OBJECTIVES: Measuring enjoyment and general satisfaction of individuals in an international clinical trial involving 24 languages required the linguistic validation of the 93-item QoL Enjoyment and Satisfaction questionnaire. The original US English questionnaire is divided into 10 sub-scales: general activities, global satisfaction, household duties, leisure time activities, physical health, satisfaction with medication, school and course work, social relationships, subjective feelings and work. METHODS: The translation process was conducted by a specialist in each target country using the following methodology: 1) two forward translations by professional translators, native speakers of the target language and fluent in English; 2) comparison and reconciliation of the translations by the specialist in the target country and the translators; 3) backward translation by a native English speaker; 4) comparison of source and backward version; 5) comprehension test on 6 healthy individuals and review by one clinician; and 6) international harmonisation to check international comparability of translations. RESULTS: Linguistic and conceptual issues emerged when translating idiomatic English phrases and the response categories. The comprehension test showed difficulties understanding the original question "how satisfied have you been...." in conjunction with a response scale entitled "overall satisfaction" followed by the answer choices: very poor, poor, fair, good, very good". To facilitate the link with the question the translations used "very dissatisfied, dissatisfied, neither dissatisfied nor satisfied, satisfied, very satisfied." Also, the original "do the banking" was problematic as in some countries it in not common to have a bank account. Translations referred to "manage everyday financial matters". CONCLUSION: The 24 language versions were established according to a rigorous process to ensure conceptual equivalence and cross-cultural acceptability of translations to facilitate the international comparison and pooling of data. Psychometric testing will be conducted to ensure the reliability and validity of each translation. This work highlights the importance of receiving international feedback on a questionnaire before finalising it in 1 language.