Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minori
http://www.100md.com
《英国医生杂志》
1 Public Health Sciences Section, Division of Community Health Sciences, Medical School, University of Edinburgh, Edinburgh EH8 9AG
Correspondence to: R Bhopal Raj.Bhopal@ed.ac.uk
Abstract
Cancers and cardiovascular disease are dominant causes of death in Britain's ethnic minority groups.1 The prevention of such disorders requires accurate information about health related behaviour such as the amount and pattern of consumption of tobacco and alcohol. Such information is usually acquired by self completed questionnaires or schedules administered by interviewers, sometimes validated by biochemical and other tests.
Patterns of tobacco and alcohol consumption in ethnic minority groups in the United Kingdom show substantial differences from those of white populations of European origin.2-6 For example, in the health survey for England in 1999 Bangladeshi men self reported a smoking prevalence of 44% compared with 27% for the general population of men, with Chinese men reporting 17%.2 For alcohol consumption even bigger differences seem to exist. Nazroo found that only 4% of Pakistani men reported drinking more than once a week compared with 69% of white men.5 Are these differences accurate or a result of study artefact?
Most survey instruments on tobacco and alcohol consumption by ethnic minorities were developed for English speaking people and translated into other languages. To compare data across language groups the items on the questionnaire, the instructions given, and the responses obtained should be conceptually and functionally equivalent in each language.7-10 If reliability and validity for each language varies, comparisons across groups may be invalid. Translation is a vital step in the process.
Highly educated translators from professional backgrounds may use the "high" form of a language in translation, when the "low" or colloquial form is more appropriate. The best epidemiological studies have used back translation, whereby the original instrument is translated, a second translator translates this back into English, and the two versions are compared. This may, however, be insufficient. People who speak different languages may interpret concepts, words, or phrases in different ways, and cultural differences may render some questions offensive, irrelevant, or inappropriate. The social, cultural, and religious taboos and norms of particular ethnic minority groups may affect the self reporting of tobacco and alcohol consumption. For example, Sikhs are prohibited by their religion from smoking, and Muslims are prohibited from drinking alcohol. It is socially unacceptable for women from several ethnic minority groups to smoke or to drink. These factors could lead to misreporting among these groups.
There are two main ways to develop a cross cultural instrument: firstly, design different language versions in parallel to produce linguistically equivalent items and, secondly, adapt a single language version for use in other languages. We have examined the adaptation of single language versions, the approach most commonly used. Adaptation of questionnaires requires an extensive process, which has been described by several authors (box 1).10-17 In practice it may not be possible to achieve this ideal—for example, comparing every language version with every other requires people who are bilingual in the languages concerned, but investigators may not be able to recruit someone who is familiar with both Cantonese and Bengali. Even in questionnaires designed for English speaking samples, there may be dissent as to the meaning, interpretation, and appropriateness of some items.18
The quality of data obtained from surveys of non-English speakers may be compromised by inadequacies in the translation procedures, failure to compare questionnaire content across languages, failure to consider the cultural appropriateness of items for use with English speakers, and lack of standardisation in terminology, sampling, and the grouping of samples.
We established whether previous studies that measured prevalence of tobacco and alcohol use in ethnic minority groups in the United Kingdom applied guidelines for cross cultural research (box 2) and looked for evidence of inconsistency in the empirical findings that might indicate problems.
Methods
Tobacco
Tables 1 and 2 show the reported prevalence of tobacco consumption by ethnic group in 14 studies.2-6 21-29 We were able to compare the five national studies because they had similar aims, but the local studies were too different to permit comparisons. The results from the national studies showed important discrepancies (table 1). For example, in Bangladeshi women in the health survey for England the prevalence of cigarette smoking was 1% compared with 6% in the survey of black and minority ethnic groups in 1994.4 The prevalence of smoking in men of Chinese origin in the health survey for England 1999 was 17% compared with 31% in the fourth national survey of ethnic minorities (1993-4). The prevalence for African-Caribbean men was 29% in the 1992 survey of black and ethnic minority groups in England6 and 42% in the fourth national survey of ethnic minorities.5
Table 1 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current tobacco consumption in national studies according to ethnic origin
Table 2 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current tobacco consumption in local studies according to ethnic origin
Cotinine, a derivative of nicotine, can indicate whether a person smokes (at levels on or above 15 mg/ml) or has had recent exposure to tobacco smoke through passive smoking.2 In the health survey for England 1999 when the prevalence of smoking was adjusted for cotinine it was substantially higher for men from most ethnic minorities except for the Chinese (table 1). For example, 53% of Bangladeshi men reported that they used any tobacco product but the cotinine adjusted rate was 59%; in Bangladeshi women the equivalent figures were 27% and 38%. This level of discrepancy was not seen in the general population—for example, in women the figures were 27% and 29%, respectively. These figures show more inaccuracy of self reported data in most ethnic minority groups compared with populations of European origin.
Alcohol consumption
Table 3 shows considerable consistency between ethnic groups in the national studies for reported drinking among men. For women, however, the results were mixed. There was consistency between studies for Pakistani, Bangladeshi, African-Caribbean, Chinese, and European women. However, in Indian women differences existed—for example, in the fourth national survey of ethnic minorities 18% of Indian women reported drinking alcohol compared with 35% in the health survey for England 1999. Table 4 summarises data on alcohol consumption from local studies.
Table 3 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current alcohol consumption in national studies according to ethnic origin
Table 4 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current alcohol consumption in local studies according to ethnic origin
Survey methods
Using the 12 guidelines in box 2 we appraised publications and information obtained from nine of the 15 authors and the study by Pearson et al reporting only on smokeless tobacco.31 The health survey for England 1999 met three of the 12 guidelines and partially met one other.2 Three studies met three guidelines.5 6 26 Two of these studies were national,5 6 and one was a local study in Newcastle.26 Most studies fulfilled one or two of the guidelines. The findings are presented in categories—administrative aspects of the survey, source of questions, testing of questionnaires, piloting, and translation methods.
Table 5 shows that all national surveys included an interview. Most questionnaires were in dual language format, with the question written in English and the translation underneath. The health survey for England 1999 differed in that its translated questionnaires were exclusively in the target language with the interviewers' coding instructions in English. Five of the local studies did not translate their questionnaires (in writing), two being targeted at schoolchildren who could be assumed to speak English.
Table 5 Assessment of studies: background data
Ideally, survey questions should be based on consultation with lay people.32 Only four studies explicitly consulted with the community to design the English questionnaire (table 6). The surveys of black and ethnic minority groups in England in 1992 and 1994 used focus groups and individual interviews with ethnic minority people to develop the questionnaire.4 6
Table 6 Assessment of studies according to recommended criteria—original questionnaire
Only two studies reported that the questionnaire had been validated (table 6). However, they gave no details of the validation process and these could not be obtained from the authors. Information on reliability and responsiveness of the English questionnaires was not provided. Fourteen of the 15 studies carried out some piloting of research instruments (table 6). This varied from piloting the questionnaire in English only, to piloting it in different language versions in particular geographical areas to test appropriateness of wording and acceptability.3 4 5
Two of the studies explicitly engaged in a group translation process.26 29 All of the others used a single translator (table 7). The 1992 survey of black and ethnic minority groups in England involved consultations with the community to investigate sensitivity of questions and cultural taboos but did not seek their opinion on the accuracy, simplicity, and conceptual equivalence of the translation.6 During piloting the health survey for England 1999 sought the views of monolingual people on how understandable the questions were. Interviewees were asked to express any concerns to the interviewer that they may have had with the translated question.2
Table 7 Assessment of studies according to recommended criteria—translated questionnaire
None of the studies compared each language version of the questionnaire with every other language to check for linguistic and conceptual equivalence. Most of the studies (such as the fourth national survey of ethnic minorities5 and the health of minority groups 19992) compared translations to the original English version. Some, but not all, studies used the written back translation method to do this.6 26 29 30 None of the studies retested the translated questions for validity, reliability, or responsiveness.
Discussion
Gill PS, Kai J, Bhopal RS, Wild S. Health care needs assessment: black and minority ethnic groups. In: Raftery J, ed. The epidemiologically based needs assessment reviews. 3rd series. (In press.) http://hcna.radcliffe-oxford.com/inttext.htm
Erens B, Primatesta P, Prior G, eds. Health survey for England: the health of minority ethnic groups 1999. Vols 1 and 2. London: Stationery Office, 2001.
Sproston K, Pitson L, Whitfield G, Walker E. Health and lifestyles of the Chinese population in England. London: Health Education Authority, 2001.
Johnson M, Owen D, Blackburn C. Black and ethnic minority groups in England: the second health and lifestyles survey. London: Health Education Authority, 2000.
Nazroo J. The health of Britain's ethnic minorities—findings from a national survey. London: Policy Studies Institute, 1997.
Rudat K. Black and minority ethnic groups in England. London: Health Education Authority, 1994.
Deutscher I. Asking questions cross-culturally: some problems of linguistic comparability. In: Warwick D, Osherson S, eds. Comparative research methods. New Jersey: Prentice Hall, 1973: 163-88.
Herdman M, Fox-Rushby J, Badia X. A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Qual Life Res 1998;7: 323-35.
Hunt SM. Cross-cultural comparability of quality of life measures. In: Gugenmoos-Holzman I, Bloomfield K, Brenner H, Flick U, eds. Quality of life and health: concepts, methods and applications. Berlin: Blackwell Wissenschaft-Verlag, 1995: 15-26.
Hunt SM. Cross-cultural issues in the use of quality of life measures in randomized controlled trials. In: Staquet M, Hays R, Fayers P, eds. Quality of life assessment in clinical trials. Oxford: Oxford University Press, 1998: 51-64.
Aaronson N, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organisation for Research and Treatment of Cancer (EORTC). A quality of life instrument for use in international clinical trials in oncology. J Nat Cancer Inst 1993;85: 365-76.
Bullinger M. Ensuring international equivalence of quality of life measures. In: Orley J, Kuykken W, eds. Quality of life assessment: international perspectives. Berlin: Springer, 1994: 33-40.
Hendricson WD, Russell JI, Prihoda TJ, Jacobson JM, Rogan A, Bishop GD. An approach to developing a valid Spanish language translation of a health status questionnaire. Med Care 1989;27: 959-66.
Hunt SM, Alonso J, Bucquet D, Niero M, Wiklind I, McKenna S. Cross-cultural adaptation of health measures. Health Policy 1991;19: 33-44.
Guillemin F, Bombardier C, Beaton D. The cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. J Clin Epidemiol 1993;46: 1417-32
Szabo S. The World Health Organization quality of life (WHOQOL) assessment instrument. In: Spilker B, ed. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Pennsylvania: Raven Publishers, 1996: 355-62.
Triandis H. Major theoretical and methodological issues in cross-cultural psychology. In: Dawson J, Lonner W, eds. Readings in cross-cultural psychology. Hong Kong: Hong Kong University Press, 1974: 26-38.
Hunt SM. Subjective health of older women. Qual Life Res 2000;9: 709-19.
European Group for Quality of Life Assessment and Health Measurement. European guide to the Nottingham health profile. Montpellier: Verret, 1992.
Herdman M, Fox-Rushby J, Badia X. `Equivalence' and the translation and adaptation of health-related quality of life questionnaires. Qual Life Res 1997;6: 237-47.
Kohli HS. A comparison of smoking and drinking among Asian and white school-children in Glasgow. Public Health 1989;103: 433-9.
Williams R, Bhopal R, Hunt K. Health of a Punjabi ethnic minority in Glasgow: a comparison with the general population. J Epidemiol Community Health 1993;47: 96-102.
Denscombe M. Ethnic group and alcohol consumption: the case of 15-16 year olds in Leicestershire. Public Health 1995;109: 133-42.
Denscombe M, Drucquer N. Diversity within ethnic groups: alcohol and tobacco consumption by young people in the East Midlands. Health Educ J 2000;59: 340-50.
White M, Harland J, Bhopal R, Unwin N. Smoking and alcohol consumption in a UK Chinese population. Public Health 2001;115: 62-9.
Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti K, et al. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999;319: 215-20.
Summers RM, Williams SA, Curzon ME. The use of tobacco and betel quid ('paan') among Bangladeshi women in West Yorkshire. Community Dent Health 1994;11: 12-6.
Shetty K, Johnson N. Knowledge, attitudes and beliefs of adult South Asians living in London regarding risk factors and signs for oral cancer. Community Dent Health 1999;16: 227-31.
Ahmed S, Rahman A, Hull S. Use of betel quid and cigarettes among Bangladeshi patients in an inner-city practice: prevalence and knowledge of health effects. Br J Gen Pract 1997;47: 431-4.
Cochrane R, Bal S. The drinking habits of Sikh, Hindu, Muslim and white men in the West Midlands. Br J Addict 1990;85: 759-69.
Pearson N, Croucher R, Marcens W, O'Farrell M. Dental service use and the implications for oral cancer screening in a sample of Bangladeshi adult medical care users living in Tower Hamlets, UK. Br Dent J 2001;186: 517-21.
Hunt SM, McEwan J, McKenna SP. Measuring health status. Cheltenham: Croom Holm, 1986.
Vettini A, Bhopal R, Hunt S, Wiebe S, Hanna L, Amos A. Measurement of risk factors for cancer in ethnicity and health research: a case study of tobacco and alcohol. Edinburgh: University of Edinburgh, 2001: 1-132.
Bowden A, Fox-Rushby JA. A systematic and critical review of the process of translation and adaptation of generic health-related quality of life measures in Africa, Asia, Eastern Europe, the Middle East, South America. Soc Sci Med 2003;57: 1289-306
Stewart AL, Napoles-Springer A. Health-related quality-of-life assessments in diverse population groups in the United States. Med Care 2000;38(suppl II): 102-24.
Hunt S, Bhopal R. Self report in research with non-English speakers. BMJ 2003;327: 352-3.(Raj Bhopal, professor of )
Correspondence to: R Bhopal Raj.Bhopal@ed.ac.uk
Abstract
Cancers and cardiovascular disease are dominant causes of death in Britain's ethnic minority groups.1 The prevention of such disorders requires accurate information about health related behaviour such as the amount and pattern of consumption of tobacco and alcohol. Such information is usually acquired by self completed questionnaires or schedules administered by interviewers, sometimes validated by biochemical and other tests.
Patterns of tobacco and alcohol consumption in ethnic minority groups in the United Kingdom show substantial differences from those of white populations of European origin.2-6 For example, in the health survey for England in 1999 Bangladeshi men self reported a smoking prevalence of 44% compared with 27% for the general population of men, with Chinese men reporting 17%.2 For alcohol consumption even bigger differences seem to exist. Nazroo found that only 4% of Pakistani men reported drinking more than once a week compared with 69% of white men.5 Are these differences accurate or a result of study artefact?
Most survey instruments on tobacco and alcohol consumption by ethnic minorities were developed for English speaking people and translated into other languages. To compare data across language groups the items on the questionnaire, the instructions given, and the responses obtained should be conceptually and functionally equivalent in each language.7-10 If reliability and validity for each language varies, comparisons across groups may be invalid. Translation is a vital step in the process.
Highly educated translators from professional backgrounds may use the "high" form of a language in translation, when the "low" or colloquial form is more appropriate. The best epidemiological studies have used back translation, whereby the original instrument is translated, a second translator translates this back into English, and the two versions are compared. This may, however, be insufficient. People who speak different languages may interpret concepts, words, or phrases in different ways, and cultural differences may render some questions offensive, irrelevant, or inappropriate. The social, cultural, and religious taboos and norms of particular ethnic minority groups may affect the self reporting of tobacco and alcohol consumption. For example, Sikhs are prohibited by their religion from smoking, and Muslims are prohibited from drinking alcohol. It is socially unacceptable for women from several ethnic minority groups to smoke or to drink. These factors could lead to misreporting among these groups.
There are two main ways to develop a cross cultural instrument: firstly, design different language versions in parallel to produce linguistically equivalent items and, secondly, adapt a single language version for use in other languages. We have examined the adaptation of single language versions, the approach most commonly used. Adaptation of questionnaires requires an extensive process, which has been described by several authors (box 1).10-17 In practice it may not be possible to achieve this ideal—for example, comparing every language version with every other requires people who are bilingual in the languages concerned, but investigators may not be able to recruit someone who is familiar with both Cantonese and Bengali. Even in questionnaires designed for English speaking samples, there may be dissent as to the meaning, interpretation, and appropriateness of some items.18
The quality of data obtained from surveys of non-English speakers may be compromised by inadequacies in the translation procedures, failure to compare questionnaire content across languages, failure to consider the cultural appropriateness of items for use with English speakers, and lack of standardisation in terminology, sampling, and the grouping of samples.
We established whether previous studies that measured prevalence of tobacco and alcohol use in ethnic minority groups in the United Kingdom applied guidelines for cross cultural research (box 2) and looked for evidence of inconsistency in the empirical findings that might indicate problems.
Methods
Tobacco
Tables 1 and 2 show the reported prevalence of tobacco consumption by ethnic group in 14 studies.2-6 21-29 We were able to compare the five national studies because they had similar aims, but the local studies were too different to permit comparisons. The results from the national studies showed important discrepancies (table 1). For example, in Bangladeshi women in the health survey for England the prevalence of cigarette smoking was 1% compared with 6% in the survey of black and minority ethnic groups in 1994.4 The prevalence of smoking in men of Chinese origin in the health survey for England 1999 was 17% compared with 31% in the fourth national survey of ethnic minorities (1993-4). The prevalence for African-Caribbean men was 29% in the 1992 survey of black and ethnic minority groups in England6 and 42% in the fourth national survey of ethnic minorities.5
Table 1 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current tobacco consumption in national studies according to ethnic origin
Table 2 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current tobacco consumption in local studies according to ethnic origin
Cotinine, a derivative of nicotine, can indicate whether a person smokes (at levels on or above 15 mg/ml) or has had recent exposure to tobacco smoke through passive smoking.2 In the health survey for England 1999 when the prevalence of smoking was adjusted for cotinine it was substantially higher for men from most ethnic minorities except for the Chinese (table 1). For example, 53% of Bangladeshi men reported that they used any tobacco product but the cotinine adjusted rate was 59%; in Bangladeshi women the equivalent figures were 27% and 38%. This level of discrepancy was not seen in the general population—for example, in women the figures were 27% and 29%, respectively. These figures show more inaccuracy of self reported data in most ethnic minority groups compared with populations of European origin.
Alcohol consumption
Table 3 shows considerable consistency between ethnic groups in the national studies for reported drinking among men. For women, however, the results were mixed. There was consistency between studies for Pakistani, Bangladeshi, African-Caribbean, Chinese, and European women. However, in Indian women differences existed—for example, in the fourth national survey of ethnic minorities 18% of Indian women reported drinking alcohol compared with 35% in the health survey for England 1999. Table 4 summarises data on alcohol consumption from local studies.
Table 3 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current alcohol consumption in national studies according to ethnic origin
Table 4 Questions asked to obtain prevalence data and prevalence (percentage) of self reported current alcohol consumption in local studies according to ethnic origin
Survey methods
Using the 12 guidelines in box 2 we appraised publications and information obtained from nine of the 15 authors and the study by Pearson et al reporting only on smokeless tobacco.31 The health survey for England 1999 met three of the 12 guidelines and partially met one other.2 Three studies met three guidelines.5 6 26 Two of these studies were national,5 6 and one was a local study in Newcastle.26 Most studies fulfilled one or two of the guidelines. The findings are presented in categories—administrative aspects of the survey, source of questions, testing of questionnaires, piloting, and translation methods.
Table 5 shows that all national surveys included an interview. Most questionnaires were in dual language format, with the question written in English and the translation underneath. The health survey for England 1999 differed in that its translated questionnaires were exclusively in the target language with the interviewers' coding instructions in English. Five of the local studies did not translate their questionnaires (in writing), two being targeted at schoolchildren who could be assumed to speak English.
Table 5 Assessment of studies: background data
Ideally, survey questions should be based on consultation with lay people.32 Only four studies explicitly consulted with the community to design the English questionnaire (table 6). The surveys of black and ethnic minority groups in England in 1992 and 1994 used focus groups and individual interviews with ethnic minority people to develop the questionnaire.4 6
Table 6 Assessment of studies according to recommended criteria—original questionnaire
Only two studies reported that the questionnaire had been validated (table 6). However, they gave no details of the validation process and these could not be obtained from the authors. Information on reliability and responsiveness of the English questionnaires was not provided. Fourteen of the 15 studies carried out some piloting of research instruments (table 6). This varied from piloting the questionnaire in English only, to piloting it in different language versions in particular geographical areas to test appropriateness of wording and acceptability.3 4 5
Two of the studies explicitly engaged in a group translation process.26 29 All of the others used a single translator (table 7). The 1992 survey of black and ethnic minority groups in England involved consultations with the community to investigate sensitivity of questions and cultural taboos but did not seek their opinion on the accuracy, simplicity, and conceptual equivalence of the translation.6 During piloting the health survey for England 1999 sought the views of monolingual people on how understandable the questions were. Interviewees were asked to express any concerns to the interviewer that they may have had with the translated question.2
Table 7 Assessment of studies according to recommended criteria—translated questionnaire
None of the studies compared each language version of the questionnaire with every other language to check for linguistic and conceptual equivalence. Most of the studies (such as the fourth national survey of ethnic minorities5 and the health of minority groups 19992) compared translations to the original English version. Some, but not all, studies used the written back translation method to do this.6 26 29 30 None of the studies retested the translated questions for validity, reliability, or responsiveness.
Discussion
Gill PS, Kai J, Bhopal RS, Wild S. Health care needs assessment: black and minority ethnic groups. In: Raftery J, ed. The epidemiologically based needs assessment reviews. 3rd series. (In press.) http://hcna.radcliffe-oxford.com/inttext.htm
Erens B, Primatesta P, Prior G, eds. Health survey for England: the health of minority ethnic groups 1999. Vols 1 and 2. London: Stationery Office, 2001.
Sproston K, Pitson L, Whitfield G, Walker E. Health and lifestyles of the Chinese population in England. London: Health Education Authority, 2001.
Johnson M, Owen D, Blackburn C. Black and ethnic minority groups in England: the second health and lifestyles survey. London: Health Education Authority, 2000.
Nazroo J. The health of Britain's ethnic minorities—findings from a national survey. London: Policy Studies Institute, 1997.
Rudat K. Black and minority ethnic groups in England. London: Health Education Authority, 1994.
Deutscher I. Asking questions cross-culturally: some problems of linguistic comparability. In: Warwick D, Osherson S, eds. Comparative research methods. New Jersey: Prentice Hall, 1973: 163-88.
Herdman M, Fox-Rushby J, Badia X. A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach. Qual Life Res 1998;7: 323-35.
Hunt SM. Cross-cultural comparability of quality of life measures. In: Gugenmoos-Holzman I, Bloomfield K, Brenner H, Flick U, eds. Quality of life and health: concepts, methods and applications. Berlin: Blackwell Wissenschaft-Verlag, 1995: 15-26.
Hunt SM. Cross-cultural issues in the use of quality of life measures in randomized controlled trials. In: Staquet M, Hays R, Fayers P, eds. Quality of life assessment in clinical trials. Oxford: Oxford University Press, 1998: 51-64.
Aaronson N, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. The European Organisation for Research and Treatment of Cancer (EORTC). A quality of life instrument for use in international clinical trials in oncology. J Nat Cancer Inst 1993;85: 365-76.
Bullinger M. Ensuring international equivalence of quality of life measures. In: Orley J, Kuykken W, eds. Quality of life assessment: international perspectives. Berlin: Springer, 1994: 33-40.
Hendricson WD, Russell JI, Prihoda TJ, Jacobson JM, Rogan A, Bishop GD. An approach to developing a valid Spanish language translation of a health status questionnaire. Med Care 1989;27: 959-66.
Hunt SM, Alonso J, Bucquet D, Niero M, Wiklind I, McKenna S. Cross-cultural adaptation of health measures. Health Policy 1991;19: 33-44.
Guillemin F, Bombardier C, Beaton D. The cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. J Clin Epidemiol 1993;46: 1417-32
Szabo S. The World Health Organization quality of life (WHOQOL) assessment instrument. In: Spilker B, ed. Quality of life and pharmacoeconomics in clinical trials. 2nd ed. Pennsylvania: Raven Publishers, 1996: 355-62.
Triandis H. Major theoretical and methodological issues in cross-cultural psychology. In: Dawson J, Lonner W, eds. Readings in cross-cultural psychology. Hong Kong: Hong Kong University Press, 1974: 26-38.
Hunt SM. Subjective health of older women. Qual Life Res 2000;9: 709-19.
European Group for Quality of Life Assessment and Health Measurement. European guide to the Nottingham health profile. Montpellier: Verret, 1992.
Herdman M, Fox-Rushby J, Badia X. `Equivalence' and the translation and adaptation of health-related quality of life questionnaires. Qual Life Res 1997;6: 237-47.
Kohli HS. A comparison of smoking and drinking among Asian and white school-children in Glasgow. Public Health 1989;103: 433-9.
Williams R, Bhopal R, Hunt K. Health of a Punjabi ethnic minority in Glasgow: a comparison with the general population. J Epidemiol Community Health 1993;47: 96-102.
Denscombe M. Ethnic group and alcohol consumption: the case of 15-16 year olds in Leicestershire. Public Health 1995;109: 133-42.
Denscombe M, Drucquer N. Diversity within ethnic groups: alcohol and tobacco consumption by young people in the East Midlands. Health Educ J 2000;59: 340-50.
White M, Harland J, Bhopal R, Unwin N. Smoking and alcohol consumption in a UK Chinese population. Public Health 2001;115: 62-9.
Bhopal R, Unwin N, White M, Yallop J, Walker L, Alberti K, et al. Heterogeneity of coronary heart disease risk factors in Indian, Pakistani, Bangladeshi, and European origin populations: cross sectional study. BMJ 1999;319: 215-20.
Summers RM, Williams SA, Curzon ME. The use of tobacco and betel quid ('paan') among Bangladeshi women in West Yorkshire. Community Dent Health 1994;11: 12-6.
Shetty K, Johnson N. Knowledge, attitudes and beliefs of adult South Asians living in London regarding risk factors and signs for oral cancer. Community Dent Health 1999;16: 227-31.
Ahmed S, Rahman A, Hull S. Use of betel quid and cigarettes among Bangladeshi patients in an inner-city practice: prevalence and knowledge of health effects. Br J Gen Pract 1997;47: 431-4.
Cochrane R, Bal S. The drinking habits of Sikh, Hindu, Muslim and white men in the West Midlands. Br J Addict 1990;85: 759-69.
Pearson N, Croucher R, Marcens W, O'Farrell M. Dental service use and the implications for oral cancer screening in a sample of Bangladeshi adult medical care users living in Tower Hamlets, UK. Br Dent J 2001;186: 517-21.
Hunt SM, McEwan J, McKenna SP. Measuring health status. Cheltenham: Croom Holm, 1986.
Vettini A, Bhopal R, Hunt S, Wiebe S, Hanna L, Amos A. Measurement of risk factors for cancer in ethnicity and health research: a case study of tobacco and alcohol. Edinburgh: University of Edinburgh, 2001: 1-132.
Bowden A, Fox-Rushby JA. A systematic and critical review of the process of translation and adaptation of generic health-related quality of life measures in Africa, Asia, Eastern Europe, the Middle East, South America. Soc Sci Med 2003;57: 1289-306
Stewart AL, Napoles-Springer A. Health-related quality-of-life assessments in diverse population groups in the United States. Med Care 2000;38(suppl II): 102-24.
Hunt S, Bhopal R. Self report in research with non-English speakers. BMJ 2003;327: 352-3.(Raj Bhopal, professor of )