Translation and validation of the Hebrew Multimorbidity Treatment Burden Questionnaire—H-MTBQ—a research protocol

Multimorbidity is highly prevalent and consistently linked to increased treatment and administrative burden in vulnerable populations. The Multimorbidity Treatment Burden Questionnaire (MTBQ) has been validated across several languages and health systems, yet its applicability for Hebrew-speaking older patients has not been examined. In this protocol, we aim to translate, culturally adapt, and validate a Hebrew version of the MTBQ (H-MTBQ), and to explore variations in treatment burden among diverse groups of Israeli older adults living with multimorbidity. The protocol includes forward–backward translation, expert panel review, piloting through cognitive interviews with patients, and a large-scale survey of 135–140 Hebrew-speaking older adults, aged 60 and older, with multimorbidity (defined as the presence of two or more self-reported chronic conditions), according to the International Society for Quality-of-Life Research (ISOQOL) guidelines for Patient-Reported Outcome Measures (PROMs) for translation and cultural adaptation. Psychometric evaluation, guided by Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) recommendations, will assess reliability, factor structure, construct validity, and interpretability. Complementary measures include sociodemographic characteristics, multimorbidity evaluation, administrative burden, quality of life, health literacy, and medication adherence. The H-MTBQ protocol validation study will produce the first validated Hebrew measure of treatment burden in multimorbidity. Findings will support clinical decision-making, improve understanding of patient workload, and facilitate culturally appropriate care within the Israeli health care system, to be used in comparative global research efforts on treatment burden. Not applicable. The protocol is registered at Open Science Framework (OSF) on November 4, 2025. Retrieved from osf.io/9bqcd; https://osf.io/zwa53 . Not applicable.