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…

The purposes of this article are, first, to argue that analyses based on level of treatment implementation can lead to biased estimates of treatment effects, and second, to discuss alternatives to this approach. (PN)