Translation of questionnaires and issues of equivalence

Parents' knowledge, risk perception and willingness to allow young males to receive human papillomavirus (HPV) vaccines in Uganda

The Ministry of Health in Uganda in collaboration with the Program for Appropriate Technology for Health (PATH) supported by Bill and Melinda Gates Foundation in 2008–2009 vaccinated approximately 10,000 girls with the bivalent humanpapilloma virus (HPV) vaccine. We assessed parent's knowledge, risk perception and willingness to allow son(s) to receive HPV vaccines in future through a cross-sectional survey of secondary school boys aged 10–23 years in 4 districts. 377 questionnaires were distributed per district and 870 were used in analysis. Parents that had ever heard about cervical cancer and HPV vaccines; those who would allow daughter(s) to be given the vaccine and those who thought that HPV infection was associated with genital warts were more willing to allow son(s) to receive the HPV vaccine. Unwilling parents considered HPV vaccination of boys unimportant (p = 0.003), believed that only females should receive the vaccine (p = 0.006), thought their son(s) couldn't contract HPV (p = 0.010), didn't know about HPV sexual transmissibility (p = 0.002), knew that males could not acquire HPV (p = 0.000) and never believed that the HPV vaccines could protect against HPV (p = 0.000). Acceptance of HPV vaccination of daughters and likelihood of recommending HPV vaccines to son(s) of friends and relatives predicted parental willingness to allow sons to receive HPV vaccines. Probable HPV vaccination of boys is a viable complement to that of girls. Successfulness of HPV vaccination relies on parental acceptability and sustained sensitization about usefulness of HPV vaccines even for boys is vital.

Validation of a cultural cancer screening scale for mammogram utilization in a sample of African American women

BACKGROUND

The Cultural Cancer Screening Scale (CCSS) was developed to identify cultural factors relevant to breast and cervical cancer screening in a sample of Hispanic and white women in Southern California. This scale identified 5 distinct cultural factors as relevant in cancer screening decision making.

OBJECTIVE

The purpose of this study was to consider psychometric estimates of the validity and reliability of this scale in a sample of African American women residing in an urban area of New Jersey.

INTERVENTIONS/METHODS

A total of 122 women, aged 40 to 90 years, with no history of breast cancer participated in the study. Internal consistency, reliability, construct, and predictive validity were assessed.

RESULTS

Exploratory factor analysis resulted in the formation of 5 subsets: cancer screening fatalism, negative beliefs about health professionals, catastrophic disease expectations, symptomatic deterrents, and sociocultural deterrents, all clearly independent of each other. The Cronbach's α for the composite score of the scale was .89. Predictive validity of the composite scale score was not significant, but 4 cultural items were significant: problems making an appointment, lack of transportation, discomfort with health professionals, and health professionals inappropriately touch their patients.

CONCLUSIONS

Overall, the CCSS demonstrated acceptable preliminary values of reliability and validity in this population.

IMPLICATIONS FOR PRACTICE

Cultural and social factors relevant to cancer screening are very important for all women. The CCSS has not yet been used in nursing research but would be very appropriate for nurses to use to better understand why women choose to access cancer screening services.

Translation of Questionnaires Into Arabic in Cross-Cultural Research

Aims:To describe the translation process of nursing instruments into Arabic and discuss the equivalence issues arising from this process. Method: Review of the literature. Results: The Arabic language is essentially three different languages: Classical Arabic; Modern Standard Arabic ( fuS-Ha or MSA); and colloquial Arabic ( Lahja A’mmeya), which is itself divided into five different regional Arabic dialects. The Arabic fuS-Ha language is the dialect most widely used in the translation of instruments into Arabic. The literature reveals that only a few studies focused on the linguistic issues in the translation of instruments into Arabic. Brislin’s back-translation emerged as the most common method widely used by researchers in studies with Arabic-speaking subjects, but not the perfect one. Conclusion: Linguistic issues in nursing research have not been sufficiently described and discussed in the context of Arabic language and culture. Although there is no standard guideline for instrument translation, the combined translation model is the most recommended procedure to use in cross-cultural research. Linguistic differences between the source culture and the target Arabic culture should be taken into account. Finally, we recommend the use of the fuS-Ha dialect and trilingual translators in the translation of nursing instruments into Arabic.

Translation and linguistic validation of the FACT-EGFRI-18 quality of life instrument from English into Dutch

PURPOSE

The Functional Assessment of Cancer Therapy-Epidermal Growth Factor Receptor Inhibitor 18 (FACT-EGFRI-18) is a patient-reported outcomes questionnaire developed to assess the effect of EGFRI on patients. The FACT-EGFR-18 was translated into Dutch and evaluated in order to document that the translation adequately captures the concepts of the original English-language version of the questionnaire and is readily understood by subjects in the target population.

METHOD

Translation of the FACT-EGFRI-18 from English to Dutch was accomplished by employing the Functional Assessment of Chronic Illness Therapy (FACIT) multilingual translation methodology. Ten native-speaking residents of the target country who reported EGFRI associated dermatological adverse events (dAEs) were asked to review the translation of the harmonized FACT-EGFRI-18.

RESULTS

Participants generally found the Dutch FACT-EGFRI-18 easy to understand and complete. In addition, the translation retained the original meaning of the FACT-EGFRI-18 items and instructions. Based on the results of the cognitive debriefing interviews, no changes to improve clarity and comprehension of translations were identified.

CONCLUSIONS

The Dutch FACT-EGFRI-18 demonstrates content validity and linguistic validity, and was found conceptually equivalent to its English source, thus confirming linguistic validation. The results suggest that the Dutch FACT-EGFRI-18 can be applied to measure dAE related health related quality of life in Dutch-speaking patients undergoing EGFRI therapy. Formal validation of the Dutch FACT-EGFRI-18 is ongoing.

Cross cultural equivalence testing of the Prosthetic Evaluation Questionnaire (PEQ) for an Arabic speaking population

BACKGROUND

There are currently no published prosthetic-related outcome measurement tools (OMT) available in the Arabic language.

OBJECTIVE

The aim of this study was to translate the Prosthetic Evaluation Questionnaire (PEQ) into Arabic, ensuring cross-cultural equivalence with the original English language version.

STUDY DESIGN

Psychometric property testing.

METHODS

The PEQ was culturally and linguistically adapted from English to Arabic using a process of forward translation, backward translation, committee review and pre-testing. Pre-testing was carried out in a clinical trial where subjects each completed the questionnaire in Arabic and English, and underwent random probe questioning. The data were compared and analysed, using intraclass correlation (ICC) and Bland Altman plots.

RESULTS

Seven patients gave consent and completed the study. For all nine PEQ scales, the ICC point estimate scores were above 0.8, indicating a good degree of correlation. However, for some scales, the 95% confidence interval was wide, indicating a large level of variation. The Bland Altman plots displayed a good distribution around the mean for most of the scales, although the results were affected by the small sample size.

CONCLUSION

The results of the analysis showed that the Arabic version of the PEQ was linguistically equivalent to the original version, although further testing with a larger sample group is recommended.

CLINICAL RELEVANCE

The availability of a prosthetic outcome measurement tool in Arabic will enable clinicians to collect evidence that can be used to monitor and improve patient care. As there is currently little information available about amputees in the Gulf region, this tool will be a useful resource to both clinicians and decision makers.

Culturally competent social work research: methodological considerations for research with language minorities

Despite the growing number of language minorities, foreign-born individuals with limited English proficiency, this population has been largely left out of social work research, often due to methodological challenges involved in conducting research with this population. Whereas the professional standard calls for cultural competence, a discussion of how to implement strategies for culturally competent research with language minorities is regrettably limited in the social work literature. This article is, to the authors' knowledge, one of the first within the field of social work to tie together unique methodological issues that may arise throughout the research conceptualization, development, and implementation process with this population. Strategies for how to overcome such issues are provided by adapting and expanding on a conceptual framework by Meleis. The incorporation of such research practices with language minorities has the potential to enhance trust and, thus, improve the recruitment and retention of this hard-to-reach population. More important, studies that aim to include such culturally responsive criteria may produce results that have improved validity and, thus, contribute to the advancement of knowledge regarding this population.

Evaluation of the Manchester clinical supervision scale: Norwegian and Swedish versions

AIM

To develop Norwegian and Swedish versions of the Manchester Clinical Supervision Scale (MCSS) and to test and verify its hypothesized seven-factor structural model.

BACKGROUND

Nurse managers are responsible for upholding and ensuring quality of care as well as for maintaining staff competence, thus safeguarding the standard of care.

METHODS

The research process included a translation-back-translation procedure with monolingual and bilingual tests in addition to psychometric evaluation. The sample consisted of 150 student and registered nurses (RNs) from Norway and Sweden, and confirmatory factor analysis was performed.

RESULTS

The translated versions did not exhibit satisfactory validity and reliability. The confirmatory factor analysis failed to show a good model fit. Low α-values were revealed except for factors 1, 2, 3 and 7. The most important factors of the MCSS were Trust/Rapport, Supervisor advice/Support, Improved care/Skills and Reflection.

CONCLUSION

Translation of an instrument for cross-cultural nursing research is important, although there are methodological limitations associated with construct validity. IMPLICATION FOR NURSE MANAGERS: Instruments for the evaluation of nursing care are necessary in order to formulate strategies at a managerial level. Nurse managers who encourage nurses to attend supervision promote professional development and enhance patient safety.

Validation of the FACT-Gastric cancer quality of life questionnaire for use in Spanish-speaking countries

OBJECTIVES

The purpose of this study was to validate a universal Spanish translation of the Functional Assessment of Cancer Therapy-Gastric Cancer (FACT-Ga; Version 4) questionnaire for use in Spanish-speaking countries.

METHODS

Translation of the FACT-Ga from English to Spanish was accomplished by employing the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology, which utilizes a multinational team of translation experts. A single (universal) Spanish version of the questionnaire was developed for use with gastric cancer patients recruited from Argentina, Chile, Mexico, Peru, and Spain. Pretesting of the questionnaire was conducted using 75 cancer patients (15 from each country), who were also cognitively debriefed.

RESULTS

Statistical analysis yielded marginal results for the Peru and Spain samples, although when analyzing pooled data from all five countries, statistics were within expected ranges. Qualitative analysis indicated that there were negligible linguistic concerns that impacted a very small proportion of the items.

CONCLUSION

The universal Spanish FACT-Ga demonstrates content and linguistic validity, and is conceptually equivalent to its English source. It is a promising tool for use in evaluating the health-related quality of life for Spanish-speaking patients with gastrointestinal-related cancers, given more research regarding universally derived reliability and validity statistics.

Social rehabilitation in long-term conditions: learning about the process

AIM

This paper is a report of a study of the process of social rehabilitation, and the analysis of the main elements and influencing factors which are important in the process.

BACKGROUND

The process of social rehabilitation lacks conceptual and empirical understanding in Neurology because most rehabilitation programmes have focused on cognitive and physical recovery.

METHODS

An action research project was undertaken in two neurological wards of a highly specialized hospital in Spain, and was completed in 2006. A social rehabilitation programme based on the assessment of social needs and individualized social education was planned with health professionals, and implemented and evaluated with patients and carers. Several instruments were used to explore how patients and carers perceived the process of social rehabilitation before and after the programme: semi-structured interviews, socio-demographic forms, field notes, participant observations, and scales of activities of daily living, social impairment and adjustment. Comparative content and statistical analyses were undertaken.

FINDINGS

Social rehabilitation was identified as a dynamic process in which the environment, activities, social interaction, self-recognition and awareness of social problems, coping and satisfaction played an essential role. Some defining criteria for social rehabilitation related to patients' and carers' attitudes, behaviour and the external implications that the socialization process had for them.

CONCLUSION

This study shows the advantages of multidisciplinary work, and user and family involvement in social rehabilitation and provides in-depth knowledge about how patients and carers experience and could face barriers to develop a role in their family environment, social groups and society.

Effects of the implementation of the web-based patient support system on staff's attitudes towards computers and IT use: a randomised controlled trial

Utilisation of information technology (IT) in the treatment of people with severe mental health problems is an unknown area in Europe. Use of IT and guiding patients to relevant sources of health information requires that nursing staff have positive attitudes toward computers and accept IT use as a part of daily practises. The aim of the study was to assess the effects of the implementation of a web-based patient support system on staff's attitudes towards computers and IT use on psychiatric wards. Hundred and forty-nine nurses in two psychiatric hospitals in Finland were randomised to two groups to deliver patient education for patients with schizophrenia and psychosis with a web-based system (n = 76) or leaflets (n = 73). After baseline nurses were followed-up for 18 months after the introduction of the system. The primary outcome was nurses' motivation to utilise computers, and the secondary outcomes were nurses' beliefs in and satisfaction with computers, and use of computer and internet. There were no statistically significant differences between study groups in attitudes towards computers (motivation p = 0.936, beliefs p = 0.270, satisfaction p = 0.462) and internet use (p = 0.276). However, nurses' general computer use (p = 0.029) increased more in the leaflet group than in the IT intervention group. We can conclude that IT has promise as an alternative method in patient education, as the implementation of the web-based patient support system in daily basis did not have a negative effect on nurses' attitudes towards IT.

Self-reported adherence to a therapeutic regimen among patients undergoing continuous ambulatory peritoneal dialysis

AIM

This paper is a report of a study conducted to examine self-reported adherence to a therapeutic regimen for continuous ambulatory peritoneal dialysis.

BACKGROUND

Studies of patients' adherence during dialysis have primarily focused on haemodialysis and have frequently yielded inconsistent results, which are attributed to the inconsistent tools used to measure adherence. Levels of adherence to all four components of the therapeutic regimen (i.e. dietary and fluid restrictions, medication, and the dialysis regimen) among patients receiving peritoneal dialysis have not been examined, especially from a patient perspective.

METHODS

A total population sample was used. A cross-sectional survey was carried out by face-to-face interviews in 2005 in one renal clinic in Hong Kong. A total of 173 patients undergoing peritoneal dialysis (56% of the total population) participated in the study.

RESULTS

Patients perceived themselves as more adherent to medication (83%; 95% confidence interval 77-88%) and dialysis (93%; 95% confidence interval 88-96%) prescriptions than to fluid (64%; 95% confidence interval 56-71%) and dietary (38%; 95% confidence interval 30-45%) restrictions. Those who were male, younger or had received dialysis for 1-3 years saw themselves as more non-adherent compared with other patients.

CONCLUSION

Healthcare professionals should take cultural issues into consideration when setting dietary and fluid restriction guidelines. Additional attention and support are required for patients who identify themselves as more non-adherent. To help patients live with end-stage renal disease and its treatment, qualitative research is required to understand how they go through the dynamic process of adherence.

Translation and cross-cultural adaptation into Brazilian Portuguese of the Measure of Parental Style (MOPS) - a self-reported scale - according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations

OBJECTIVE: To describe the translation and adaptation methodology for the Measure of Parental Style, a self-report instrument developed originally in English, following the International Society for Pharmacoeconomics and Outcomes Research guidelines, comparing this to other methodologies used for the same purposes. METHOD: Translation and Cultural Adaptation group International Society for Pharmacoeconomics and Outcomes Research guidelines were followed (preparation, first forward translation, reconciliation, back translation, revision of back translation, harmonization, cognitive debriefing, revision of debriefing results, syntax and orthographic revision, final report). CONCLUSION: A careful and qualified cross-cultural translation and adaptation of an instrument contribute for measuring what it is designed to measure across cultures. Presenting this process, besides its final product, provides the opportunity that this experience could be replicated for adaptation of other instruments.

Assessing linguistic and cultural equivalency of two Chinese-version sexual health instruments among Chinese immigrant youth

This study aimed to evaluate the linguistic and cultural equivalency of two Chinese-version instruments measuring sexual knowledge, attitudes, and behaviors among 10 bilingual and 2 monolingual Chinese immigrant youth aged 13-19 years. We used a rigorous design to translate, back-translate, and pilot test the instruments. Kappa coefficient, percentage agreement, and qualitative feedback from participants were used to examine reliability and validity of the instruments. Telephone interviews revealed that answer discrepancies in different language versions were due to external factors rather than lack of linguistic and cultural equivalency. This study offers preliminary evidence supporting the cultural and linguistic equivalence of two Chinese-version sexual scales.

Effectiveness of Supportive Educative Learning programme on the level of strain experienced by caregivers of stroke patients in Thailand

In Thailand, the crude death rate from stroke is 10.9/100,000 population and increasing. Unlike Western countries where community rehabilitation programmes have been established to provide services following the acute stage of stroke recovery, there is no stroke rehabilitation team in the community in Thailand. Therefore, family caregivers are the primary source for ongoing care and support. While family members accompany patients during their hospitalisation, they receive little information about how to assist their relatives, and as a result feel inadequately trained, poorly informed and dissatisfied with the support that is available after discharge. Family caregivers report that they suffer both physically and psychologically and find themselves overwhelmed with strain, experiencing burden and exhaustion. This study aimed to develop and implement a nurse-led Supportive Educative Learning programme for family caregivers (SELF) of stroke survivors in Thailand and to evaluate the effect of the SELF programme on family caregiver's strain and quality of life. This was a non-randomised comparative study with concurrent controls, using a two-group pre-test and post-test design. A total of 140 stroke survivors and 140 family caregivers were recruited; 70 patients/caregiver pair in each group. Caregivers of patients admitted to the intervention hospital following an acute stroke received the intervention, while caregivers of patients admitted to the comparison hospital received the usual care provided at the hospital. The data were collected prior to discharge of the patients and after 3 months. The family caregivers in the intervention group had a significantly better quality of life than the comparison group (GHQ-28 at discharge t = 2.82, d.f. = 138, P = 0.006; and at 3 months t = 6.80, d.f. = 135, P < 0.001) and they also reported less strain (Caregiver Strain Index at discharge t = 6.73, d.f. = 138, P < 0.001; and at 3 months t = 7.67, d.f. = 135, P < 0.001). This research demonstrated that providing education and support to the family caregiver of stroke survivors can reduce caregiver strain and enhance their quality of life.

Initial Reliability of a Turkish Version of the Dyadic Trust Scale

The Dyadic Trust Scale, previously adapted for a range of applications in organizational research, was translated into Turkish in this study and evaluated with a sample of 117 service employees (69 men and 48 women), whose mean age was 21.5 yr. ( SD=1.8). The internal consistency of the Turkish version was estimated with a Cronbach alpha of .90. Test-retest reliability was .88. Both principal component analysis and confirmatory factor analysis supported the prior unidimensional structure of the eight items. These findings indicate that the Turkish version provides a reliable assessment of interpersonal trust in a service environment.

A psychometric evaluation of the Chinese version of the Cardiovascular Limitations and Symptoms Profile in patients with coronary heart disease

AIMS AND OBJECTIVES

The aim of this study was to translate from English and evaluate the validity, reliability and cultural relevance of the Cardiovascular Limitations and Symptoms Profile (CLASP) as a health-related quality-of-life (HRQL) measure in Chinese patients with coronary heart disease.

BACKGROUND

Improvement in HRQL is increasingly used as a primary outcome in determining the treatment benefit using a generic instrument. However, disease-specific instruments are being cited as more responsive and sensitive in detecting even the smallest changes in health status. Therefore, valid and reliable disease-specific measures for patients with coronary heart disease are now being developed and evaluated.

DESIGN

Questionnaire design.

METHODS

The translation equivalence and content validity of the Chinese version of CLASP were evaluated by an expert panel. Measurement performance was tested on a convenience sample of 369 Chinese coronary heart disease patients.

RESULTS

The instrument demonstrated good content validity (content validity index 0.94), acceptable internal consistency (>0.70), except for two subscales of angina and tiredness and significant positive correlations among the subscales of CLASP, Hospital Anxiety Depression Scale and the Short Form 36 Health Survey. Principal components analysis revealed nine factors that together explained 69% of the variance.

CONCLUSIONS

The results of this study support that CLASP is a valid and reliable disease-specific health status measure for Chinese patients with coronary heart disease. However, further item modifications and testings are needed when considering the cross-cultural context.

RELEVANCE TO CLINICAL PRACTICE

The use of disease-specific HRQL measures could effectively evaluate nursing interventions in clinical practice. Further validations of CLASP among different diagnostic groups, such as patients with heart failure and those who have survived an acute myocardial infarction, would provide further empirical support for its use with all patients with heart disorders.

A preliminary reliability and validity study of the Chinese version of the self-efficacy for exercise scale for older adults

BACKGROUND

Population ageing affects most undeveloped, developing and developed countries. Less than a quarter of older people undertake a level of physical activity worldwide that is sufficient to lead to health benefits. Understanding older people's confidence regarding engaging in exercise helps to structure physical activity interventions that motivate them to initiate and adhere to regular exercise. Estimates of the reliability and validity of the English version of the self-efficacy for exercise (SEE) scale has been widely tested and shown to be valid for use in various settings and among older people. The reliability and validity of a Chinese version of the SEE for older adults has not been tested.

AIM

To undertake a preliminary assessment of the reliability and validity of the SEE scale when applied to the older Chinese adults.

METHODS

The Chinese version of the self-efficacy for exercise (SEE-C) scale was tested on a sample of 192 older people from Taiwan with a mean age of 71.2 years recruited between October and December 2003.

RESULTS

There was acceptable internal consistency of the SEE-C scale. The fit of the measurement model to the data for the SEE-C scale was acceptable. There was evidence of validity of the measure based on hypothesis testing: health status predicted exercise self-efficacy, and exercise self-efficacy predicted physical activity. Those who exercised regularly (n=102) had a higher mean SEE-C score (5.3) than those who did not (2.9, n=90).

CONCLUSION

This preliminary validation study provided evidence for the reliability and validity of the Chinese version of the SEE scale. Future testing of the SEE-C scale needs to be carried out to see whether these results are generalisable to older Chinese people living in urban areas and with different characteristics. A test of the scale among younger adults for a wider use of the instrument is also warranted.

Care dependency of children in Egypt

AIMS

This study aimed to modify the Care Dependency Scale so that it could be used for children, to apply its Arabic version to Egyptian children to test the reliability and validity of the modified scale and to compare the care dependency of disabled and non-disabled Egyptian children.

BACKGROUND

A higher dependence of children in their daily tasks undoubtedly places a greater burden on their caregivers. To estimate the extent of the problem of care dependency, data from different countries and proper standard instruments are required.

METHOD

The Care Dependency Scale was modified for children by Delphi technique. This study assessed the care dependency of non-disabled children compared with children with physical and mental disabilities using the modified version of the Care Dependency Scale for paediatrics. The total sample included 260 Egyptian school-age children (50.8% of whom were disabled and 49.2% were non-disabled).

RESULTS

Reliability was examined in terms of internal consistency using Cronbach's alpha (0.91). Inter-rater reliability revealed moderate to very good Kappa statistics between 0.57-0.89. Content validity and criterion validity were evaluated. Differences regarding care dependency were found between disabled and non-disabled children.

CONCLUSION

The psychometric properties of the Care Dependency Scale for paediatrics support its usefulness in measuring the care dependency of children in Egypt. This study provides an Arabic version of the Care Dependency Scale for paediatrics that is easy to administer and may be useful to measure the care dependency in various Arabic countries.

RELEVANCE TO CLINICAL PRACTICE

The findings raise concerns regarding the extent to which disabled and also non-disabled school-age children are care dependent leading to an increased burden of care on nurses or on caregivers in general. The Care Dependency Scale for Paediatrics can help nurses conduct an appropriate assessment of children's care dependency so that any nursing care can be planned according to the children's needs.

Paediatric health-related quality of life instrument for primary school children: cross-cultural validation

AIM

This article is a report of a study to validate the Finnish version of the Pediatric Quality of Life Inventory(TM) (PedsQL*) for children aged 8-12 years.

BACKGROUND

Promoting and improving health and well-being of children are the global goals of primary-day health care. Sophisticated, internationally valid measurement tools are needed for planning, conducting and evaluating interventions to meet these challenges. The PedsQL is a promising, relatively new instrument developed in the United States to assess health-related quality of life (HRQL) in children and adolescents.

METHOD

Content validity of the Finnish version of PedsQL 4.0 was assessed in 2004 during the translation process and tested by performing cognitive interviews with children aged 8-12 years (n = 7) and their parents (n = 5). Construct validity and reliability of the Finnish version of the PedsQL 4.0 were statistically tested on a sample of school children (n = 1097) and their parents (n = 999).

FINDINGS

Cognitive interviews confirmed that the concepts, questions and response alternatives of the Finnish version are equivalent to the original PedsQL 4.0. The Finnish version was easy to understand and complete. The construct validity was good. Cronbach s alpha values were excellent for the total scale score (Child-Self Report alpha = 0.91 and Parent-Proxy Report alpha = 0.88) and good for sub- and summary scales (Child-Self Report alpha = 0.73-0.89 and Parent-Proxy Report alpha = 0.69-0.86).

CONCLUSION

Results support previous research on validity and reliability of the PedsQL 4.0. The Finnish version of the PedsQL 4.0 demonstrated good validity and reliability in primary school children. Future research is needed to examine, construct and predictive validity of the Finnish version of the PedsQL 4.0.

Validity and Reliability of the Brief Multidimensional Students' Life Satisfaction Scale With Turkish Children

The Brief Multidimensional Students' Life Satisfaction Scale (BMSLSS) was designed to measure life satisfaction among children and adolescents. The present study aimed to assess the reliability and validity of the Turkish version of the BMSLSS. The Turkish version of BMSLSS was administered to 394 students from fourth through eighth grade. The results revealed acceptable internal consistency reliability, criterion-related validity, and construct validity for the BMSLSS. The BMSLSS scores had acceptable test-retest reliability ( r = .82) and internal consistency ( r = .89). Item-total correlations varied from .64 to .78. The BMSLSS had a significant correlation with the Children's Depression Inventory and the Piers Haris Self-Concept Scale. The results indicated that the BMSLSS has strong pyschometric properties for the sample of the study.

Development of a Family Dynamic Environment Scale for Korean Adolescents

The objective of this study was to develop a short and reliable Family Dynamic Environment Scale (FDES) that would better serve the needs of mental health professionals in detecting the potential for delinquent behavior in Korean adolescents related to a dysfunctional family dynamic environment. Semi-structured interviews with 30 adolescents were initially conducted to generate a set of items, after which, 44 participants were included in method test-retest reliability test. Finally, 544 participants recruited by proportional stratified random sampling were included in a factor analysis. The original version of the FDES had 60 items in 7 categories; the final version included 42 items grouped into 5 factors. Both test-retest reliability and Cronbach's alpha coefficient were high for the final version of the scale. As a result of factor analysis, five factors were extracted: family psychological climate, parent-child relationship, paternal parenting attitude, family cohesion, and maternal parenting attitude. These contributed 50.3% of the variance in the item scores. All 42 items loaded above .35 on their respective factors. The Cronbach's alpha coefficients for internal consistency were .95 for the total 42 items and .92, .81, .82, .78, and .71, respectively, for each of the 5 factors.

Measuring individualized nursing care: assessment of reliability and validity of three scales

AIM

This paper is a report of a study to assess the reliability and convergent validity of three measures of nursing care individualization.

BACKGROUND

Individualized care is a key element of nursing care quality, yet little is known about the extent to which it is implemented, its effects, and the factors that help or hinder nurses in giving individualized care. Therefore reliable and valid instruments are needed to measure individualized nursing care.

METHOD

A cross-sectional correlational survey design was used. The purposive sample consisted of 861 patients from six hospitals in Finland (response rate 82%). Data were collected in 2004. The Individualized Care Scale was administered simultaneously with translated versions of the Schmidt's Perceptions of Nursing Care Survey and the Oncology Patients' Perceptions of the Quality of Nursing Care Scale. Internal consistency reliability and convergent validity were assessed for each scale.

FINDINGS

Evidence for convergent validity was identified between the Individualized Care Scale (part A/B), the Individualization subscale (r = 0.64 with Part A, r = 0.66 with part B) and the Seeing the Individual Patient subscale (r = 0.68 with part A, r = 0.71 with part B). Cronbach alpha coefficient was 0.97 for the Individualized Care Scale, 0.82 for Seeing the Individual Patient and 0.87 for the Individualization subscale.

CONCLUSION

Data provided preliminary evidence for the convergent validity of the individualized care scales, as well as acceptable internal consistency reliability for each scale. These scales represent useful measures for assessing patients' perceptions of the individualization of nursing care received.

[Adaptation and validation of the "Positions on Nursing Diagnosis" tool to Portuguese language]

The Positions on Nursing Diagnosis tool (PND) was developed in English to assess nurses' attitudes toward nursing diagnosis.

AIMS

To adapt and validate the PND to Portuguese Brazilian language; and to verify associations between PND and selected variables. The Brazilian version of PND, named Posições frente ao Diagnóstico de Enfermagem (PDE), was obtained by translation, back-translation, and comparison between the original version and the back-translated one. The PDE was applied to 400 nurses and nursing students. The PDE scores were positively correlated with a general statement favorable to nursing diagnosis; the factor analysis produced 3 factors (evaluative, potency, and activity). The nursing students showed more favorable attitudes toward nursing diagnosis.

Are psychological consequences of stigma enduring or transitory? A longitudinal study of HIV stigma and distress among Asians and Pacific Islanders living with HIV illness

Cross-sectional findings have shed considerable light on the relationships between illness stigma and psychological outcomes among persons living with HIV/AIDS in the United States. However, no studies have examined the possible long-term consequences of illness stigma on mental health among Asians and Pacific Islanders living with HIV/AIDS, a group particularly vulnerable to HIV stigma due to ingrained sociocultural norms. This 2-year longitudinal study examined the relationship between five HIV-stigma factors (social rejection, negative self-worth, perceived interpersonal insecurity, financial insecurity, discretionary disclosure) and changes in psychological distress dimensions (self-esteem, hopelessness, dread, confused thinking, sadness, anxiety) among a convenience sample of 44 HIV-seropositive Asians and Pacific Islanders in New York City from 2002 to 2004. Undocumented Asians independently endorsed higher levels of perceived interpersonal insecurity and lower levels of self-esteem than documented participants at both baseline and 2-year follow-up. Results from hierarchical multiple regression analyses indicated that baseline social rejection and perceived interpersonal insecurity were significantly associated with changes in self-esteem at 2-year follow-up, controlling for baseline self-esteem and physical symptoms at follow-up. An interaction effect between baseline financial insecurity and discretionary disclosure was significantly associated with dread at 2-year follow-up. Findings highlight the importance of stigma reduction interventions that: (1) recognize multiple layers of stigma based sexual orientation, gender, and immigration status; and (2) address both individual and structural constraints that perpetuate HIV-stigma among Asians and Pacific Islanders in the United States.

Translation and validation of the Chinese version of the Gastrointestinal Quality of Life Index in patients with gastric tumor

OBJECTIVE

Patients with gastric tumor are known to have deterioration in quality of life (QOL) following surgery. However, there is no valid disease-specific self-report QOL measure for clinical practice and research designated for Chinese in Hong Kong. The current study aimed at translating and validating a Chinese version of the Gastrointestinal Quality of Life Index (C-GIQLI) for use in patients with gastric tumors after gastrectomy.

METHODS

A translation of the English version of the instrument was performed. The psychometric properties of the C-GIQLI were investigated using internal consistency analysis, correlational analysis, and confirmatory factor analysis in 140 Chinese patients who had undergone surgery for gastric tumor.

RESULTS

The C-GIQLI demonstrated good test-retest reliability, internal consistency, and a factor structure consistent with the measurement model of the European version of the instrument.

CONCLUSION

The C-GIQLI is recommended as a valid and reliable self-report measure of QOL in patients with gastric tumor after gastrectomy.

A Chinese Mandarin translation and validation of the Myocardial Infarction Dimensional Assessment Scale (MIDAS)

AIMS

To evaluate the validity, reliability, and cultural relevance of the Chinese Mandarin version of Myocardial Infarction Dimensional Assessment Scale (MIDAS) as a disease-specific quality of life measure.

METHODS

The cultural relevance and content validity of the Chinese Mandarin version of the MIDAS (CM-MIDAS) was evaluated by an expert panel. Measurement performance was tested on 180 randomly selected Chinese MI patents. Thirty participants from the primary group completed the CM-MIDAS for test-retest reliability after 2 weeks. Reliability, validity and discriminatory power of the CM-MIDAS were calculated.

RESULTS

Two items were modified as suggested by the expert panel. The overall CM-MIDAS had acceptable internal consistency with Cronbach's alpha coefficient 0.93 for the scale and 0.71-0.94 for the seven domains. Test-retest reliability by intraclass correlations was 0.85 for the overall scale and 0.74-0.94 for the seven domains. There was acceptable concurrent validity with significant (p < 0.05) correlations between the CM-MDAS and the Chinese Version of the Short Form 36. The principal components analysis extracted seven factors that explained 67.18% of the variance with high factor loading indicating good construct validity.

CONCLUSION

Empirical data support CM-MIDAS as a valid and reliable disease-specific quality of life measure for Chinese Mandarin speaking patients with myocardial infarction.

Translation and cultural adaptation of the Piper Fatigue Scale for use in Sweden

The aim of this study was to translate and culturally adapt the revised Piper Fatigue Scale to Swedish. For translation, guidelines for cross-cultural adaptation were used. Two teams independently translated the instrument and two other teams produced back-translations, after which a multidisciplinary committee decided on a Swedish version. In pre-test interviews, ten cancer patients were encouraged to think out loud while completing the Swedish version. Their verbal responses were analysed and used for a second revision. The initial translations varied in words, expressions and grammar, shown in a lack of equivalence to the original instrument after back-translation. In order to establish semantic equivalence, the committee changed some grammatical constructions, and some words were replaced for experiential and conceptual equivalence. When analysing the pre-test, obscurities due to the phrasing of some items were revealed and dealt with in the second revision. This study does not fulfil the process of validation for a translated instrument but offers a sound basis for further accumulation of evidence for validity, and facilitates the choice of an appropriate instrument for studying cancer-related fatigue in Sweden.

Validation of the Punjabi version of the Edinburgh postnatal depression scale (EPDS)

This study reports a project to validate a Punjabi translation of the Edinburgh postnatal depression scale (EPDS). The study involved three points of data collection. Bilingual (Punjabi and English speaking) new mothers completed the English and Punjabi EPDS on two separate occasions and underwent a diagnostic interview. At a threshold of 12.5 the Punjabi scale yielded a sensitivity of 71.4 and specificity of 93.7. Analysis suggests criterion and conceptual equivalence between the two scales. A users' evaluation indicates that the tool was acceptable to the majority of mothers, however, the scale may be more applicable for mothers for whom Punjabi is their first language.

Development and validation of the Human Activity Profile into Chinese language: Lessons in determining equivalence

The Human Activity Profile (HAP), and associated Dyspnea Scale, is a self-report instrument for assessing levels of human activity. Although it has been used in studies examining the levels of activity in people, it is limited to people who are only able to understand English. However, many countries are multicultural with significant numbers of people whose native language is not English. This study sought to demonstrate the equivalence between the Chinese and English versions of the HAP and Dyspnea scales. Thirty-five bilingual university students completed both the Chinese and English versions of each questionnaire. There was 89% and 85% agreement between items across the HAP and Dyspnea Scale questionnaires, respectively. Although the psychometric evaluations suggested there was equivalence between the Chinese and English versions of both the HAP and Dyspnea Scale, lessons have been learnt regarding the different written forms of Chinese.

Structural ambiguity of the Chinese version of the Hospital Anxiety and Depression Scale in patients with coronary heart disease

Background

The Hospital Anxiety and Depression Scale (HADS) is a widely used screening tool designed as a case detector for clinically relevant anxiety and depression. Recent studies of the HADS in coronary heart disease (CHD) patients in European countries suggest it comprises three, rather than two, underlying sub-scale dimensions. The factor structure of the Chinese version of the HADS was evaluated in patients with CHD in mainland China.

Methods

Confirmatory factor analysis (CFA) was conducted on self-report HADS forms from 154 Chinese CHD patients.

Results

Little difference was observed in model fit between best performing three-factor and two-factor models.

Conclusion

The current observations are inconsistent with recent studies highlighting a dominant underlying tri-dimensional structure to the HADS in CHD patients. The Chinese version of the HADS may perform differently to European language versions of the instrument in patients with CHD.

Dimensions of the Turkish version of the Psychological Empowerment Scale

The purpose of the present study was to examine the dimensions of Spreitzer's Psychological Empowerment Scale for Turkish-speaking people. The scale was tested with a group of undergraduate students in Turkey (N = 214; M age = 22.6 yr., SD = 1.5, range = 19-27). Cronbach coefficient alpha was .84. By using maximum likelihood analysis with oblique rotation, three factors emerged and were labeled Influence, Meaning, and Competence.

Severe acute respiratory syndrome (SARS): knowledge, attitudes, practices and sources of information among physicians answering a SARS fever hotline service

In June 2003, Taiwan introduced a severe acute respiratory syndrome (SARS) telephone hotline service to provide concerned callers with rapid access to information, advice and appropriate referral where necessary. This paper reports an evaluation of the knowledge, attitude, practices and sources of information relating to SARS among physicians who staffed the SARS fever hotline service. A retrospective survey was conducted using a self-administered postal questionnaire. Participants were physicians who staffed a SARS hotline during the SARS epidemic in Taipei, Taiwan from June 1 to 10, 2003. A response rate of 83% was obtained. All respondents knew the causative agent of SARS, and knowledge regarding SARS features and preventive practices was good. However, only 54% of respondents knew the incubation period of SARS. Hospital guidelines and news media were the major information sources. In responding to two case scenarios most physicians were likely to triage callers at high risk of SARS appropriately, but not callers at low risk. Less than half of all respondents answered both scenarios correctly. The results obtained suggest that knowledge of SARS was generally good although obtained from both medical and non-medical sources. Specific knowledge was however lacking in certain areas and this affected the ability to appropriately triage callers. Standardized education and assessment of prior knowledge of SARS could improve the ability of physicians to triage callers in future outbreaks.

Issues of instrument translation in research on Asian immigrant populations

Health disparity research often includes non-English-speaking populations, and instrument translation is a major methodological issue with which researchers must contend. Yet most existing nursing research do not adequately describe translation method processes used. This article describes the procedures used to translate the Caregiver Reaction Assessment instrument into Ilocano for use in a study with elderly Filipinos caring for their grandchildren and the Parenting Practice Interview into Korean for use in a study of parenting practices among Korean immigrant parents. An explanation of Brislin's method for instrument translation is first provided, followed by a detailed description of how this method was applied in the two studies and the challenges encountered in assessing translation accuracy. Achieving semantic and content equivalence posed a major challenge in both studies. Recommendations for cross-cultural nursing research are provided; the experiences described in this article illuminate translation issues to be considered by nurse researchers.

Obesity: translation and testing of a survey instrument for use in Taiwan

AIM AND OBJECTIVES

The purpose of this paper is to describe a cross-cultural translation and validation methodology recommended by Vallerand. The translation technique has seven steps and ensures the instrument provides data that are valid and reliable.

BACKGROUND

Translation of data collection instruments is a challenge increasingly being faced by overseas students studying in the West as they choose to research contextual issues of relevance to their home culture.

METHODS

Six of Vallerand's seven steps are used and modified as the methodical translation of a survey from English to Mandarin.

RESULTS

The results revealed there was no significant difference between the original English questionnaire and Mandarin questionnaire. The validation study indicated good internal consistency. The construct validity of the Mandarin version was determined except one item which failed the test. The validation demonstrates only minor effects of language translation.

CONCLUSION

The Mandarin version thus is a valid tool for investigating from the perspective of school nurses, their role and potential contribution to health promotion in relation to the prevention of obesity among school children in Taiwan.

RELEVANCE TO CLINICAL PRACTICE

The results of the study will enable school nurses and their managers to reflect critically on their contribution to the prevention of obesity among Taiwanese school children. The translation technique has enabled the researcher to minimize errors that may have occurred in translation. It adds to the quality of the instrument and offers opportunities in the future to undertake cross-cultural comparison in an issue of great concern globally.

Multiple dimensions of HIV stigma and psychological distress among Asians and Pacific Islanders living with HIV illness

Asians and Pacific Islanders (APIs) living with HIV/AIDS in the US are particularly vulnerable to HIV-related stigma largely due to ingrained socio-cultural norms that strongly associate HIV transmission with activities perceived to be immoral. This cross-sectional study examined the relationship between five HIV-stigma factors and psychological distress among 54 HIV-seropositive APIs. Social Rejection, Negative Self-Worth, Perceived Interpersonal Insecurity, and Financial Security were all significantly associated with psychological distress. Results from hierarchical multiple regression analyses indicated that Social Rejection, Negative Self-Worth, and Perceived Interpersonal Insecurity significantly predicted psychological distress after control for physical symptoms and country of birth. Undocumented Asians endorsed higher levels of Social Rejection, Negative Self-Worth and Perceived Interpersonal Insecurity than documented APIs. Future studies examining mechanisms of psychological distress among HIV-seropositive APIs are needed.

Nursing models and self-concept in patients with spinal cord injury—a comparison between UK and Taiwan

The purpose of this study is to investigate rehabilitation nurses' care for patients with spinal cord injury (SCI). It also examines how rehabilitation nurses perceive their role in assessing the alteration of self-concept and the interventions they use in helping patients to develop a more positive perception of themselves. A critical review of common models in use was undertaken including Roper, Logan and Tierney's Activities of Living Model, Roy's Adaptation Model and Orem's Self-care Deficit Nursing Theory. A nursing framework has been developed for rehabilitation nursing. Data were collected by questionnaire. The findings indicate that rehabilitation nurses are aware of the alteration in self-concept for patients with SCI. Although nursing interventions include physiological, psychological and social aspects of care, nurses do not feel that current nursing models are useful in SCI nursing and tend to support the specially designed model.