking the average of all the items). If some dimensions are more important than others, it may not be reasonable to assign the same weight to the questions. Rather, one may consider examining the results from each dimension separately.

Determine the format in which the questionnaire will be administered

Will the questionnaire be self-administered or administered by a research/clinical staff? This decision depends, in part, on what the questionnaire intends to measure. If the questionnaire is designed to measure catastrophic thinking related to pain, respondents may be less likely to respond truthfully if a research/clinical staff asked the questions, whereas they may be more likely to respond truthfully if they are allowed to complete the questionnaire on their own. If the questionnaire is designed to measure patients' mobility after surgery, respondents may be more likely to overreport the amount of mobility in an effort to demonstrate recovery. To obtain a more accurate measure of mobility after surgery, it may be preferable to obtain objective ratings by clinical staff.

If respondents are to complete the questionnaire by themselves, the items need to be written in a way that can be easily understood by the majority of the respondents, generally about Grade 6 reading level.[3] If the questionnaire is to be administered to young respondents or respondents with cognitive impairment, the readability level of the items should be lowered. Questionnaires intended for children should take into consideration the cognitive stages of young people [4] (e.g., pictorial response choices may be more appropriate, such as pain faces to assess pain [5]).

Determine the item format

Will the items be open ended or close ended? Questions that are open ended allow respondents to elaborate upon their responses. As more detailed information may be obtained using open-ended questions, these items are best suited for situations in which investigators wish to gather more information about a specific domain. However, these responses are often more difficult to code and score, which increases the difficulty of summarizing individuals' responses. If multiple coders are included, researchers have to address the additional issue of inter-rater reliability.

Questions that are close ended provide respondents a limited number of response options. Compared to open-ended questions, these items are easier to administer and analyze. On the other hand, respondents may not be able to clarify their responses, and their responses may be influenced by the response options provided.

If close-ended items are to be used, should multiple-choice, Likert-type scales, true/false, or other close-ended formats be used? How many response options should be available? If a Likert-type scale is to be adopted, what scale anchors are to be used to indicate the degree of agreement (e.g., strongly agree, agree, neither, disagree, strongly degree), frequency of an event (e.g., almost never, once in a while, sometimes, often, almost always), or other varying options? To make use of participants' responses for subsequent statistical analyses, researchers should keep in mind that items should be scaled to generate sufficient variance among the intended respondents.[6],[7]

Item development

A number of guidelines have been suggested for writing items.[7] Items should be simple, short, and written in language familiar to the target respondents. The perspective should be consistent across items; items that assess affective responses (e.g., anxiety, depression) should not be mixed with those that assess behavior (e.g., mobility, cognitive functioning).[8] Items should assess only a single issue. Items that address more than one issue, or “double-barreled” items (e.g., “My daily activities and mood are affected by my pain.”), should not be used. Avoid leading questions as they may result in biased responses. Items that all participants would respond similarly (e.g., “I would like to reduce my pain.”) should not be used, as the small variance generated will provide limited information about the construct being assessed. [Table 1] summarizes important tips on writing questions.
Table 1: Tips on writing questions[15],[16]

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The issue of whether reverse-scored items should be used remains debatable. Since reverse-scored items are negatively worded, it has been argued that the inclusion of these items may reduce response set bias.[9] On the other hand, others have found a negative impact on the psychometric properties of scales that included negatively worded items.[10] In recent years, an increasing amount of literature reports problems with reverse-scored items.[11],[12],[13],[14] Researchers who decide to include negatively worded items should take extra steps to ensure that the items are interpreted as intended by the respondents, and that the reverse-coded items have similar psychometric properties as the other regularly coded items.[7]

Determine the intended length of questionnaire

There is no rule of thumb for the number of items that make up a questionnaire. The questionnaire should contain sufficient items to measure the construct of interest, but not be so long that respondents experience fatigue or loss of motivation in completing the questionnaire.[17],[18] Not only should a questionnaire possess the most parsimonious (i.e., simplest) structure,[19] but it also should consist of items that adequately represent the construct of interest to minimize measurement error.[20] Although a simple structure of questionnaire is recommended, a large pool of items is needed in the early stages of the questionnaire's development as many of these items might be discarded throughout the development process.[7]

Review and revise initial pool of items

After the initial pool of questionnaire items are written, qualified experts should review the items. Specifically, the items should be reviewed to make sure they are accurate, free of item construction problems, and grammatically correct. The reviewers should, to the best of their ability, ensure that the items do not contain content that may be perceived as offensive or biased by a particular subgroup of respondents.

Preliminary pilot testing

Before conducting a pilot test of the questionnaire on the intended respondents, it is advisable to test the questionnaire items on a small sample (about 30–50)[21] of respondents.[17] This is an opportunity for the questionnaire developer to know if there is confusion about any items, and whether respondents have suggestions for possible improvements of the items. One can also get a rough idea of the response distribution to each item, which can be informative in determining whether there is enough variation in the response to justify moving forward with a large-scale pilot test. Feasibility and the presence of floor (almost all respondents scored near the bottom) or ceiling effects (almost all respondents scored near the top) are important determinants of items that are included or rejected at this stage. Although it is possible that participants' responses to questionnaires may be affected by question order,[22],[23],[24] this issue should be addressed only after the initial questionnaire has been validated. The questionnaire items should be revised upon reviewing the results of the preliminary pilot testing. This process may be repeated a few times before finalizing the final draft of the questionnaire.


So far, we highlighted the major steps that need to be undertaken when constructing a new questionnaire. Researchers should be able to clearly link the questionnaire items to the theoretical construct they intend to assess. Although such associations may be obvious to researchers who are familiar with the specific topic, they may not be apparent to other readers and reviewers. To develop a questionnaire with good psychometric properties that can subsequently be applied in research or clinical practice, it is crucial to invest the time and effort to ensure that the items adequately assess the construct of interest.

  Translating a Questionnaire Top

The following section summarizes the guidelines for translating a questionnaire into a different language.

Forward translation

The initial translation from the original language to the target language should be made by at least two independent translators.[25],[26] Preferably, the bilingual translators should be translating the questionnaire into their mother tongue, to better reflect the nuances of the target language.[27] It is recommended that one translator be aware of the concepts the questionnaire intend to measure, to provide a translation that more closely resembles the original instrument. It is suggested that a naïve translator, who is unaware of the objective of the questionnaire, produce the second translation so that subtle differences in the original questionnaire may be detected.[25],[26] Discrepancies between the two (or more) translators can be discussed and resolved between the original translators, or with the addition of an unbiased, bilingual translator who was not involved in the previous translations.

Backward translation

The initial translation should be independently back-translated (i.e., translate back from the target language into the original language) to ensure the accuracy of the translation. Misunderstandings or unclear wordings in the initial translations may be revealed in the back-translation.[25] As with the forward translation, the backward translation should be performed by at least two independent translators, preferably translating into their mother language (the original language).[26] To avoid bias, back-translators should preferably not be aware of the intended concepts the questionnaire measures.[25]

Expert committee

Constituting an expert committee is suggested to produce the prefinal version of the translation.[25] Members of the committee should include experts who are familiar with the construct of interest, a methodologist, both the forward and backward translators, and if possible, developers of the original questionnaires. The expert committee will need to review all versions of the translations and determine whether the translated and original versions achieve semantic, idiomatic, experiential, and conceptual equivalence.[25],[28] Any discrepancies will need to be resolved, and members of the expert committee will need to reach a consensus on all items to produce a prefinal version of the translated questionnaire. If necessary, the process of translation and back-translation can be repeated.

Preliminary pilot testing

As with developing a new questionnaire, the prefinal version of the translated questionnaire should be pilot tested on a small sample (about 30–50)[21] of the intended respondents.[25],[26] After completing the translated questionnaire, the respondent is asked (verbally by an interviewer or via an open-ended question) to elaborate what they thought each questionnaire item and their corresponding response meant. This approach allows the investigator to make sure that the translated items retained the same meaning as the original items, and to ensure there is no confusion regarding the translated questionnaire. This process may be repeated a few times to finalize the final translated version of the questionnaire.


In this section, we provided a template for translating an existing questionnaire into a different language. Considering that most questionnaires were initially developed in one language (e.g., English when developed in English-speaking countries [25]), translated versions of the questionnaires are needed for researchers who intend to collect data among respondents who speak other languages. To compare responses across populations of different language and/or culture, researchers need to make sure that the questionnaires in different languages are assessing the equivalent construct with an equivalent metric. Although the translation process is time consuming and costly, it is the best method to ensure that a translated measure is equivalent to the original questionnaire.[28]

  Validating a Questionnaire Top

Initial validation

After the new or translated questionnaire items pass through preliminary pilot testing and subsequent revisions, it is time to conduct a pilot test among the intended respondents for initial validation. In this pilot test, the final version of the questionnaire is administered to a large representative sample of respondents for whom the questionnaire is intended. If the pilot test is conducted for small samples, the relatively large sampling errors may reduce the statistical power needed to validate the questionnaire.[2]


The reliability of a questionnaire can be considered as the consistency of the survey results. As measurement error is present in content sampling, changes in respondents, and differences across raters, the consistency of a questionnaire can be evaluated using its internal consistency, test-retest reliability, and inter-rater reliability, respectively.

Internal consistency

Internal consistency reflects the extent to which the questionnaire items are inter-correlated, or whether they are consistent in measurement of the same construct. Internal consistency is commonly estimated using the coefficient alpha,[29] also known as Cronbach's alpha. Given a questionnaire x, with k number of items, alpha (α) can be computed as:

Where, σi2 is the variance of item i, and σx2 is the total variance of the questionnaire.

Cronbach's alpha ranges from 0 to 1 (when some items are negatively correlated with other items in the questionnaire, it is possible to have negative values of Cronbach's alpha). When reverse-scored items are [incorrectly] not reverse scored, it can be easily remedied by correctly scoring the items. However, if a negative Cronbach's alpha is still obtained when all items are correctly scored, there are serious problems in the original design of the questionnaire), with higher values indicating that items are more strongly interrelated with one another. Cronbach's α = 0 indicates no internal consistency (i.e., none of the items are correlated with one another), whereas α = 1 reflects perfect internal consistency (i.e., all the items are perfectly correlated with one another). In practice, Cronbach's alpha of at least 0.70 has been suggested to indicate adequate internal consistency.[30] A low Cronbach's alpha value may be due to poor inter-relatedness between items; as such, items with low correlations with the questionnaire total score should be discarded or revised. As alpha is a function of the length of the questionnaire, alpha will increase with the number of items. In addition, alpha will increase if the variability of each item is increased. It is, therefore, possible to increase alpha by including more related items, or adding items that have more variability to the questionnaire. On the other hand, an alpha value that is too high (α ≥ 0.90) suggests that some questionnaire items may be redundant;[31] investigators may consider removing items that are essentially asking the same thing in multiple ways.

It is important to note that Cronbach's alpha is a property of the responses from a specific sample of respondents.[31] Investigators need to keep in mind that Cronbach's alpha is not “the” estimate of reliability for a questionnaire under all circumstances. Rather, the alpha value only indicates the extent to which the questionnaire is reliable for “a particular population of examinees.”[32] A questionnaire with excellent reliability with one sample may not necessarily have the same reliability in another. Therefore, the reliability of a questionnaire should be estimated each time the questionnaire is administered, including pilot testing and subsequent validation stages.

Test-retest reliability

Test-retest reliability refers to the extent to which individuals' responses to the questionnaire items remain relatively consistent across repeated administration of the same questionnaire or alternate questionnaire forms.[2] Provided the same individuals were administered the same questionnaires twice (or more), test-retest reliability can be evaluated using Pearson's product moment correlation coefficient (Pearson's r) or the intraclass correlation coefficient.

Pearson's r between the two questionnaires' responses can be referred to as the coefficient of stability. A larger stability coefficient indicates stronger test-retest reliability, reflecting that measurement error of the questionnaire is less likely to be attributable to changes in the individuals' responses over time.

Test-retest reliability can be considered the stability of respondents' attributes; it is applicable to questionnaires that are designed to measure personality traits, interest, or attitudes that are relatively stable across time, such as anxiety and pain catastrophizing. If the questionnaires are constructed to measure transitory attributes, such as pain intensity and quality of recovery, test-retest reliability is not applicable as the changes in respondents' responses between assessments are reflected in the instability of their responses. Although test-retest reliability is sometimes reported for scales that are intended to assess constructs that change between administrations, researchers should be aware that test-retest reliability is not applicable and does not provide useful information about the questionnaires of interest. Researchers should also be critical when evaluating the reliability estimates reported in such studies.

An important question to consider in estimating test-retest reliability is how much time should lapse between questionnaire administrations? If the duration between time 1 and time 2 is too short, individuals may remember their responses in time 1, which may overestimate the test-retest reliability. Respondents, especially those recovering from major surgery, may experience fatigue if the retest is administered shortly after the first administration, which may underestimate the test-retest reliability. On the other hand, if there is a long period of time between questionnaire administrations, individuals' responses may change due to other factors (e.g., a respondent may be taking pain management medications to treat chronic pain condition). Unfortunately, there is no single answer. The duration should be long enough to allow the effects of memory to fade and to prevent fatigue, but not so long as to allow changes to take place that may affect the test-retest reliability estimate.[17]

Inter-rater reliability

For questionnaires in which multiple raters complete the same instrument for each examinee (e.g., a checklist of behavior/symptoms), the extent to which raters are consistent in their observations across the same group of examinees can be evaluated. This consistency is referred to as the inter-rater reliability, or inter-rater agreement, and can be estimated using the kappa statistic.[33] Suppose two clinicians independently rated the same group of patients on their mobility after surgery (e.g., 0 = needs help of 2+ people; 1 = needs help of 1 person; 2 = independent), kappa (к) can be computed as follows:

Where, Po is the observed proportion of observations in which the two raters agree, and Pe is the expected proportion of observations in which the two raters agree by chance. Accordingly, к is the proportion of agreement between the two raters, after factoring out the proportion of agreement by chance. к ranges from 0 to 1, where к = 0 indicates all chance agreements and к =1 represents perfect agreement between the two raters. Others have suggested к = 0 as no agreement, к = 0.01 − 0.20 as poor agreement, к = 0.21 − 0.40 as slight agreement, к = 0.41 − 0.60 as fair agreement, к = 0.61 − 0.80 as good agreement, к = 0.81 − 0.92 as very good agreement, and к = 0.93 − 1 as excellent agreement.[34],[35] If more than two raters are used, an extension of Cohen's к statistic is available to compute the inter-rater reliability across multiple raters.[36]


The validity of a questionnaire is determined by analyzing whether the questionnaire measures what it is intended to measure. In other words, are the inferences and conclusions made based on the results of the questionnaire (i.e., test scores) valid?[37] Two major types of validity should be considered when validating a questionnaire: content validity and construct validity.

Content validity

Content validity refers to the extent to which the items in a questionnaire are representative of the entire theoretical construct the questionnaire is designed to assess.[17] Although the construct of interest determines which items are written and/or selected in the questionnaire development/translation phase, content validity of the questionnaire should be evaluated after the initial form of the questionnaire is available.[2] The process of content validation is particularly crucial in the development of a new questionnaire.

A panel of experts who are familiar with the construct that the questionnaire is designed to measure should be tasked with evaluating the content validity of the questionnaire. The experts judge, as a panel, whether the questionnaire items are adequately measuring the construct intended to assess, and whether the items are sufficient to measure the domain of interest. Several approaches to quantify the judgment of content validity across experts are also available, such as the content validity ratio [38] and content validation form.[39],[40] Nonetheless, as the process of content validation depends heavily on how well the panel of experts can assess the extent to which the construct of interest is operationalized, the selection of appropriate experts is crucial to ensure that content validity is evaluated adequately. Example items to assess content validity include:[41]

  • The questions were clear and easy
  • The questions covered all the problem areas with your pain
  • You would like the use of this questionnaire for future assessments
  • The questionnaire lacks important questions regarding your pain
  • Some of the questions violate your privacy.

A concept that is related to content validity is face validity. Face validity refers to the degree to which the respondents or laypersons judge the questionnaire items to be valid. Such judgment is based less on the technical components of the questionnaire items, but rather on whether the items appear to be measuring a construct that is meaningful to the respondents. Although this is the weakest way to establish the validity of a questionnaire, face validity may motivate respondents to answer more truthfully. For example, if patients perceive a quality of recovery questionnaire to be evaluating how well they are recovering from surgery, they may be more likely to respond in ways that reflect their recovery status.

Construct validity

Construct validity is the most important concept in evaluating a questionnaire that is designed to measure a construct that is not directly observable (e.g., pain, quality of recovery). If a questionnaire lacks construct validity, it will be difficult to interpret results from the questionnaire, and inferences cannot be drawn from questionnaire responses to a behavior domain. The construct validity of a questionnaire can be evaluated by estimating its association with other variables (or measures of a construct) with which it should be correlated positively, negatively, or not at all.[42] In practice, the questionnaire of interest, as well as the preexisting instruments that measure similar and dissimilar constructs, is administered to the same groups of individuals. Correlation matrices are then used to examine the expected patterns of associations between different measures of the same construct, and those between a questionnaire of a construct and other constructs. It has been suggested that correlation coefficients of 0.1 should be considered as small, 0.3 as moderate, and 0.5 as large.[43]

For instance, suppose a new scale is developed to assess pain among hospitalized patients. To provide evidence of construct validity for this new pain scale, we can examine how well patients' responses on the new scale correlate with the preexisting instruments that also measure pain. This is referred to as convergent validity. One would expect strong correlations between the new questionnaire and the existing measures of the same construct, since they are measuring the same theoretical construct.

Alternatively, the extent to which patients' responses on the new pain scale correlate with instruments that measure unrelated constructs, such as mobility or cognitive function, can be assessed. This is referred to as divergent validity. As pain is theoretically dissimilar to the constructs of mobility or cognitive function, we would expect zero, or very weak, correlation between the new pain questionnaire and instruments that assess mobility or cognitive function. [Table 2] describes different validation types and important definitions.
Table 2: Questionnaire-related terminology[16],[44],[45]

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Subsequent validation

The process described so far defines the steps for initial validation. However, the usefulness of the scale is the ability to discriminate between different cohorts in the domain of interest. It is advised that several studies investigating different cohorts or interventions should be conducted to identify whether the scale can discriminate between groups. Ideally, these studies should have clearly defined outcomes where the changes in the domain of interest are well known. For example, in subsequent validation of the Postoperative Quality of Recovery Scale, four studies were constructed to show the ability to discriminate recovery and cognition in different cohorts of participants (mixed cohort, orthopedics, and otolaryngology), as well as a human volunteer study to calibrate the cognitive domain.[46],[47],[48],[49]

Sample size

Guidelines for the respondent-to-item ratio ranged from 5:1[50] (i.e., fifty respondents for a 10-item questionnaire), 10:1,[30] to 15:1 or 30:1.[51] Others suggested that sample sizes of 50 should be considered as very poor, 100 as poor, 200 as fair, 300 as good, 500 as very good, and 1000 or more as excellent.[52] Given the variation in the types of questionnaire being used, there are no absolute rules for the sample size needed to validate a questionnaire.[53] As larger samples are always better than smaller samples, it is recommended that investigators utilize as large a sample size as possible. The respondent-to-item ratios can be utilized to further strengthen the rationale for the large sample size when necessary.

Other considerations

Even though data collection using questionnaires is relatively easy, researchers should be cognizant about the necessary approvals that should be obtained prior to beginning the research project. Considering the differences in regulations and requirements in different countries, agencies, and institutions, researchers are advised to consult the research ethics committee at their agencies and/or institutions regarding the necessary approval needed and additional considerations that should be addressed.

  Conclusion Top

In this review, we provided guidelines on how to develop, validate, and translate a questionnaire for use in perioperative and pain medicine. The development and translation of a questionnaire requires investigators' thorough consideration of issues relating to the format of the questionnaire and the meaning and appropriateness of the items. Once the development or translation stage is completed, it is important to conduct a pilot test to ensure that the items can be understood and correctly interpreted by the intended respondents. The validation stage is crucial to ensure that the questionnaire is psychometrically sound. Although developing and translating a questionnaire is no easy task, the processes outlined in this article should enable researchers to end up with questionnaires that are efficient and effective in the target populations.

Financial support and sponsorship

Siny Tsang, PhD, was supported by the research training grant 5-T32-MH 13043 from the National Institute of Mental Health.

Conflicts of interest

There are no conflicts of interest.

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79 Comparison of conventional and wide field direct ophthalmoscopy on medical students’ self-confidence for fundus examination: a 1-year follow-up
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80 How do Japanese rate the severity of different diseases and injuries?—an assessment of disability weights for 231 health states by 37,318 Japanese respondents
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81 Continuity and coordination of care in highly selected chronic cancer patients treated with multiple repeat radiation therapy
Sebastian M. Christ, Maiwand Ahmadsei, Annina Seiler, Eugenia Vlaskou Badra, Jonas Willmann, Caroline Hertler, Matthias Guckenberger
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82 Economic burden in the management of transfusion-dependent thalassaemia patients in Malaysia from a societal perspective
Asrul Akmal Shafie, Jacqueline Hui Yi Wong, Hishamshah Mohd Ibrahim, Noor Syahireen Mohammed, Irwinder Kaur Chhabra
Orphanet Journal of Rare Diseases. 2021; 16(1)
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83 The TEAM instrument for measuring emergency team performance: validation of the Swedish version at two emergency departments
Klas Karlgren, Anders Dahlström, Anderz Birkestam, Annelie Drevstam Norling, Gustav Forss, Mikael Andersson Franko, Simon Cooper, Thomas Leijon, Charlotta Paulsson
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2021; 29(1)
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84 Monitoring of patients with microdialysis following pancreaticoduodenectomy—the MINIMUM study: study protocol for a randomized controlled trial
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85 Cycling in people with a lower limb amputation
Jutamanee Poonsiri, Rienk Dekker, Pieter U. Dijkstra, Juha M. Hijmans, Jan H. B. Geertzen
BMC Sports Science, Medicine and Rehabilitation. 2021; 13(1)
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86 Collecting quantitative experimental data from a non-WEIRD population: challenges and practical recommendations from a field experiment in rural Sierra Leone
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87 Internal and external aspects of freedom of choice in mental health: cultural and linguistic adaptation of the Hungarian version of the Oxford CAPabilities questionnaire—Mental Health (OxCAP-MH)
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88 An assessment of nursing mothers’ and young people’s access to proprietary and patent medicine vendors’ services in rural communities of south-eastern Nigeria: implication for review of national drug policy
C. J. Uneke, I. Obeka, B. I. Uneke, A. Umeokonkwo, C. A. Nweze, K. I. Otubo, O. E. Uguru
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89 Exploring determinants of community pharmacist-led influenza vaccination in a Middle Eastern country: a national web-based cross-sectional study
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90 Psychometric adequacy of the Persian adapted version of the Tilburg pregnancy distress scale (P-TPDS)
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BMC Pregnancy and Childbirth. 2021; 21(1)
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91 Translation, cultural adaptation and reproducibility of a Portuguese version of the Functional Index for Hand OsteoArthritis (FIHOA)
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Advances in Rheumatology. 2021; 61(1)
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92 Development, Validation, and Results of a Survey of Personal Electronic Device Use Among 299 Anesthesia Providers From a Single Institution
Steven B. Porter, J. Ross Renew, Stephania Paredes, Christopher R. Roscher, Matthew F. Plevak, Kathleen J. Yost
Anesthesia & Analgesia. 2021; Publish Ah
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93 Translation, validity and reliability of the Danish version of the Adolescent Insomnia Questionnaire
Alessandro Andreucci, Christian Lund Straszek, Michael Skovdal Rathleff, Clara Guldhammer, Rocio de la Vega, Tonya M. Palermo
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94 Adaptation and validation of the Physical Activity Questionnaire for Older Children (PAQ-C) among Czech children
Roman Cuberek, Marcela Janíková, Jan Dygrýn, Peter M ten Klooster
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95 A mixed method study design to explore the adherence of haematological cancer patients to oral anticancer medication in a multilingual and multicultural outpatient setting: The MADESIO protocol
Sandra Michiels, Sandra Tricas-Sauras, Marie Dauvrin, Dominique Bron, Fati Kirakoya-Samadoulougou, Joseph Telfair
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96 Validating the Michigan Hand Outcomes Questionnaire in patients with rheumatoid arthritis using Rasch analysis
Mayank Jayaram, Chang Wang, Lu Wang, Kevin C. Chung, Karl Bang Christensen
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97 Evaluating subjective cognitive decline: a systematic review of tools available for evaluating cognitive complaints in Portuguese
Wyllians Vendramini BORELLI, Vanessa Nicola LABREA, Eduardo LEAL-CONCEICAO, Mirna Wetters PORTUGUEZ, Jaderson Costa da COSTA
Arquivos de Neuro-Psiquiatria. 2021; 79(3): 238
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98 Adaptação transcultural do questionário EFFECT para português brasileiro
Lourrany Borges Costa, Shamyr Sulyvan de Castro, Diovana Ximenes Cavalcante Dourado, Bruna Soares Praxedes, Thayná Custódio Mota, Thais Marcella Rios de Lima Tavares
Revista Brasileira de Educação Médica. 2021; 45(3)
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99 Cross-cultural adaptation of the EFFECT questionnaire into Brazilian Portuguese
Lourrany Borges Costa, Shamyr Sulyvan de Castro, Diovana Ximenes Cavalcante Dourado, Bruna Soares Praxedes, Thayná Custódio Mota, Thais Marcella Rios de Lima Tavares
Revista Brasileira de Educação Médica. 2021; 45(3)
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100 The Development, Translation, and Validation of Malaysian Survey on the Propensity to Volunteer (MySPV)
Shahrul Aiman Soelar, Zainal ‘Akla Shamsudin, Kumaresan Palanisamy, Mohamad Shukri Abdul Hamid, Nurakmal Ahmad Mustaffa, Noor Amalina Mat Yusof
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101 Dental Visits and Predictors of Regular Attendance Among Female Schoolchildren in Dammam, Saudi Arabia
Muhanad Alhareky, Muhammad Ashraf Nazir
Clinical, Cosmetic and Investigational Dentistry. 2021; Volume 13: 97
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102 Health Professional Frontline Leaders’ Experiences During the COVID-19 Pandemic: A Cross-Sectional Study
Bibi Hølge-Hazelton, Mette Kjerholt, Elizabeth Rosted, Stine Thestrup Hansen, Line Zacho Borre, Brendan McCormack
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103 Application of the EQ-5D in the Middle East: A Systematic Review Focusing on Patients Living in the Kingdom of Saudi Arabia
Abdullah Althemery
Journal of Multidisciplinary Healthcare. 2021; Volume 14: 1101
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104 Turkish Validity and Reliability of the Reproductive Coercion Scale
Turkish Journal of Family Medicine and Primary Care. 2021;
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105 Medical and psychosocial evaluation of patients with complications after sinonasal surgery: Creating a questionnaire
Manuela-Andra Vidinei, Codrut Sarafoleanu
Romanian Journal of Rhinology. 2021; 11(42): 60
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106 Students’ Preparedness to Learn in e-Learning Environment and their Perception on The MPKT Lecturers’ Readiness to Manage Online Class
Titin Siswantining, Herley Shaori Al-Ash, Kasiyah Junus, Lia Sadita, Diana Nur Vitasari, Luthfiralda Sjahfirdi, Harinaldi Harinaldi
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107 Exploring Undergraduate Pharmacy Students Perspectives Towards Antibiotics Use, Antibiotic Resistance, and Antibiotic Stewardship Programs Along With the Pharmacy Teachers’ Perspectives: A Mixed-Methods Study From Pakistan
Faiz Ullah Khan, Amjad Khan, Shahid Shah, Khezar Hayat, Abubakar Usman, Farman Ullah Khan, Zakir Khan, Yusuf Karatas, Tawseef Ahmad, Jie Chang, Usman Rashid Malik, Asad Khan, Sundus Shukar, Muhtar Kadirhaz, Yu Fang
Frontiers in Pharmacology. 2021; 12
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108 Adaptation and Psychometric Evaluation of the Chinese Counseling Competencies Scale-Revised
Wei Xia, William Ho Cheung Li, Tingna Liang, Yuanhui Luo, Laurie Long Kwan Ho, Ankie Tan Cheung, Peige Song
Frontiers in Psychology. 2021; 12
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109 Clinical Validation of the Greek Version of the Acute Cystitis Symptom Score (ACSS)—Part II
Konstantinos Stamatiou, Evangelia Samara, Jakhongir F. Alidjanov, Adrian M. E. Pilatz, Kurt G. Naber, Florian M. E. Wagenlehner
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110 Cross-cultural adaptation and validation of the Turkish Yellow Flag Questionnaire in patients with chronic musculoskeletal pain
Meltem Koç, Zilan Bazancir, Hakan Apaydin, Burcu Talu, Kiliçhan Bayar
The Korean Journal of Pain. 2021; 34(4): 501
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111 Effect of Psychological Factors on Credit Risk: A Case Study of the Microlending Service in Mongolia
Mandukhai Ganbat, Erdenebileg Batbaatar, Ganzul Bazarragchaa, Togtuunaa Ider, Enkhjargalan Gantumur, Lkhamsuren Dashkhorol, Khosgarig Altantsatsralt, Mandakhbayar Nemekh, Erdenebaatar Dashdondog, Oyun-Erdene Namsrai
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112 Undiagnosed Hypertension in a Workplace: The Case of a Logistics Company in Gauteng, South Africa
Morongwa Bokaba, Perpetua Modjadji, Kebogile Elizabeth Mokwena
Healthcare. 2021; 9(8): 964
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113 Perception of the Online Learning Environment of Nursing Students in Slovenia: Validation of the DREEM Questionnaire
Lucija Gosak, Nino Fijacko, Carolina Chabrera, Esther Cabrera, Gregor Štiglic
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114 Vietnamese Version of the General Medication Adherence Scale (GMAS): Translation, Adaptation, and Validation
Thao Huong Nguyen, Hoa Van Truong, Mai Tuyet Vi, Katja Taxis, Thang Nguyen, Kien Trung Nguyen
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115 Knowledge, Attitude, and Practice on Antibiotics and Its Resistance: A Two-Phase Mixed-Methods Online Study among Pakistani Community Pharmacists to Promote Rational Antibiotic Use
Faiz Ullah Khan, Farman Ullah Khan, Khezar Hayat, Tawseef Ahmad, Amjad Khan, Jie Chang, Usman Rashid Malik, Zakir Khan, Krizzia Lambojon, Yu Fang
International Journal of Environmental Research and Public Health. 2021; 18(3): 1320
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116 HAPPY MAMA Project (PART 1). Assessing the Reliability of the Italian Karitane Parenting Confidence Scale (KPCS-IT) and Parental Stress Scale (PSS-IT): A Cross-Sectional Study among Mothers Who Gave Birth in the Last 12 Months
Alice Mannocci, Azzurra Massimi, Franca Scaglietta, Sara Ciavardini, Michela Scollo, Claudia Scaglione, Giuseppe La Torre
International Journal of Environmental Research and Public Health. 2021; 18(8): 4066
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117 Redesigning a Healthcare Demand Questionnaire for National Population Survey: Experience of a Developing Country
Diane Woei Quan Chong, Suhana Jawahir, Ee Hong Tan, Sondi Sararaks
International Journal of Environmental Research and Public Health. 2021; 18(9): 4435
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118 Hesitancy towards COVID-19 Vaccines: An Analytical Cross–Sectional Study
Abdelkarim Aloweidi, Isam Bsisu, Aiman Suleiman, Sami Abu-Halaweh, Mahmoud Almustafa, Mohammad Aqel, Aous Amro, Neveen Radwan, Dima Assaf, Malak Ziyad Abdullah, Malak Albataineh, Aya Mahasneh, Ala’a Badaineh, Hala Obeidat
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119 Clinical Activities, Contaminations of Surgeons and Cooperation with Health Authorities in 14 Orthopedic Departments in North Italy during the Most Acute Phase of Covid-19 Pandemic
Alessandro Aprato, Nicola Guindani, Alessandro Massè, Claudio C. Castelli, Alessandra Cipolla, Delia Antognazza, Francesco Benazzo, Federico Bove, Alessandro Casiraghi, Fabio Catani, Dante Dallari, Rocco D’Apolito, Massimo Franceschini, Alberto Momoli, Flavio Ravasi, Fabrizio Rivera, Luigi Zagra, Giovanni Zatti, Fabio D’Angelo
International Journal of Environmental Research and Public Health. 2021; 18(10): 5340
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120 Frequency of Injury and Illness in the Final 4 Weeks before a Trail Running Competition
Rubén Gajardo-Burgos, Manuel Monrroy-Uarac, René Mauricio Barría-Pailaquilén, Yessenia Norambuena-Noches, Dina Christa Janse van Rensburg, Claudio Bascour-Sandoval, Manuela Besomi
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121 Polish Adaptation of the Italian Spine Youth Quality of Life Questionnaire
Edyta Kinel, Krzysztof Korbel, Piotr Janusz, Mateusz Kozinoga, Dariusz Czaprowski, Tomasz Kotwicki
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122 Unpacking the Mental Health of Nurses during COVID-19: Evidence from Pakistan
Xinxing Xu, Faiza Manzoor, Shaoping Jiang, Ayesha Mumtaz
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123 Malawian mothers’ experiences of raising children living with albinism: A qualitative descriptive study
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124 Psychometric Properties of the Clergy Suicide Prevention Competencies Developmental Rubric and Faith Leaders’ Readiness to Address Suicide Stigma
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125 Need for a central survey-based registry-for effective conduct of survey-based medical research
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126 Addiction-like behavior associated with social media usage in undergraduate students of a government medical college in Delhi, India
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127 Evaluating Construct Validity and Reliability of Intention to Transfer Training Conduct Instrument Using Rasch Model Analysis
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128 Determining the Entrepreneurial and Intrapreneurial Intentions of Student Pharmacists in Iran
Fatemeh Mirzayeh Fashami, Mona Nili, Ali Vasheghani Farahani, Nazneen Shaikh, Nilanjana Dwibedi, S. Suresh Madhavan
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129 Pilot of a questionnaire study regarding perception of undergraduate medical students towards online classes: Process and perspectives
UnnikrishnanK Menon, Suja Gopalakrishnan, CSumithra N. Unni, Riju Ramachandran, B Poornima, Anu Sasidharan, MS Ashika, Natasha Radhakrishnan
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130 Attitudes of the elderly towards interprofessional cooperation and collaborative pharmacy practices: Questionnaire development
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131 Development of a Questionnaire to Assess the Psychosocial Effects of COVID-19 on Peripartum Women
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132 Development of the First Health-Related Quality of Life Questionnaires in Arabic for Women With Polycystic Ovary Syndrome (Part II): Dual-Center Validation of PCOSQoL-47 and PCOSQoL-42 Questionnaires
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133 Perceived barriers to medical leadership training and methods to mitigate them in the undergraduate medical curriculum: A mixed-methods study of final-year medical students at two medical schools
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134 Sample study protocol for adapting and translating the 5C scale to assess the psychological antecedents of vaccination
Cornelia Betsch, Katrine Bach Habersaat, Sergei Deshevoi, Dorothee Heinemeier, Nikolay Briko, Natalia Kostenko, Janusz Kocik, Robert Böhm, Ingo Zettler, Charles Shey Wiysonge, Ève Dubé, Arnaud Gagneur, Elisabeth Botelho-Nevers, Amandine Gagneux-Brunon, Jonas Sivelä
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135 Organ Donation Decisional Balance Survey: Reliability and Validity of the Turkish Version
Ayca Aytar, Aydan Aytar, Atahan Altintas, Ebru H. Ayvazoglu Soy, Aydincan Akdur, Mehmet Haberal
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136 Translation, validation and test–retest reliability of the VISA-G patient-reported outcome tool into Danish (VISA-G.DK)
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137 The Development and Validation of Quality of Life Scale for Iraqi Patients with Type 2 Diabetes Mellitus
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138 Psychometric Properties of the Pornography Craving Questionnaire (PCQ) in Iran
Nader Molavi, Shahrzad Khosravifar, Masumeh Ghazanfanpour, Mohammad Reza Najarzadegan, Abdolhadi Saeidi, Masoudeh Babakhanian
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139 Adapting and using the quality of dying and death questionnaire
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140 Factors Affecting Consumers’ Alternative Meats Buying Intentions: Plant-Based Meat Alternative and Cultured Meat
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141 Is Teamwork Different Online Versus Face-to-Face? A Case in Engineering Education
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142 Translation, cultural adaptation, and validation of the duke activity status index in the hindi language
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143 Translation, cultural adaptation, and validation of the duke activity status index in the hindi language
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144 Survey research methods: Preparing a validity argument
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145 Development of the Home Cooking EnviRonment and Equipment Inventory Observation form (Home-CookERITM): An Assessment of Content Validity, Face Validity, and Inter-Rater Agreement
Sonja Schönberg, Roberta Asher, Samantha Stewart, Matthew J. Fenwick, Lee Ashton, Tamara Bucher, Klazine Van der Horst, Christopher Oldmeadow, Clare E. Collins, Vanessa A. Shrewsbury
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146 Development and Validation of the Short Healthy Eating Index Survey with a College Population to Assess Dietary Quality and Intake
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147 Exploring the Validity of the 14-Item Mediterranean Diet Adherence Screener (MEDAS): A Cross-National Study in Seven European Countries around the Mediterranean Region
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148 Translation and Validation of the Mindful Self-Care Scale—Chinese Version: A Pilot Study
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149 Treatment-Seeking Behavior Among Male Civil Servants in Northeastern Malaysia: A Mixed-Methods Study
Pathman Arumugam, Tengku Alina Tengku Ismail, Aziah Daud, Kamarul Imran Musa, Noor Aman A. Hamid, Shaiful Bahari Ismail, Zakiah Mohd Said
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150 Preparedness of Frontline Doctors in Jordan Healthcare Facilities to COVID-19 Outbreak
Aiman Suleiman, Isam Bsisu, Hasan Guzu, Abeer Santarisi, Murad Alsatari, Ala’ Abbad, Ahmad Jaber, Taima’a Harb, Ahmad Abuhejleh, Nisreen Nadi, Abdelkarim Aloweidi, Mahmoud Almustafa
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151 A Questionnaire Survey of Management of Patients with Aneurysmal Subarachnoid Haemorrhage in Poland
Mariusz Hofman, Norbert Hajder, Izabela Duda, Lukasz J. Krzych
International Journal of Environmental Research and Public Health. 2020; 17(11): 4161
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152 A Snapshot of Knowledge about Oral Cancer in Italy: A 505 Person Survey
Riccardo Nocini, Giorgia Capocasale, Daniele Marchioni, Francesca Zotti
International Journal of Environmental Research and Public Health. 2020; 17(13): 4889
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153 Attitudes and Consumer Behavior toward Foods Offered in Staff Canteens
Ewa Czarniecka-Skubina, Hanna Górska-Warsewicz, Joanna Trafialek
International Journal of Environmental Research and Public Health. 2020; 17(17): 6239
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154 Design and Validity of a Choice-Modeling Questionnaire to Analyze the Feasibility of Implementing Physical Activity on Prescription at Primary Health-Care Settings
Sergio Calonge-Pascual, Francisco Fuentes-Jiménez, José A. Casajús Mallén, Marcela González-Gross
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155 Impact of COVID-19Quarantine on Low Back Pain Intensity, Prevalence, and Associated Risk Factors among Adult Citizens Residing in Riyadh (Saudi Arabia): A Cross-Sectional Study
Peter Šagát, Peter Bartík, Pablo Prieto González, Drago? Ioan Tohanean, Damir Knjaz
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156 German Dentists’ Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey
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157 Persistent Malnutrition and Associated Factors among Children under Five Years Attending Primary Health Care Facilities in Limpopo Province, South Africa
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158 Development and Validation of a Well-Being Measure on Young Basketball Players: The NFAPW Scale
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159 Factorial Validity and Variance of the Maslach Burnout Inventory between Demographic and Workload Groups among Dentists of Lithuania
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160 Systematic Review of Patient-Reported Outcomes following Surgical Treatment of Lymphedema
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161 The Epilepsy Risk Awareness (ERA) Scale: A New Era for Holistic Risk Assessment in Epilepsy
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162 Development and Evaluation of a Screening Tool to Aid the Diagnosis of Cluster Headache
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A TASMAN Expedition: Development of a Questionnaire to Assess Specific Self-Management Abilities

Maarten Voorhaar, Jitske Tiemensma, Guus Asijee, Annerika Slok, Jean Muris, Ad Kaptein
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199 The gastrointestinal endoscopy satisfaction questionnaire captures patient satisfaction as a key quality indicator of gastrointestinal endoscopy
Govert Veldhuijzen, Mike J.P. de Jong, Cariline M. Roosen, Peter D. Siersema, Joost P.H. Drenth, Aura A.J. van Esch
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203 Development and validation of antisnake venom knowledge assessment tool (AKAT) for healthcare practitioners
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213 Evaluation of dietary pattern in early pregnancy using the FIGO Nutrition Checklist compared to a food frequency questionnaire
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Physiotherapy Research International. 2020; 25(3)
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215 Translation of self-efficacy scale (SCSES) stoma care instruments Indonesia version: Test validity and reliability
Masriani Zainuddin, Yuliana Syam, Saldy Yusuf
Enfermería Clínica. 2020; 30: 439
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216 Effect of digital storytelling on self-efficacy of patients with a stoma: Preliminary study
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217 A mixed-method exploration into the experience of members of the FAO/WHO International Food Safety Authorities Network (INFOSAN): study protocol
Carmen Joseph Savelli, Céu Mateus
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218 German translation, cultural adaption and validation of the unidimensional self-efficacy scale for multiple sclerosis: a study protocol
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