Logo of jepicomhJournal of Epidemiology and Community HealthVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Epidemiol Community Health. Apr 2003; 57(4): 259–263.
PMCID: PMC1732425

Chinese SF-36 Health Survey: translation, cultural adaptation, validation, and normalisation


Study objective: To develop a self administered Chinese (mainland) version of the Short-Form Health Survey (SF-36) for use in health related quality of life measurements in China.

Design: A three stage protocol was followed including translation, tests of scaling construction and scoring assumptions, validation, and normalisation.

Setting: 1000 households in 18 communities of Hangzhou.

Participants: 1688 respondents recruited by multi-stage mixed sampling.

Main results: The assumption of equal intervals was violated for the vitality and mental health scales. The recoded item values were used to calculate scale scores. The clustering and ordering of item means was the same as that of the source and other two Chinese versions. The items in each scale had similar standard deviations except those in the physical functioning, boduily pain, social functioning scales. The item hypothesised scale correlations were identical for all except the social functioning and vitality scales. Convergent validity and discriminant validity were satisfactory for all except the social functioning scale. Cronbach's α coefficients ranged from 0.72 to 0.88 except 0.39 for the social functioning scale and 0.66 for the vitality scale. Two weeks test-retest reliability coefficients ranged from 0.66 to 0.94. Factor analysis identified two principal components explaining 56.3% of the total variance. The Chinese SF-36 could distinguish known groups.

Conclusions: This study suggested that the Chinese (mainland) version of the SF-36 functioned in the general population of Hangzhou, China quite similarly to the original American population tested. Caution is recommended in the interpretation of the social functioning and vitality scales pending further studies.

Full Text

The Full Text of this article is available as a PDF (121K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Geigle R, Jones SB. Outcomes measurement: a report from the front. Inquiry. 1990 Spring;27(1):7–13. [PubMed]
  • van Campen C, Sixma H, Friele RD, Kerssens JJ, Peters L. Quality of care and patient satisfaction: a review of measuring instruments. Med Care Res Rev. 1995 Mar;52(1):109–133. [PubMed]
  • Till JE, Osoba D, Pater JL, Young JR. Research on health-related quality of life: dissemination into practical applications. Qual Life Res. 1994 Aug;3(4):279–283. [PubMed]
  • Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993 Dec;46(12):1417–1432. [PubMed]
  • Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed]
  • McHorney CA, Ware JE, Jr, Raczek AE. The MOS 36-Item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Med Care. 1993 Mar;31(3):247–263. [PubMed]
  • McHorney CA, Ware JE, Jr, Lu JF, Sherbourne CD. The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994 Jan;32(1):40–66. [PubMed]
  • Aaronson NK, Acquadro C, Alonso J, Apolone G, Bucquet D, Bullinger M, Bungay K, Fukuhara S, Gandek B, Keller S, et al. International Quality of Life Assessment (IQOLA) Project. Qual Life Res. 1992 Oct;1(5):349–351. [PubMed]
  • Perneger TV, Leplège A, Etter JF, Rougemont A. Validation of a French-language version of the MOS 36-Item Short Form Health Survey (SF-36) in young healthy adults. J Clin Epidemiol. 1995 Aug;48(8):1051–1060. [PubMed]
  • Bullinger M. German translation and psychometric testing of the SF-36 Health Survey: preliminary results from the IQOLA Project. International Quality of Life Assessment. Soc Sci Med. 1995 Nov;41(10):1359–1366. [PubMed]
  • Gandek B, Ware JE., Jr Methods for validating and norming translations of health status questionnaires: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol. 1998 Nov;51(11):953–959. [PubMed]
  • Ren XS, Amick B, 3rd, Zhou L, Gandek B. Translation and psychometric evaluation of a Chinese version of the SF-36 Health Survey in the United States. J Clin Epidemiol. 1998 Nov;51(11):1129–1138. [PubMed]
  • Lam CL, Gandek B, Ren XS, Chan MS. Tests of scaling assumptions and construct validity of the Chinese (HK) version of the SF-36 Health Survey. J Clin Epidemiol. 1998 Nov;51(11):1139–1147. [PubMed]
  • Fuh JL, Wang SJ, Lu SR, Juang KD, Lee SJ. Psychometric evaluation of a Chinese (Taiwanese) version of the SF-36 health survey amongst middle-aged women from a rural community. Qual Life Res. 2000;9(6):675–683. [PubMed]
  • Bullinger M, Alonso J, Apolone G, Leplège A, Sullivan M, Wood-Dauphinee S, Gandek B, Wagner A, Aaronson N, Bech P, et al. Translating health status questionnaires and evaluating their quality: the IQOLA Project approach. International Quality of Life Assessment. J Clin Epidemiol. 1998 Nov;51(11):913–923. [PubMed]
  • Ware JE, Jr, Keller SD, Gandek B, Brazier JE, Sullivan M. Evaluating translations of health status questionnaires. Methods from the IQOLA project. International Quality of Life Assessment. Int J Technol Assess Health Care. 1995 Summer;11(3):525–551. [PubMed]
  • McHorney CA, Kosinski M, Ware JE., Jr Comparisons of the costs and quality of norms for the SF-36 health survey collected by mail versus telephone interview: results from a national survey. Med Care. 1994 Jun;32(6):551–567. [PubMed]
  • Thumboo J, Fong KY, Machin D, Chan SP, Leon KH, Feng PH, Thio ST, Boe ML. A community-based study of scaling assumptions and construct validity of the English (UK) and Chinese (HK) SF-36 in Singapore. Qual Life Res. 2001;10(2):175–188. [PubMed]

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Group


Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...