Abstract
BACKGROUND: The Quality Maternal and Newborn Care Framework index (QMNCFi) is a validated English-language instrument developed to assess women's experiences during pregnancy, childbirth, and the postnatal period. These experiences include respect, dignity, communication, continuity of care, and involvement in decision-making. Despite Arabic being spoken in 22 countries, substantial variations exist in dialects, terminology, and healthcare practices. Because maternity care models, communication styles, and clinical terminology vary across Arabic-speaking contexts, ensuring semantic and experiential equivalence is essential when adapting the QMNCFi for use in Middle Eastern settings. This study aimed to translate and culturally adapt the QMNCFi into Arabic and to document the international collaborative methodological process supporting this adaptation. METHODS: We followed an internationally recognized six-stage approach for translation and cultural adaptation (forward translation, synthesis, back translation, expert committee review, pre-final testing, and finalization). Two research teams, representing institutions across five countries, collaborated under a unified protocol. Cognitive interviews were conducted with 48 postpartum participants in Palestine and the Kingdom of Saudi Arabia. RESULTS: Refinements included adding a country identifier within demographic items to distinguish data collection sites, aligning demographic categories (e.g., education and income/currency), clarifying items with context-relevant examples, and adding "not applicable" where appropriate. These adjustments improved clarity and contextual fit without altering item order or scoring. Inter-rater agreement reached 99.1%, exceeding the a priori 80% benchmark. Operational challenges, including ethics approvals, data-sharing restrictions, supervision structures, and cross-site coordination, were addressed through structured mentorship, version-controlled documentation, and regular joint meetings. CONCLUSION: A shared language did not ensure semantic or experiential equivalence. Addressing institutional, regulatory, capacity, and linguistic factors was essential for developing a usable Arabic QMNCFi. This work provides a transparent methodological guideline for same-language, multi-country adaptation of health measurement tools and prepares the Arabic QMNCFi for psychometric validation and future implementation in Arabic-speaking maternity care settings.