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Cross-cultural adaptation of study instruments is a difficult, time-consuming, but arguably cost-effective process. If conducted properly, it has the advantage that the translated study instruments are accurate, easy to understand, accessible, and culturally appropriate to the target audience and produce reliable and valid data. This article explores issues, challenges, and solutions for translating a set of research instruments used in a randomized, controlled trial for four separate community languages (Chinese, Vietnamese, Greek, Italian).

Self-management programs are now regarded as important facets in the overall care of people with chronic illnesses. They are seen as producing long-lasting benefits both to participants and to the health system in terms of reduced hospitalisations and reduced lengths of stay, as well as decreasing medication usage. In this article we examine what constitutes self-management and the evidence supporting the views that the benefits are unequivocal. We argue that greater attention to research design is required before the benefits can be assessed. We also argue that greater attention must be paid to access issues for people from culturally and linguistically diverse backgrounds (CALD) and lower socioeconomic status.

These results demonstrate the multidimensional nature of the economic burden experienced at the end of life and imply the need for nuanced solutions to better support patients and their families. If terminally ill people wish to die at home and are to be supported to do so, policies must take account of the shift in economic burden from the health system onto families.

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