Cross-cultural adaptation and face validity of the PREM-C9 version of the Patient Reported Experience Measure in patients with Chronic Obstructive Pulmonary Disease

Montse Moharra, Beatriu Bayés, Anna Llupià, Caritat Almazan



The 'Patient Reported Experience Measure in Chronic Obstructive Pulmonary Disease (PREM-C9)' is a scale developed and validated within the English healthcare context to better measure and understand the experience of patients with chronic obstructive pulmonary disease (COPD) and the care that they receive.


To cross-culturally adapt the PREM-C9 questionnaire into Catalan and Spanish.


The process to adapt the PREM-C9 questionnaire consisted of the following phases: production of a first consensus version in the target languages; Backtranslation; Cognitive debriefing; Face validity and Harmonisation. In the cognitive debriefing phase, the questionnaire was tested in a convenience sample of 10 patients with COPD (5 in Catalan and 5 in Spanish).


Forward (FT) and back translation (BT) stages Overall, the language used in the original version of the questionnaire did not cause substantial problems for translation into Catalan and Spanish.

Face validity and cognitive debriefing The content was considered relevant both by the health care professionals who participated in the assessment of face validity, and by the patients who participated in the cognitive interviews. However, some potentially relevant concepts were noted by patients and professionals as being lacking in the questionnaire.

Harmonisation It allowed the research team to pull together the best elements of the Catalan and Spanish versions and use them to optimise and align the wording in both.


By following a rigorous, multi-phase process of cultural adaptation, it was possible to produce versions in Catalan and Spanish of the PREMS-C9 questionnaire, which were acceptable to patients and health-care professionals.

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Hodson M, Roberts CM, Andrew S, Graham L, Jones PW, Yorke J. Development and first validation of a patient-reported experience measure in chronic obstructive pulmonary disease (PREM-C9). Thorax 2019;74(6):600-603.

Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P; ISPOR Task Force for Translation and Cultural Adaptation. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value Health. 2005 Mar-Apr;8(2):94-104.

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