OBJECTIVES: In the context of a French national post-marketing study on patients’ satisfaction with routine care management, decision was made to use the Patient Satisfaction Questionnaire (PSQ III). Developed in the USA, the PSQ-III contains 8 items related to the financial aspect of caring. The objective was to test the French translation of the PSQ III and evaluate its content validity considering the local health care system.  METHODS: The French version of the PSQ-III was tested on 5 patients with rheumatoid arthritis. The aim of these cognitive interviews was to test clarity and comprehension of the translation but also the relevance of the 8 financial items to the French context from the patients’ point of view.  RESULTS: A direct translation of the financial items didn’t prove difficult as they could be rendered literally. Cognitive interviews showed that the items were also easily understood. Respondents mostly didn’t consider the items, however, as relevant to their situation (e.g. “I worry sometimes about having to pay large medical bills” or “I have to pay for more of my medical care that I can afford”) although they showed some concern regarding future evolution of the reimbursement process in France. After consultation, the developer of the instrument confirmed that if needed, the items related to the financial domain could be left aside. Decision was made to create two versions of the translation: one including the eight financial items and another excluding them. CONCLUSIONS: As far as health care systems are concerned, linguistic validation goes beyond understanding the text and direct translation of the relevant items. It requires knowledge of the local context in order to collect meaningful data. The target healthcare system needs to be carefully considered and adequacy of the translation can be tested through cognitive interviews and consultation with experts in the domain.