# Cultural adaptation of a self-review tool for health promoting universities in Bulgaria

## TL;DR

This paper describes adapting a UK health promotion self-review tool for use in Bulgarian universities to support health initiatives.

## Contribution

The study provides a culturally adapted Bulgarian version of a health promoting university self-review tool.

## Key findings

- A four-stage cultural adaptation process was applied to the Self-Review-Tool (SRT).
- 61 out of 68 elements in the SRT were modified based on feedback and expert consensus.
- The adapted tool addresses challenges like unclear terminology and limited applicability in the Bulgarian context.

## Abstract

The Health Promoting University initiative is unknown in Bulgaria, and the health promotion potential of Bulgarian universities has not been studied. In order to examine it, a suitable instrument is needed. The UK Healthy Universities Network provides an accessible Self-Review-Tool (SRT). Aim: To present the process of cultural adaptation of the SRT in Bulgarian language.

The standardized WHO methodology for cultural adaptation of instruments was followed in four stages: (1) Two language translations of the instrument into Bulgarian were made; (2) An expert Delphi discussion reached a consensus on specific health promoting (HP) terms, followed by a backward translation; (3) Pilot testing of the tool among university community representatives was conducted through a survey among a small sample, with independent responses to the SRT questionnaire followed by cognitive interviews; (4) Final revision of the instrument.

Ten public health experts reached a consensus on the name of the initiative and various HP terms. Ten other respondents pre-tested the tool. Difficulties in responding the SRT concerned the meaning of some HP terms, complex words, the system of answers, limited applicability of some statements. Changes were made to 61 of the total 68 elements in the SRT.

All stages of the cultural adaptation were important for the final result. The adapted Bulgarian version of the SRT would be useful to Bulgarian universities that want to make a clear commitment to improving the health of their university community and the wider society.