Conventional translation strategies are limited because they enshrine deficiencies of the original questionnaire and do not permit modifications that reflect differences in culture and values. An alternative philosophy would require a conceptual definition of what one wanted to measure and would allow flexibility in the methods to achieve this goal. If an investigator had considerable time and resources, he or she could replicate the process used to construct the original English language questionnaire. With very limited resources, he or she could still omit irrelevant items, include new items, and modify the wording of questions and response options. This new philosophy allows improvement in content and presentation, and moves away from the hegemony of the American middle-class outlook in quality of life questionnaires.