Key result
Urdu adaptation of the MLHFQ successfully achieves cultural and linguistic accuracy for Pakistani patients.
Why the study?
Evidence on cross-cultural adaptation of health-related quality of life tools for chronic illnesses is limited, particularly for Urdu speakers in Pakistan.
This study provides a systematically adapted and culturally relevant Pakistani Urdu version of the MLHFQ, enabling reliable assessment of health-related quality of life for heart failure patients in this population.
May support HRQoL assessment in Pakistani Urdu-speaking HF patients; extends MLHFQ adaptation but leaves psychometric validation open.
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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Gowani et al. (2026) studied Heart Failure (n=4). Cross-cultural adaptation of the Minnesota Living with Heart Failure Questionnaire (MLHFQ) was evaluated on Linguistic accuracy, cultural relevance, and comprehensiveness of the translated MLHFQ. The Minnesota Living with Heart Failure Questionnaire was successfully adapted for Urdu-speaking patients in Pakistan, identifying four themes of methodological challenges and adaptation strategies.
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