Cross-cultural Validation Methods for Generic PROMs

Project Summary

Multiculturalism is highly valued and present in Canadian society.

In British Columbia (BC), based on Statistics Canada (2016), more than 200 ethnic groups are reported in Greater Vancouver. About 42% of the population is made up of visible minorities. There is a need for enhancing the representation of culturally diverse populations in patient-centred measurement surveys.


Patient-reported outcome measures (PROMs) are increasingly used in patient surveys to obtain information about patients’ perspectives of their health outcomes, including their symptoms and physical, emotional, and social wellbeing.

Although many PROMs have been translated into different languages, it is unknown to what extent these translated versions equivalently represent people’s perspectives from different cultural traditions.


Our project tested the VR-12’s Chinese translations using our newly developed psychometric methods and engaged Chinese-speaking immigrants to uncover their perspectives on, experiences with, and needs for BC health care.

Project Findings

Our project developed a “patient-oriented cross-cultural measurement validation methodology” using:

  • Psychometric (psychological measurement) engagement methods
  • Community consultation and engagement methods


Psychometric engagement with the VR-12

We developed novel multivariate statistical models, then used them to demonstrate that the two Chinese language versions of the VR-12 equivalently represent the perspectives of respondents who chose either the Simplified or Traditional Chinese language versions.

Further research will test each Chinese language version against the original English version.


Community consultation and engagement

In our community consultation and engagement process, we engaged Chinese-speaking immigrants, who tended to prefer to complete questionnaires in Simplified or Traditional Chinese.

Five main findings emerged:

In general, the translated two VR-12 Chinese versions are applicable to uncover patients’ basic needs (physical & mental health) and health outcomes.

However, more concepts need to be included to uncover more comprehensive health needs and outcomes, such as:

  • Chinese yin-yang health beliefs practices
  • Length of stay in Canada
  • Acculturation level into Canadian culture
  • Values and language abilities

Participants expressed their needs from the existing healthcare system in BC to provide diversity and inclusion care programs to commensurate their Chinese Yin-yang health beliefs embedded in their unique cultural background.

For example, participants emphasized:

  • Traditional Chinese Medicine (TCM)
  • Physicians to be educated in their medical school training about patients’ lived experiences due to their cultural upbringing

Participants expressed a significant need for language translation support, especially for new immigrants, for example, the need for Chinese-speaking doctors to understand and communicate with them.

Participants shared their difficulties in booking an appointment with their GP or specialist. The resources available to them are limited—especially for new Chinese-speaking immigrants.

The responses to the translated VR-12, and the community consultation and engagement process, uncovered urgent mental health needs among the Chinese-speaking participants. The COVID-19 pandemic has enhanced the severity of this issue and need.

Participants expressed a need for mental health professionals who understand their cultural backgrounds. Finding appropriate mental health professionals is especially difficult for new immigrants, who have struggled to find Chinese-speaking providers.

This project is part of the Patient-Centred Measurement Cluster.


Dr. Tina Wu, PI ✉︎
Dr. Bruno D. Zumbo, PI ✉︎
Dr. Richard Sawatzky, Co-PI
Sophie Ma Zhu
Xuyan Tang
Kyle Dewsnap
Nancy Zhang
Clark Tang
Qunguanyi Xu
Dr. Keith Chan
Dr. Cynthia Chan