Translation and cultural adaption of Chinese Health and Self-Management in Diabetes Questionnaire

Abstract Background This study aimed to translate and culturally adapt the HASMID into Chinese to support future cost-effectiveness analyses of diabetes-related interventions and policies. Methods Translating the HASMID from English to Chinese involves initial translation by two bilingual experts familiar with the medical context, followed by two back-translations to ensure accuracy. A review committee then reconciles discrepancies. Cognitive interviews with individuals with diabetes and healthy adults are conducted to evaluate the translated version's clarity, comprehensibility, and relevance to confirm cultural and linguistic appropriateness. Results A total of 30 interviews were conducted (10 with healthy individuals, 5 with type 1 diabetes, and 15 with type 2 diabetes). Cognitive debriefing showed good comprehension of the HASMID's Mood, Vitality, Hassle, and Stress dimensions, with participants understanding item intent and offering wording feedback. The term ‘hypoglycaemic attacks’ was often unclear, perceived as clinical or abstract. Participants related to symptoms like ‘dizziness’ and ‘fatigue,’ suggesting these culturally familiar terms improve clarity, especially for lower health literacy groups. ‘Mealtime limitations’ was misinterpreted as lifestyle-related rather than diabetes-specific, prompting a recommendation to add ‘due to diabetes’ for clarity (‘Diabetes forces fixed mealtimes, declining social dinners’). The phrase ‘ability to control’ was preferred for its autonomy, with ‘controlling blood sugar’ aligning with Cantonese usage (‘Control targets diet, not disease’). Conclusions This study developed a culturally adapted Chinese version of the HASMID questionnaire through meticulous translation and cognitive debriefing with Hong Kong residents. The Chinese HASMID version exhibits strong content validity, making it suitable for evaluating diabetes-related quality of life and self-management in Hong Kong's population. Key messages • The culturally adapted Chinese HASMID questionnaire demonstrates strong content validity for assessing diabetes-related quality of life and self-management in Hong Kong's population. • Cognitive interviews revealed the need for clearer, culturally relevant terms like “dizziness” for “hypoglycaemic attacks” and explicit diabetes references to enhance comprehension and relevance.