# German translation, cultural adaptation and linguistic validation of the PedsQL healthcare satisfaction module

## TL;DR

This paper describes the translation and adaptation of a healthcare satisfaction questionnaire for use in Germany, ensuring it is culturally appropriate and linguistically accurate.

## Contribution

The paper provides a validated German version of the PedsQL Healthcare Satisfaction Generic Module for pediatric surgery contexts.

## Key findings

- A preliminary version of the questionnaire was tested with caregivers, revealing areas for improvement.
- Ten major and nine minor issues were identified and addressed through qualitative content analysis.

## Abstract

Healthcare satisfaction (HCS) is a crucial patient-reported outcome that is essential for evaluating medical care quality from the patient’s viewpoint and may also significantly impact other patient-reported outcome measures. However, currently validated German instruments lack a generic focus, which is essential for treating various diagnoses in pediatric surgery contexts. This study presents the translation and cultural adaptation of the PedsQL Healthcare Satisfaction Generic Module (HCSGM) for Germany.

The PedsQL 3.0 HCSGM is a 24-item questionnaire assessing six dimensions: information, family inclusion, communication, technical skills, emotional needs, and overall satisfaction. After two independent forward translations and a back translation, a preliminary version was tested with caregivers of 10 patients who provided feedback using the thinking-aloud technique while completing the questionnaire. Interviews were analyzed using qualitative content analysis (QCA), leading to the final German version of the HCSGM.

The initial consensus meeting after the forward translations identified five areas for improvement. The backward translation was approved with no further changes. QCA revealed ten major and nine minor issues, which resulted in ten modifications to item wordings, question-wording, verbal anchors of answer options, and layout during a second consensus meeting. Those modifications resulted in the final version also being approved by the original authors.

The German version of the PedsQL HCSGM is now available to measure HCS, a crucial PROM for clinical research and patient management. While qualitative methods have been employed to ensure equivalence, further studies should evaluate psychometric properties.

The online version contains supplementary material available at 10.1186/s12955-026-02492-1.