OBJECTIVES: To facilitate international comparison of data, PRO translations must be conceptually equivalent to the original and culturally relevant to the target country. To assess the relevance of conducting a multi-step process on a PRO translation with the aim of using it on an immigrant population speaking that language in a different country, we investigated the presence and nature of differences between the 2 language versions thus obtained. METHODS: Three translations were compared before and after adaptation to the context of a host country: 1) the Turkish and German Turkish version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ); 2) the Indian Gujarati and UK Gujarati version of the Subject Self Report on Symptoms Worksheet (SSRSW); and 3) the Chinese Mandarin and US Mandarin version of the National Eye Institute Visual Functioning Questionnaire (NEI-VFQ-25). RESULTS: Six of the eight items in the Turkish DTSQ were modified following cognitive debriefing with Turkish speakers in Germany. The Turkish population in Germany tends to use more old-fashioned wording which doesn’t reflect the original language’s recent evolution. All four items in the Gujarati SSRSW needed changing when adapting it to a UK context. Some initially translated wording was reverted back to English, or substituted with transliterated English terms. In the Mandarin NEI-VFQ-25, out of 29 items, 11 were modified when adapting it for the USA. The language used in the initial translation was considered too basic for the target population in the USA, which tends to have a higher level of education. CONCLUSIONS: Immigrant language is affected by the host country’s culture and language, and/or by separation from the mother country, and is no longer fully comparable with the language in the country of origin. Adaptation and cognitive debriefing on immigrant populations in target countries is advisable to establish culturally relevant translations.