OBJECTIVES: The word ‘hassle’ is commonly used in PRO measures including the Morisky Medication Adherence Scale (MMAS-8). The translation of the word ‘hassle’ is used as an example of how creation of a concept elaboration and a full translation and linguistic validation process can result in a translation that is conceptually equivalent to the source text and to aid in the future translation of ambiguous words. METHODS: The MMAS-8 was translated into 29 languages using the standard methodology of two forward translations, reconciliation, two back translations, back-translation review, developer review and proofreading. Examples of translation issues of the word ‘hassled’ in the following statement were assessed: Do you ever feel hassled about sticking to your anti-rejection treatment plan? RESULTS: A ‘hassle’ is defined in the Oxford English Dictionary as an ‘irritating inconvenience’. In the above question, this word encompasses several concepts – bothered, troubled, disturbed – which were provided to translators in a concept elaboration document. The translation process resulted in the following: The initial French translation was back-translated as bothered/annoyed. Alternatives back-translating as ‘preoccupied’ and ‘inconvenient’ were suggested but rejected. The developer piloted the final suggestion, debordé (overwhelmed), with French-speaking students, who agreed that this was the best translation in this context. For other languages, ‘hassled’ was translated variously as: a nuisance, cumbersome, difficult, bothersome, troubling, tiresome, irksome, burdensome and complicated. These were queried with translator and the developer to confirm conceptual equivalence to ‘hassled’. CONCLUSIONS: Though not always possible to translate an English word exactly into the target language, a full translation and linguistic validation process, including creation of a concept elaboration document followed by an in-depth discussion at back-translation review stage, enables a conceptually equivalent translation to be found. The concept elaboration document should, where possible, be created in conjunction with the instrument developer.