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

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.