Development of a culturally adaptable internet-based cognitive behavioral therapy for Japanese women with bulimia nervosa

BACKGROUND

The process of cultural adaptation of internet-based cognitive behavioral therapy (ICBT) programs for bulimia nervosa (BN) have rarely been reported despite the potential influence of cultural adaptation of psychosocial interventions on therapeutic response.

AIM

This study aimed to illustrate development process of an ICBT program for Japanese women with bulimia nervosa (BN).

METHODS

A mixed methods approach was used to assess cultural adaptation of the prototype of an original ICBT program by using the Cultural Relevance Questionnaire (CRQ). Five women with BN and seven clinicians were interviewed using the CRQ.

RESULTS

Quantitative analyses were conducted to assess cultural adaptation of the prototype of the program and participants rated cultural adaptation as high. A qualitative analysis of the mixed method supported the culturally sensitive changes implemented.

CONCLUSIONS

The results of this study show that a series of processes can make ICBT programs more culturally adapted.

Translation, Cultural Adaptation and Validation of the Hill Bone Compliance to High Blood Pressure Therapy Scale to Nepalese Language

BACKGROUND

Control of high blood pressure and prevention of cardiovascular complications among hypertensive patients depends on patients' adherence to therapy. The Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBCTS) is one of the most popular scale to assess hypertensive patients' adherence behaviour. Unfortunately, no questionnaire in the Nepalese language is available to date to assess adherence to anti-hypertensive therapy.

AIM

To translate, culturally adapt and validate the English original version of the HBCTS into Nepalese language to measure treatment adherence of Nepalese hypertensive patients.

METHODS

The cross-sectional study was conducted to translate, culturally adapt and validate the HBCTS into Nepalese version. The standard translation process was followed and was evaluated among 282 hypertensive patients visiting selected primary healthcare centers (PHCCs) of Kathmandu district, Nepal. Cronbach's alpha was measured to assess the reliability of the tool. Exploratory factor analysis using principal component analysis with varimax rotation was used to evaluate structural validity.

RESULTS

The mean±SD age of 282 participants was 58.49±12.44 years. Majority of participants were literate (75.2%), and consumed at least one anti-hypertensive medication per day (85.5%). Nearly half (42.2%) of the participants had a family history of hypertension, and almost half (48%) of them had comorbid conditions. Mean ±SD score for overall adherence was 17.85±3.87 while those of medication taking, reduced salt taking, and appointment keeping subscales were 10.63±2.55, 4.16±1.12 and 3.06±1.07, respectively. Kaiser Meyer Olkin (KMO) was found to be 0.877. Exploratory factor analysis revealed a three-component structure; however, the loading of components into medication adherence, reduced salt intake and appointment keeping constructs were not identical to the original tool. Cronbach's alpha score for the entire HBCTS scale was 0.846.

CONCLUSION

The translated Nepali version of the HBCTS demonstrated acceptable reliability and validity to measure adherence to antihypertensive therapy among hypertensive patients in clinical and community settings in Nepal.

Italian Version of the YQOL-DHH Questionnaire: Translation and Cross-cultural Adaptation

Objective

To translate and cross-culturally adapt into Italian the YQOL-DHH (Youth Quality of Life Instrument–Deaf and Hard of Hearing Module), an instrument to evaluate the health-related quality of life in young deaf people. It could be useful for professionals, teachers, and parents to take care of deaf adolescents’ needs.

Study Design

Forward-backward translation, cross-cultural adaptation, and cognitive debriefing.

Setting

The cognitive debriefing was performed online with professionals and during clinical practice with deaf adolescents.

Methods

A methodological study was conducted according to the guidelines provided by the development team. The study consisted of a forward-backward translation and a cross-cultural adaptation. After the original authors’ confirmation, a cognitive debriefing was conducted with 30 professionals who work with deaf young people and with 10 deaf adolescents aged 11 to 18 years.

Results

For the linguistic translation and cross-cultural adaptation, some variations to the original instrument were made to obtain equivalence, such as the expression “deaf or hard of hearing” translated only with the Italian word “sordo.” During the cognitive debriefing, the clarity and comprehensibility of the items were reported by professionals and deaf adolescents. Eventually, the authors approved the final version.

Conclusion

The YQOL-DHH was translated and culturally adapted into Italian. The translated items were pertinent to the Italian culture and equivalent to the original ones. A validation study is suggested to make the instrument feasible for use in different clinical or educational contexts. In addition, to guarantee accessibility and autonomy for young deaf signers, Italian Sign Language translation of the questionnaire is suggested.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders Among Japanese Children: A Pilot Study

At present, there is no established cognitive behavioral therapy (CBT) for treating emotional disorders in Japanese children. Therefore, we introduced the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) in Japan and adapted it to the Japanese context. We then examined its feasibility and preliminary efficacy using a single-arm pretest, posttest, follow-up design. Seventeen Japanese children aged between 8 and 12 years (female n = 11; male n = 6; M = 10.06 ± 0.97 years) with a principal diagnosis of anxiety, obsessive-compulsive, or depressive disorders, and their parents were enrolled in the study. The primary outcome was the overall severity of emotional disorders as assessed by psychiatrists using the Clinical Global Impression-Severity Scale. Secondary outcomes included child- and parent-reported anxiety symptoms, depressive symptoms, and functional status. No severe adverse events were observed. The feasibility was confirmed by the low dropout proportion (11.76%), high attendance proportion (children: 95.6%; parents: 94.6%), and sufficient participant satisfaction. Linear mixed models (LMMs) showed that the overall severity of emotional disorders and child- and parent-reported anxiety symptoms improved from pre-treatment to post-treatment, and that these treatment effects were maintained during the 3-month follow-up period. Additionally, child- and parent-reported functional status improved from pre-treatment to the 3-month follow-up. In contrast, child-reported depressive symptoms improved from pre-treatment to follow-up, but there was no significant change in parent-reported depressive symptoms between pre-treatment and other time points. These findings demonstrate the feasibility and preliminary efficacy of the Japanese version of the UP-C, suggesting that future randomized controlled trials (RCTs) are warranted (Clinical trial registration: UMIN000026911).

A Culturally Adapted Colorectal Cancer Education Video for the Somali Community in Minnesota: A Pilot Investigation

PURPOSE

This study aims to develop and test feasibility of a colorectal cancer (CRC) education video appropriate for Somali immigrants.

DESIGN

One-group pretest-posttest design.

SETTING

Minneapolis, MN.

SAMPLE

Thirty-one Somali men (mean age = 60.6; SD = 13.0).

INTERVENTION

A CRC education video was developed in the Somali language with Somali community partners. Participants were invited to a workshop and watched the video.

MEASURES

Levels of understanding about CRC and screening were assessed before vs after the video.

ANALYSIS

Binomial tests were conducted to examine changes in level of understanding.

RESULTS

Analysis on pre-post, within-person changes in understanding about cancer, and CRC screening showed that proportions with a positive change in understanding risks of cancer (80%) and benefits of CRC screening (90%) were significantly higher than expected if the video had no effect (50%; P = .012, P < .001, respectively). Ninety-three percent of participants agreed that the video contained useful information.

CONCLUSION

These results provide evidence of usefulness of culturally tailored videos to facilitate CRC screening in the Somali community. Results of this study were limited by a small sample size and lack of a control group.

Translation, Cultural Adaptation, and Psychometric Properties of the Life Satisfaction Index for the Third Age-Short Form (LSITA-SF12) for Use among Ethiopian Elders

(1) Background: Self-reported measures play a crucial role in research, clinical practice, and health assessment. Instruments used to assess life satisfaction need validation to ensure that they measure what they are intended to detect true variations over time. An adapted instrument measuring life satisfaction for use among Ethiopian elders was lacking; therefore, this study aimed to culturally adapt and evaluate the psychometric properties of the Life Satisfaction Index for the Third Age—Short Form (LSITA-SF12) in Ethiopia. (2) Methods: Elderly people (n = 130) in Metropolitan cities of northwestern Ethiopia answered the LSITA-SF12 in the Amharic language. Selected reliability and validity tests were examined. (3) Result: The scale had an acceptable limit of content validity index, internal consistency, test-retest, inter-rater reliabilities, and concurrent and discriminant validities. (4) Conclusion: The Amharic language version of LSITA-SF12 appeared to be valid and reliable measures and can be recommended for use in research and clinical purposes among Amharic-speaking Ethiopian elders.

Psychodynamic Psychiatry in the Philippines

The authors describe the practice of psychodynamic psychiatry in the Philippines. They review features of contemporary psychodynamic psychiatry, the state of psychodynamic psychiatry in training programs, and its integration in national professional societies. Despite psychodynamic psychiatry's wide acceptance in the professional community in the Philippines and neighboring Southeast Asian countries, delivery of care to over 110 million residents of the archipelago requires creativity given the small number of psychiatrists. The authors discuss how psychodynamic psychiatry impacts the national mental health scene and propose future directions involving forging international linkages.

Cross-cultural adaptation and validation of the Persian version of the painDETECT questionnaire

OBJECTIVE

The purpose of this study was to translate and cross-culturally adapt the painDETECT questionnaire into the Persian language and assess the clinometric properties of the translated version (P-PDQ).

METHODS

This is a single-center prospective observational study. After forward and backward translations, consensus was achieved by the expert panel on the pre-final version. Semantic equivalence of this version was assessed and necessary modifications were made accordingly to achieve the final version (P-PDQ). One hundred and fifty chronic pain patients were sub-classified into neuropathic pain (NeP (n = 82)) or non-NeP (n = 68) groups by two pain specialists. P-PDQ was then administered to 50 patients twice with an interval of 5-7 days to assess relative reliability. Chronbach's α and intraclass correlation coefficient (ICC) were calculated to evaluate internal consistency and test-retest reliability of the P-PDQ, respectively. Criterion validity was assessed as the correlation of the P-PDQ and the validated Persian version of the self-report Leeds Assessment of Neuropathic Symptoms and Signs (P-sLANSS).

RESULTS

Chronbach's α and ICC of the P-PDQ were 0.76 and 0.97, respectively. The P-PDQ scores were significantly correlated with those of P-sLANSS (ρ = 0.87, p < .01). The mean overall score of P-PDQ was significantly higher in the NeP group (p < .01) which reflects discriminant validity. Sensitivity, specificity, positive and negative predicting values and Youden index were 74.70%, 98.51%, 78.04%, 98.48%, and 0.73, respectively at the cutoff value ≤17.

CONCLUSION

The P-PDQ is a reliable and valid tool to distinguish neuropathic component in chronic pain cases.

Rewarding journeys: exploring medical students' learning experiences in international electives

International electives are recognized as a high-impact practice in clinical education. However, medical students' actual learning experiences during electives have not been explored fully. Specifically, drawing on language management theory, this exploratory case study investigates students' perceived learning outcomes and the managing processes by which they gained benefits from cross-cultural learning experiences in international electives. Written reflective reports in a series of e-portfolios were collected from 43 Japanese medical students who participated in a four-week international elective. Moreover, to further explore their emotions and the reasons behind adopting a particular adjustment behaviour, follow-up interviews with 12 students were undertaken soon after they returned home. Using reflexive thematic analysis, the qualitative data were analysed. Their perceived learning outcomes were categorized into seven themes: medical knowledge and skills, communication, career management and development, international healthcare, society and culture, medical education, and personal development. During the programme, they experienced linguistic, sociolinguistic, and sociocultural difficulties, and attempted to overcome them by employing various adjustment strategies, such as meaning-focused coping, social relationship building, management of learning opportunities, communication management, and developing approaches to learning. Managing problems in academic contact situations is not a linear process; it is iterative and cyclical. Since the combination of several strategies was needed depending on the situation, the management process is a context-dependent and complex phenomenon. The findings in this study provide new insights into student participation in short-term international elective programmes in order to develop academic and social support strategies for educators at both home and host institutions.

Normative data of olfactory abilities using cultural adaption Sniffin' sticks smell test in different age groups

Objectives:

To assess olfactory abilities using a culturally adapted Sniffin’ Sticks smell test in different age groups.

Methods:

This was a cross-sectional study, conducted at Otorhinolaryngology outpatient clinic of Universiti Kebangsaan Malaysia Medical Centre, Secondary Science School, and Children Learning Centre in Kuala Lumpur, Malaysia, from August 2019 until December 2021.

Results:

In 450 healthy participants, the cut-off points of the threshold discrimination identification (TDI) scores at the 10th percentile for olfactory abilities were 19 in children, 30.1 in adolescents, 32.1 in young adults, 31.1 in middle-aged adults, and 28.6 in older adults. The children had significantly lower olfactory abilities, with the Bonferroni post-hoc tests of p<0.001. The young adults had higher olfactory abilities than older adults (p<0.05). The results showed that the identification score was highest in middle-aged adults (p<0.001). The discrimination score was the highest in young adults (p<0.001). The best odor threshold performance was observed in adolescents (p<0.001). The TDI score showed a significant difference in olfactory abilities between men and women (p=0.001).

Conclusion:

Using a culturally adapted smell test, our population was able to identify, discriminate, and perceive odorants better than the European population. This data will help clinicians and researchers with a tool to reliably establish the correct results of olfactory function in our population. Women had better olfactory abilities than men.

Developing a realist informed framework for cultural adaptation of lifestyle interventions for the prevention of type 2 diabetes in South Asian populations in Europe

AIMS

Selected lifestyle interventions proven effective for White-European populations have been culturally adapted for South Asian populations living in Europe, who are at higher risk of type 2 diabetes. However, a limited theoretical basis underpins how cultural adaptations are believed to augment intervention effectiveness. We undertook a realist review to synthesise existing literature on culturally adapted type 2 diabetes prevention interventions, to develop a framework that shows 'how' cultural adaptation works, for 'whom' and in 'what contexts'.

METHODS

We followed the stepped methodological approach of realist review. Our work concluded a European-wide project (EuroDHYAN), and core studies were identified from the preceding EuroDHYAN reviews. Data were extracted, coded into themes and synthesised to create 'Context-Mechanism-Outcome' configurations and to generate a refined explanatory framework.

RESULTS

We identified eight core intervention papers. From this evidence, and supporting literature, we examined the 'Team' domain of cultural adaptation and identified a mechanism of shared cultural identity which we theorised as contributing to strong team-participant relationships. We also identified four key contexts which influenced intervention outcomes: 'research setting' and 'heterogeneous populations' (intrinsic to the intervention) and 'broader environment' and 'socio-cultural stress' (extrinsic barriers).

CONCLUSIONS

This work instigates research into the mechanisms of cultural adaptation which, if pursued, will allow a more nuanced understanding of how to apply adaptations, and for whom. In practice we recommend greater consideration of heterogeneous and intersecting population characteristics; how intervention design can safeguard sustainability; and how the four key contexts identified influence how, and whether, these interventions work.

Development and validation of an instrument (CSII - Brazil) to assess users' conceptual and procedural knowledge of continuous subcutaneous infusion systems

OBJECTIVE

To develop, adapt and validate an instrument named "CSII - Brazil" to assess users' conceptual and procedural knowledge of continuous subcutaneous insulin infusion systems.

METHODS

Methodological and exploratory study developed in three stages: a) instrument development; b) content validation and cultural adaptation (evaluation by a committee of experts and pre-test with CSII users); c) psychometric validation through instrument application in a sample of 60 patients by means of the web tool e-Surv. Internal consistency and reproducibility analyses were performed within IBM SPSS Statistics 20 programming environment.

RESULTS

The 16 multiple-choice question instrument successfully attained a content validity index of 0.97, showing satisfactory internal consistency, with 0.61 Cronbach's alpha [95% CI 0.462-0.746] and an intraclass correlation coefficient of 0.869 [95% CI: 0.789-0.919] between the test and retest scores.

CONCLUSION

The CSII - Brazil instrument is considered adequate and validated to assess continuous subcutaneous infusion system users' conceptual and procedural knowledge.

Adaptation of a school-based mental health literacy curriculum: from Canadian to English classrooms

BACKGROUND

School-based mental health literacy (MHL) interventions are increasingly trialled outside of the country in which they were developed. However, there is a lack of published studies that qualitatively explore their cultural adaptation. This study investigated the reasons for adaptations made and suggested to a Canadian MHL curriculum (The Guide) within the English school context.

METHOD

Semi-structured interviews were conducted with 11 school staff responsible for the planning and/or implementation of The Guide across three schools in the South East of England, as part of the Education for Wellbeing (EfW) feasibility study. Transcripts were analysed using a hybrid, deductive-inductive thematic analysis.

RESULTS

Adaptations made and suggested included dropping and emphasising content, and adapting language, examples and references. Most adaptations were proactive and related to The Guide's implementation methods, including developing more interactive and student-led approaches. Staff Capacity and Expertise, Timetabling, and Accessibility of Resources were identified as logistical reasons for adaptations. Philosophical reasons included Consistency of Messages, Student Characteristics, Reducing Stigma and Empowering Students, National and Local Context, and Appropriate Pedagogic Practices.

CONCLUSION

Overall, recommendations were for immediately implementable lesson plans informed by teachers' knowledge about best pedagogic practices in England. Adequate training, attended by both senior leadership and those implementing, was also emphasised. While ensuring that the core components are clear, MHL interventions should be developed with a necessary level of flexibility to accommodate contextual characteristics. Future research should ensure that adaptations are captured through process and implementation evaluations conducted alongside efficacy trials.

German Translation, Linguistic Validation, and Cultural Adaptation of the Environmental Audit Tool-High Care

Background:

In dementia-specific care, the design of the environment is regarded as an influential element in the support and maintenance of skills and can improve the quality of life of residents. To date, there is no valid instrument in the German-speaking countries with which the quality of the physical environment in residential long-term care facilities can be systematically assessed.

Objective:

To report the translation, linguistic validation, cultural adaptation, and content validity evaluation of the Australian Environmental Audit Tool—High Care in preparation for use in German nursing homes.

Method:

The procedure was guided by an adapted multistep process of the World Health Organization (1998) and included focus groups involving potential users of the new tool such as scientific experts and healthcare professionals (n = 40). Content validity indices were calculated following a two-step expert survey.

Results:

The final draft versions of the German Environmental Audit Tool (G-EAT) included 74 and 77 items, for non-secured units and secure units, respectively, divided into 10 key design principles according to the Australian original. The evaluation of content validity showed that cultural differences existed in several items.

Conclusions:

The G-EAT provides the means for conducting a valid assessment of the environmental quality of people with dementia in German nursing homes. However, its usability in healthcare research must be preceded by testing its interrater reliability.

Creating accessible Spanish language materials for Clinical Sequencing Evidence-Generating Research consortium genomic projects: challenges and lessons learned

Aim: To increase Spanish speakers' representation in genomics research, accessible study materials on genetic topics must be made available in Spanish. Materials & methods: The Clinical Sequencing Evidence-Generating Research consortium is evaluating genome sequencing for underserved populations. All sites needed Spanish translation of recruitment materials, surveys and return of results. Results: We describe our process for translating site-specific materials, as well as shared measures across sites, to inform future efforts to engage Spanish speakers in research. Conclusion: In translating and adapting study materials for roughly 1000 Spanish speakers across the USA, and harmonizing translated measures across diverse sites, we overcame numerous challenges. Translation should be performed by professionals. Studies must allocate sufficient time, effort and budget to translate and adapt participant materials.

Acculturative stress and coping among migrant workers: A global mixed-methods systematic review

No existing review has synthesized key questions about acculturation experiences among international migrant workers. This review aimed to explore (1) What are global migrant workers' experiences with acculturation and acculturative stress? (2) What are acculturative stress coping strategies used by migrant workers? And (3) how effective are these strategies for migrant workers in assisting their acculturation in the host countries? Peer-reviewed and gray literature, without time limitation, were searched in six databases and included if the study: focused on acculturative stress and coping strategies; was conducted with international migrant workers; was published in English; and was empirical. Eleven studies met the inclusion criteria. Three-layered themes of acculturation process and acculturative stress were identified as: individual layer; work-related layer; and social layer. Three key coping strategies were identified: emotion-focused; problem-focused; and appraisal-focused. These coping strategies were used flexibly to increase coping effectiveness and evidence emerged that a particular type of acculturative stress might be solved more effectively by a specific coping strategy. Migrant workers faced numerous challenges in their acculturative process. Understanding this process and their coping strategies could be used in developing research and interventions to improve the well-being of migrant workers.

Translation, Cultural Adaptation, and Validation of the Mini-Z 2.0 Survey among Japanese Physicians and Residents

Objective The Mini-Z 2.0 is a new, simple, and nonproprietary tool for assessing physician well-being and burnout. To date, a non-English version of the Mini-Z 2.0 survey has not been validated. Therefore, we aimed to develop a Japanese version of the Mini-Z 2.0 and to evaluate its validity and reliability using survey data from physicians affiliated with an internal medicine academic society. Methods The Mini-Z 2.0 survey was translated into Japanese using a forward-backward translation method. The participants belonged to the American College of Physicians' Japan Chapter. The translated version of the Mini-Z 2.0 survey was distributed to participants using an electronic mailing list. Convergent validity was assessed between burnout and other items using Pearson's product-moment statistic. Structural validity was evaluated using an exploratory factor analysis and confirmatory factor analysis, and reliability was assessed using internal consistency. Results Of the 1,255 physicians and medical residents contacted, 283 responded (22.5%). Burnout was present in 34.6% of the participants, with 48.8% reporting high stress levels. Convergent validity was demonstrated, with satisfactory correlations between burnout and satisfaction, value alignment, work control, and stress. An exploratory factor analysis identified two factors (i.e., Well-Being and Relationships and Work-Related Stressors); however, the three models evaluated using the confirmatory factor analysis revealed a poor fit. Cronbach's alpha for the sample was 0.80. Conclusion The Japanese version of the Mini-Z 2.0 demonstrated good internal consistency and convergent validity. Despite its inadequate structural validity, it can be used to measure physician well-being and related workplace conditions in Japan.

Community providers' experiences with evidence-based practices: The role of therapist race/ethnicity

OBJECTIVES

Examining therapists' experiences implementing evidence-based practices (EBPs) is fundamental to understanding how these interventions are perceived, adapted, and delivered in community settings. However, little is known about racial/ethnic variation in the experiences of therapists serving racial/ethnic minority youth and their families. Through an innovative QUAN → qual → QUAN mixed-methods approach, we examined differences in therapists' perceptions, adaptations performed, and client-engagement challenges in the largest county-operated department of mental health in the United States.

METHOD

Surveys were completed by 743 therapists (Latinx [44%], White [34%], other ethnic minority [22%]), most of whom were female (88%), master's level (85%), and unlicensed (58%). A subset of therapists (n = 60) completed semistructured interviews.

RESULTS

Latinx therapists reported more positive experiences implementing EBPs, making more adaptations to EBPs, and encountering fewer client-engagement challenges than therapists from other racial/ethnic groups. Qualitative analyses expanded on these results, revealing that Latinx therapists commonly described adapting EBPs in terms of language and culture to improve fit and promote client engagement. Informed by these qualitative themes, a refined statistical model revealed that the ability to deliver EBPs in languages other than English might have accounted for differences in therapist-reported EBP adaptations and client-engagement challenges.

CONCLUSIONS

The findings suggest that racial/ethnic minority therapists have positive experiences in implementing EBPs in community settings. In the case of Latinx therapists, bilingual/bicultural competence may facilitate adapting EBPs in ways that reduce perceptions of engagement challenges with racially/ethnically diverse clients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cultural Adaptation of the Illness Management and Recovery Intervention Among Israeli Arabs

Awareness of the need for culturally adapted mental health interventions is growing. The authors describe the cultural adaptation of an evidence-based practice (EBP), illness management and recovery (IMR), to the Arab population in Israel. The process included reviewing the literature on cultural adaptations of EBPs and interviewing Arab and IMR professionals, which helped inform modifications that reflected the norms of Arab society in Israel related to family, religion, and beliefs about mental health. The process yielded a culturally adapted IMR intervention, which was translated into Arabic and used to train Arab practitioners on implementation with Arab clients in Israel.

What Happens When Individuals Answer Questionnaires in Two Different Languages

The aim of the present study was to compare scores from the English and the Spanish versions of two well-known measures of psychological distress using a within-subject approach. This method involved bilingual participants completing both measures in four conditions. For two groups of people, measures were offered in the same language both times and for the other two groups, each language version was offered, the order differing between the groups. The measures were the Clinical Outcomes in Routine Evaluation-Outcome Measure and the Schwartz Outcome Scale-10, both originally created in English and then translated to Spanish. In total, 109 bilingual participants (69.7% women) completed the measures in two occasions and were randomly allocated to the four conditions (English-English, English-Spanish, Spanish-English and Spanish-Spanish). Linear mixed effects models were performed to provide a formal null hypothesis test of the effect of language, order of completion and their interaction for each measure. The results indicate that for the total score of the Clinical Outcomes in Routine Evaluation-Outcome Measure just language had a significant effect, but no significant effects were found for completion order or the language by order interaction. For the Schwartz Outcome Scale-10 scores, none of these effects were statistically significant. This method offers some clear advantages over the more prevalent psychometric methods of testing score comparability across measure translations.

Facilitators and Barriers to Healthy Eating Among American Indian and Alaska Native Adults with Type 2 Diabetes: Stakeholder Perspectives

BACKGROUND

American Indian and Alaska Native (AI/AN) adults have a higher prevalence of type 2 diabetes (T2D) and related complications than non-AI/AN adults. As healthy eating is a cornerstone of diabetes self-management, nutrition education plays an important role in diabetes self-management education.

OBJECTIVE

To understand stakeholder perspectives on facilitators and barriers to healthy eating for AI/AN adults with T2D in order to inform the cultural adaptation of an existing diabetes nutrition education curriculum.

METHODS

Individual interviews were conducted with 9 national content experts in diabetes nutrition education (e.g. registered dietitians, diabetes educators, experts on AI/AN food insecurity) and 10 community-based key informants, including tribal health administrators, nutrition/diabetes educators, Native elders, and tribal leaders. Four focus groups were conducted with AI/AN adults with T2D (n = 29) and 4 focus groups were conducted with their family members (n = 22). Focus groups and community-based key informant interviews were conducted at 4 urban and reservation sites in the USA. Focus groups and interviews were recorded and transcribed verbatim. We employed the constant comparison method for data analysis and used Atlas.ti (Mac version 8.0) to digitalize the analytic process.

RESULTS

Three key themes emerged. First, a diabetes nutrition education program for AI/ANs should accommodate diversity across AI/AN communities. Second, it is important to build on AI/AN strengths and facilitators to healthy eating (e.g. strong community and family support systems, traditional foods, and food acquisition and preparation practices). Third, it is important to address barriers to healthy eating (e.g. food insecurity, challenges to preparation of home-cooked meals, excessive access to processed and fast food, competing priorities and stressors, loss of access to traditional foods, and traditional food-acquisition practices and preparation) and provide resources and strategies for mitigating these barriers.

CONCLUSIONS

Findings were used to inform the cultural adaptation of a nutrition education program for AI/AN adults with T2D.

Brazilian version of "The Insulin Delivery System Rating Questionnaire": translation, cross-cultural adaptation and validation

OBJECTIVE

The aim of this study was to translate and cross-culturally adapt the Insulin Delivery System Rating Questionnaire (IDSRQ) for Brazilian users. Validation and reliability analysis of measures were also performed.

METHODS

Methodological study comprising the following stages: forward translation, synthesis, back-translation, assessment by Expert Committee, pre-test and validation. International guidelines for translation and cross-cultural adaptation of measurement tools were followed. Validation data provided information about reliability (internal consistency, test-retest) and construct validity of the IDSRQ.

RESULTS

Content validation by Experts' assessment was successful, with a mean Content Validity Index of 0.87 (±0.2). The IDSRQ validation study involved 113 T1DM patients, 46% male, mean age 32.61 (±12.59) years and mean age at diagnosis of diabetes of 17.51 (±12.41). The scale presented good internal consistency (Cronbach's alpha =0.786). The reliability analysis of the instrument was conducted by calculating the Intra-class Correlation Coefficient 0.885 (0.834-0.921), which indicated adequate concordance in all measures.

CONCLUSION

The translated and cross-culturally adapted Brazilian Portuguese version of the IDSRQ may be used to assess health-related quality of life (HRQOL) and treatment preferences for insulin delivery systems in T1DM Brazilian patients.

Polish Adaptation of the Italian Spine Youth Quality of Life Questionnaire

The study aimed to carry on the process of the cultural adaptation of the Italian Spine Youth Quality of Life Questionnaire (ISYQOL) into Polish (ISYQOL-PL). The a priori hypothesis was: the ISYQOL-PL questionnaire is reliable and appropriate for adolescents with a spinal deformity. Fifty-six adolescents (mean age 13.8 ± 1.9) with idiopathic scoliosis (AIS) with a mean Cobb angle 29.1 (±9.7) and two with Scheuermann juvenile kyphosis (SJK) with a kyphosis angle 67.5 (±17.7) degrees were enrolled. All patients had been wearing a corrective TLSO brace for an average duration of 2.3 (±1.8) years. The Institutional Review Board approved the study. The cross-cultural adaptation of the ISYQOL-PL was performed following the guidelines set up by the International Quality of Life Assessment Project. The reliability was assessed using internal consistency (the Cronbach’s alpha coefficient) and test–retest reliability (intraclass correlation coefficient ICC_2.1, CI = 95%); moreover, floor and ceiling effects were calculated. The internal consistency was satisfactory (Cronbach’s alpha coefficient 0.8). The test–retest revealed high reliability with the value of ICC_2.1 for the entire group 0.90, CI (0.84 to 0.94). There was neither floor nor ceiling effect for the ISYQOL-PL overall score. The ISYQOL-PL is reliable and can be used in adolescents with spinal deformity.

Adaptation and psychometric validation of a questionnaire about organizational safety culture and climate for the Brazilian reality

Surveys are the most widely used instruments to assess safety opinions, attitudes and behaviours of workers, as a reflection of a dimensional manifestation of an organization's safety culture. The fact that there are few instruments of this nature adapted to the Brazilian reality motivated the attempt to validate tools used in Portugal in this field. The questionnaire to workers about occupational safety culture and climate (QTCCS) will be explored in this article. The main objective is to present the data from the cultural adaptation and psychometric validation process of this instrument, and it can be confirmed that this intention was properly achieved. Through a study carried out with a sample of 200 workers from a company in the northeast of Brazil, it was statistically confirmed that it is possible to maintain the factorial structure of the original instrument when applied to Brazilian workers of different characteristics.

Japanese Translation and Validation of the Environmental Assessment Tool-Higher Care

OBJECTIVE

The purpose of this study was to translate the Environmental Assessment Tool-Higher Care (EAT-HC) into Japanese and validate its use in small-scale group living facilities in Japan.

BACKGROUND

Environment of a facility is shown to improve its residents' quality of life (QOL). Japan's "welfare-based nursing homes for the elderly" are gradually shifting to a small-scale group living concept called group care units (GCUs). However, there is no appropriate environmental tool available for evaluating GCUs. The application of valid environmental assessment tools brings about a better understanding of the nature of good environments and the relationship between environments and outcomes for residents living with dementia.

METHODS

The study had a mixed method design conducted in several steps, covering translation and adaptation. The translation phase involved (1) forward translation and (2) backward translation. The adaptation phase involved (3) content validity and homogeneity reliability and (4) concurrent validity and interrater reliability.

RESULTS

71 Items (92%) met the acceptable level of content validity (item-content validity index [CVI] > .79) and had good scale-CVI of .88. Concurrent validity was confirmed between .65 and .78 (p < .001). For reliability test, the internal consistency of six subscales was between .88 and .98. Overall interobserver agreement was 90.3%. Intraclass correlation coefficients were .80-.98 (p < .001), and homogeneity reliability coefficient for all items was >.76 (p < .01).

CONCLUSIONS

Validation of the EAT-HC-Japanese Version (EAT-HC-JV) was confirmed as an appropriate tool for environmental assessment to enhance the QOL in Japan's GCUs. For future study, we plan to modify the EAT-HC-JV to adapt to Japanese cultural aspects in order to increase its usability in Japan.