Real-World Evidence (RWE) and Clinical Outcomes Assessments (COA)

We handle all aspects of the development
of Clinical Outcomes Assessments (COA)

COA/eCOA Development:

  • Qualitative Real-World Evidence (RWE) research that feeds into item generation and COA/eCOA development.


  • Item development, incorporating best practices in questionnaire design.


  • Concept elicitation and Content validity studies.

Linguistic Validation:

  • Cognitive debriefing of COA/eCOA. To date, we have completed over 9000 individual in-country studies,

    covering over 250 languages in more than 190 countries and territories around the world.


  • Usability testing of eCOA. We conduct these studies in the source language and country.


  • Clinician reviews.


  • Translatability assessments.


  • Concept elaboration of COA text (instructions and items).


For all these activities, we have developed our own methodology. Our approach builds on industry standards and aims to gain maximum amount of insights from clinicians, language experts and patients, respectively, for all COAs that we test. Other services in this area include:

  • Translation and localisation. We can do this in-house, although we typically partner with trusted Language Service Providers.


  • Paper to electronic migration activities, such as screenshot reviewing.


  • Providing information design advice to the text and layout of both paper-based and electronic COAs.

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Join us in shaping the future of healthcare

Contact us if you want to find out how we can help you with your project, if you wish to become part of our network of in-country partners or if you want to take part in one of our studies.