Translation and cultural adaptation of the Minnesota Living with Heart Failure Questionnaire for use in Pakistan
4 affiliations
- 1University of Alberta, Edmonton, Canada
- 2Aga Khan University School of Nursing and Midwifery, Karachi, Pakistan
- 3The Indus Hospital, Opposite Darussalam Society, Karachi, Pakistan
- 4York University, North York, Ontario, Canada
Abstract
Several tools measure the Health-related quality of life (HRQOL) of people with chronic illnesses but evidence on their cross-cultural adaptation is limited. This study performed the cross-cultural adaptation of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) for use with Urdu speakers in Pakistan, while documenting the adaptation process in detail. This methodological study employed a structured cross-cultural adaptation and linguistic validation design. We incorporated a Delphi Pannel to the MAPI Research Trusts’ 5-step linguistic validation process. Two forward translators independently adapted and reconciled the Indian Urdu version of the MLHFQ for use in Pakistan. Using a modified Delphi approach comprising three Heart Failure patients and one cardiologist reviewed the translation for linguistic accuracy, cultural relevance, and comprehensiveness, identified problems and provided feedback that informed the Pakistani Urdu version 1.0. Two independent back translators translated version 1.0 back to English. The Principal Investigator and back translators reconciled back-translations and proposed changes that were approved by forward translators. Translations, reconciliation reports, and Delphi panel feedback were analyzed using inductive qualitative content analysis, resulting in four themes describing the methodological challenges and adaptation strategies encountered during cross-cultural adaptation: (1) direct transferring of compatible words from the Indian Urdu version to Pakistani Urdu version of the MLHFQ, (2) using indirect substitutes for words lacking direct Urdu equivalents, (3) balancing the tone of written and spoken Urdu, and (4) incorporating contextual nuances within each element of the tool. This study successfully adapted the MLHFQ for Urdu-speaking patients with Heart Failure in Pakistan while systematically documenting the linguistic, cultural, and contextual challenges encountered throughout the adaptation process. The findings offer valuable methodological insights for researchers adapting HRQOL tools and provide quality evidence regarding the use of the MLHFQ for use with Urdu speakers in Pakistan.
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BibTeX
@article{gowani2026translation,
title = {{Translation and cultural adaptation of the Minnesota Living with Heart Failure Questionnaire for use in Pakistan}},
author = {Ambreen Gowani and Colleen Norris and Gail Low and Khairulnissa Ajani and Ahmed Noor and Matthias Hoben},
journal = {PLOS One},
year = {2026},
month = oct,
doi = {10.1371/journal.pone.0360245},
url = {https://doi.org/10.1371/journal.pone.0360245},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Translation and cultural adaptation of the Minnesota Living with Heart Failure Questionnaire for use in Pakistan
AU - Ambreen Gowani
AU - Colleen Norris
AU - Gail Low
AU - Khairulnissa Ajani
AU - Ahmed Noor
AU - Matthias Hoben
PY - 2026
DA - 2026/10/09
JO - PLOS One
DO - 10.1371/journal.pone.0360245
UR - https://doi.org/10.1371/journal.pone.0360245
AB - Several tools measure the Health-related quality of life (HRQOL) of people with chronic illnesses but evidence on their cross-cultural adaptation is limited. This study performed the cross-cultural adaptation of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) for use with Urdu speakers in Pakistan, while documenting the adaptation process in detail. This methodological study employed a structured cross-cultural adaptation and linguistic validation design. We incorporated a Delphi Pannel to the MAPI Research Trusts’ 5-step linguistic validation process. Two forward translators independently adapted and reconciled the Indian Urdu version of the MLHFQ for use in Pakistan. Using a modified Delphi approach comprising three Heart Failure patients and one cardiologist reviewed the translation for linguistic accuracy, cultural relevance, and comprehensiveness, identified problems and provided feedback that informed the Pakistani Urdu version 1.0. Two independent back translators translated version 1.0 back to English. The Principal Investigator and back translators reconciled back-translations and proposed changes that were approved by forward translators. Translations, reconciliation reports, and Delphi panel feedback were analyzed using inductive qualitative content analysis, resulting in four themes describing the methodological challenges and adaptation strategies encountered during cross-cultural adaptation: (1) direct transferring of compatible words from the Indian Urdu version to Pakistani Urdu version of the MLHFQ, (2) using indirect substitutes for words lacking direct Urdu equivalents, (3) balancing the tone of written and spoken Urdu, and (4) incorporating contextual nuances within each element of the tool. This study successfully adapted the MLHFQ for Urdu-speaking patients with Heart Failure in Pakistan while systematically documenting the linguistic, cultural, and contextual challenges encountered throughout the adaptation process. The findings offer valuable methodological insights for researchers adapting HRQOL tools and provide quality evidence regarding the use of the MLHFQ for use with Urdu speakers in Pakistan.
SN - 1932-6203
ER -