Available online at www.sciencedirect.com journal homepage: www.elsevier.com/locate/vhri The Living with Medicines Questionnaire: Translation and Cultural Adaptation into the Arabic Context Amani Zidan, BScPharm 1 , Ahmed Awaisu, PhD 1 , Sanah Hasan, PhD 2 , Nadir Kheir, PhD 1, * 1 Qatar University College of Pharmacy, Doha, Qatar; 2 College of Pharmacy, Sharjah University, Sharjah, United Arab Emirates ABSTRACT Background: The Living with Medicines Questionnaire (LMQ) was devel- oped in English language to assess, from a patient’s perspective, issues related to the burden resulting from the use of medicines. Objectives: To translate and culturally adapt the LMQ into the Arabic language and context. Methods: Permission to translate the LMQ was obtained from the original developers, and a protocol for its translation and cultural adaptation was developed using the International Society for Pharmacoeconomics and Outcomes Research guidelines for the translation and cultural adaptation of patient-reported outcome measures. Two forward translations (from English into Arabic) were developed and compared to produce the first reconciled version, which was back-translated into English. The resulting English version was compared with the original questionnaire leading to the second reconciled version. The emerged Arabic questionnaire was then cognitively tested among purposively selected individuals to assess the linguistic and cultural equivalence, and produce the final Arabic version. Results: Issues identified and related to cul- tural and conceptual equivalence of some terms were resolved by rewording some items in the tool. The translation process and cognitive debriefing exercise generated comments regarding the original tool’s construct and its Arabic equivalent, which were communicated to the developers of the LMQ for their consideration while conducting further comparative studies. Conclusions: A cul- turally suitable translation of the LMQ was generated for potential use in research and clinical practice in Arabic-speaking countries. Further validation of the developed Arabic version is recommended and planned. Keywords: cultural adaptation, medication burden, questionnaire, polypharmacy, translation. Copyright & 2016, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. Highlights  Medication burden has a negative effect on patients’ lives and is associated with adverse drug events.  In this study, a culturally adapted Arabic version of the Living with Medicines Questionnaire was developed. This question- naire was originally developed in English to assess medica- tion burden from a patient’s perspective.  The translated version could be used in clinical practice and/or research where it is important to assess burden related to medi- cation intake. This, in turn, could inform designing of interven- tions aiming at providing minimally disruptive health care. Introduction Patients on multiple drug therapy and those with comorbidities are highly prone to drug-related problems [1]. The number of these at-risk patients is on the rise worldwide [2]. Polypharmacy, which is the use of several medications simultaneously, has been associated with increased morbidity and mortality, hospitaliza- tions, and demand for nursing home care [1,3]. Polypharmacy could also increase medication burden and may result in drug- related consequences, such as poor adherence, adverse drug reactions, and unnecessary drug therapy [4,5]. Medication burden could still occur in patients using any number of medications, when considering the negative feelings and experiences related to those medications [6]. Identification, prevention, and resolution of drug-related problems are considered the main responsibilities of a pharma- ceutical care (PC) provider [7]. Consequently, an effective PC practice, with its patient-centered philosophy and outcome- oriented tenets, should, hypothetically, lead to reduced burden of drug therapy. Given that patients’ perspectives on issues related to the use of medicines are arguably different from those of health care providers, more attention has been drawn toward assessing the burden of drug therapy from the perspective of the patient in recent years [6,8,9]. Consequently, the assessment of the burden of medicine use from the patient’s viewpoint is an important element in providing PC because it will help to identify 2212-1099$36.00 – see front matter Copyright & 2016, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. http://dx.doi.org/10.1016/j.vhri.2016.07.001 Conflicts of interest: The authors have indicated that they have no conflicts of interest with regard to the content of this article. E-mail: nadirk@qu.edu.qa. * Address correspondence to: Nadir Kheir, Clinical Pharmacy and Practice Section, Qatar University College of Pharmacy, P.O. Box 2713, Doha, Qatar. VALUE IN HEALTH REGIONAL ISSUES 10C (2016) 36 – 40