Cultural diversity issues in the development of valid and reliable measures of health status

Child and adolescent participation measurement tools and their translations: A systematic review

BACKGROUND

Numerous participation measurement tools targeting children and youth have been developed. Despite the translation of these tools into specific languages and cultures, the reliability and validity of the translated versions remain uncertain. To address this gap in knowledge, this study aims to identify tools for assessing the participation of children aged 5-18 years and to appraise the psychometric properties of their translated versions.

METHODS

Four electronic databases were searched for peer-reviewed studies published in English. Preferred Reporting Items for Systematic Reviews guidelines was followed. Study titles and abstracts were screened by four independent reviewers. Data were extracted for both original and translated versions of eligible tools. Instrument quality assessments were performed using the Outcome Measures Rating Form Guidelines. Any discrepancies were resolved by consensus.

RESULTS

Out of the 31 measurement tools examined, 18 tools had at least one translated version available, and among those original measurement tools, a total of 58 translated versions were identified. The most widely translated tool was the Physical Activity Questionnaire for Children (12 languages), and the most frequently translated language was Chinese (7 tools). Most translated versions verified internal consistency and content validity. Only three translated versions were verified inter-rater reliability, and seven translated versions were tested criterion validity with the gold standard tools assessing participation of children (e.g., accelerometer, Pediatric Evaluation of Disability Inventory and four 24-h recalls). None of the translated versions were tested for intra-rater reliability and responsiveness.

CONCLUSIONS

These findings can support the selection of psychometrically sound tools for children with disabilities, given their culture and language, and tool quality.

Cross-Cultural Adaptation and Validation of the Hindi Version of EuroQol (EQ-5D-3L) Health Questionnaire in Patients With Chronic Low Back Pain

OBJECTIVE

The present study is an attempt to validate the Hindi version of the EuroQoL (EQ-5D-3L) questionnaire for patients with chronic low back pain (CLBP).

DESIGN

Prospective clinical study.

SETTING

The study was conducted on an outpatient basis with the subjects being followed via online platform on day 3.

SUBJECT

Native Indian patients above 18 years of age having CLBP who could speak and read Hindi were enrolled in the study.

METHODS

This study is a cross-sectional study on 132 patients presenting with CLBP. Hi-SF-36 was used as a reference scale. Pain was evaluated using the numeric rating scale. Psychometric properties including internal consistency, test-retest reliability on day 3 and convergent validity were evaluated. Confirmation factor analysis was carried out in order to establish the relationship between the five dimensions of Hi-EQ-5D-3L and the eight domains of Hi-SF-36.

RESULTS

The Cronbach alpha of 0.984 for index value and 0.944 for visual analog scale confirmed internal consistency of the Hi-EQ-5D. Intraclass correlation coefficient was found to be excellent for EQ index value (0.969, 95% CI: 0.954-0.979) and very good for visual analog scale (0.894, 95% CI: 0.844-0.928). Spearman rho correlation coefficients for the index value correlated strongly with all domains except role emotion ( r =0.181 on day 0 and r =0.239 on day 3). A good relationship between Hi-SF-36 and Hi-EQ-5D-3L was confirmed through factor analysis.

CONCLUSION

The Hindi version of the EQ-5D-3L demonstrated comprehensibility, reliability and proved to be a valid instrument for the evaluation of health-related quality of life in CLBP patients.

Measuring psychological distress using the K10 in Kenya

BACKGROUND

The Kessler psychological distress scale (K10) is a brief screening tool that assesses psychological distress in both clinical and epidemiological settings. Despite wide applicability of the K10 globally, there are no data on psychometric properties of the K10 in Kenya. This study investigated the reliability, factor structure, and construct validity of the K10 as a measure of psychological distress among adults in Kenya.

METHODS

A total of 2556 adults attending 11 outpatient clinics in the western and coastal regions of Kenya without a history or clinical diagnosis of psychotic disorders were included. Data were collected on demographic characteristics of the participants and the K10. Internal consistency was evaluated using Cronbach's alpha. Construct validity and factor structures of the K10 were evaluated using both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) approaches.

RESULTS

The mean K10 score was 3.4 and Cronbach's alpha was 0.85, indicating good internal consistency (reliability). EFA resulted in a two-factor solution that accounted for 67.6% of variance. CFA results indicated that a unidimensional model with correlated errors best fit the data.

LIMITATIONS

The K10 was only administered to a control group of our study population, which had low levels of psychological distress.

CONCLUSION

The K10 has good construct validity and reliability for use as a broad measure of psychological distress in Kenyan adults and may be useful in general medical setting to assess anxiety and depressive disorders.

Validity and Reliability of the Stress and Anxiety to Viral Epidemics-6 (SAVE-6) Scale to Measure Viral Anxiety of Healthcare Workers in Spain During the COVID-19 Pandemic

This study examined the validity and applicability of the Spanish version of the Stress and Anxiety to Viral Epidemics-6 items (SAVE-6) scale, which can be usually applied to the general population, to healthcare workers to briefly measure their anxiety responses to the viral epidemic. A total of 135 healthcare workers participated in this online survey from January to July 2021. Participants' sociodemographic characteristics were gathered, and their psychiatric symptoms were rated using SAVE-6, Goldberg Anxiety and Depression Scale (GDAS), and the Pittsburgh Sleep Quality Index (PSQI). The confirmatory factor analysis was conducted to examine the validity of the scales. The single-structure model of the SAVE-6 scale was adopted based on the results of the parallel analysis. We decided on the SAVE-6 scale, as it proved to be a good fit to measure healthcare workers' anxiety response to the viral epidemic. SAVE-6 showed good internal consistency (Cronbach's alpha = 0.827 and McDonald's omega = 0.834) and good convergent validity with Goldberg anxiety (r = 0.434, p < 0.001) and depression (r = 0.193, p = 0.043) scores, and PSQI score (r = 0.262, p = 0.002). The Spanish version of SAVE-6 is a reliable and valid rating scale to assess the anxiety response of healthcare workers specifically to the viral epidemic as a brief measure during the COVID-19 pandemic.

The Hausa 12-item short-form health survey (SF-12): Translation, cross-cultural adaptation and validation in mixed urban and rural Nigerian populations with chronic low back pain

INTRODUCTION

Measuring health-related quality of life (HRQOL) in patients with chronic low back pain (LBP) is crucial to monitor and improve the patients' health status through effective rehabilitation. While the 12-item short-form health survey (SF-12) was developed as a shorter alternative to the 36-item short-form health survey for assessing HRQOL in large-scale studies, to date, no cross-culturally adapted and validated Hausa version exists. This study aimed to translate and cross-culturally adapt the SF-12 into Hausa language, and test its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP.

METHODS

The Hausa version of the SF-12 was developed following the guidelines of the International Quality of Life Assessment project. Fifteen patients with chronic LBP recruited from urban and rural communities of Nigeria pre-tested the Hausa SF-12. A consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the instrument, among which 100 respondents re-tested the instrument after two weeks. Factorial structure and invariance were assessed using confirmatory factor analysis (CFA) and multi-group CFA respectively. Multi-trait scaling analysis (for convergent and divergent validity) and known-groups validity were performed to assess construct validity. Composite reliability (CR), internal consistency (Cronbach's α), intraclass correlation coefficients (ICC), and Bland-Altman plots were computed to assess reliability.

RESULTS

After the CFA of the original conceptual SF-12 model, 2 redundant items were removed and 4 error terms were allowed to covary, thus providing adequate fit to the sample. The refined model demonstrated good fit and evidence of factorial invariance in three demographic groups (age, gender, and habitation). Convergent (11:12; 91% success rate) and divergent (10:12; 83% success rate) validity were satisfactory. Known-groups comparison showed that the instrument discriminated well for those who differed in age (p < 0.05) but in gender and habitation (p > 0.05). The physical component summary and the mental component summary demonstrated acceptable CR (0.69 and 0.79 respectively), internal consistency (α = 0.73 and 0.78 respectively), test-rest reliability (ICC = 0.79 and 0.85 respectively), and good agreement between test-retest values.

CONCLUSIONS

The Hausa SF-12 was successfully developed and showed evidence of factorial invariance across age, gender, and habitation. The instrument demonstrated satisfactory construct validity, internal consistency, and test-retest reliability. However, stronger psychometric properties need to be established in general population and other patients groups in future studies. The instrument can be used clinically and for research in Hausa-speaking patients with chronic LBP.

Depression and intimate partner violence among urban Kenyan caregivers of children with disabilities

WHAT IS KNOWN ON THE SUBJECT?: Caregivers of children with disabilities are at increased risk of experiencing interpersonal violence and its consequences; however, there is limited research targeting this population. This problem is understudied in Sub-Saharan Africa. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Study examines intimate partner violence and depression among men and women caregivers of children with disabilities. Study findings showed that while a higher proportion of women caregivers of children with disabilities than men reported experiencing intimate partner violence and were at increased risk depression, the differences were not statistically significant. Participants reporting any form of violence (i.e. psychological aggression or physical assault) were at increased risk for depression, with those experiencing a combination of physical assault and psychological aggression having the highest risk for depression. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Professionals working families of individuals with disabilities should be cognizant of the added stress and comorbid factors associated with caring for a child with a disability. Future research should examine whether there is a causal relationship between intimate partner violence and depression among caregivers of children with disabilities and compare this relationship with the general population. ABSTRACT: Introduction Mental health correlates of intimate partner violence (IPV) victimization are well documented. However, caregivers of children with disabilities (CCWDs) are underrepresented in empirical investigations and may have an increased risk of experiencing IPV and its consequences. This is particularly important in Sub-Saharan Africa where this problem is understudied. Method The present study estimated the prevalence of IPV victimization and examined the association between IPV and depression in a sample of CCWDs living in Nairobi, Kenya. Results Nearly half (49.8%) of the participants experienced some form of IPV and more than half (51.8%) were at risk of depression. Participants reporting psychological and physical violence were 1.76 and 4.81 times more likely to be at risk for depression, respectively. Those experiencing a combination of physical and psychological violence were 4.85 times more likely to be at risk for depression. Discussion Both men and women CCWDs are at an increased risk for IPV and depression. Social-cultural factors are also important in the prediction of depression risk and should be taken into account when working with CCWDs. Implications Mental health professionals should be cognizant of the added stress of being a CCWD, and the link between CCWDs and comorbid mental health outcomes.

Cross-cultural adaptation and validation of the VISA-A questionnaire for Chilean Spanish-speaking patients

Background

The purpose of this study is to translate, culturally adapt, and validate the VISA-A questionnaire for Chilean Spanish speakers with Achilles tendinopathy (AT), which has been originally developed for English-speaking population.

Methods

According to the guidelines published by Beaton et al., the questionnaire was translated and culturally adapted to Chilean patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version (cohort n = 35), and development of VISA-A-CH. The resulting Chilean version was tested for validity on 60 patients: 20 healthy individuals (group 1), 20 patients with a recently diagnosed AT (group 2), and 20 with a severe AT that already initiated conservative treatment with no clinical improvement (group 3). The questionnaire was completed three times by each participant: at the time of study enrollment, after an hour, and after a week of the initial test.

Results

All six steps were successfully completed for the translation and cultural adaptation of the VISA-A-CH. VISA-A-CH final mean scores in the healthy group was significantly higher than those in the other groups. Group 3 had the lowest scores. Validity showed excellent test-retest reliability (rho c = 0.999; Pearson’s r = 1.000) within an hour and within a week (rho c = 0.837; Pearson’s r = 0.840).

Conclusions

VISA-A was translated and validated to Chilean Spanish speakers successfully, being comparable to the original version. We believe that VISA-A-CH can be recommended as an important tool for clinical and research settings in Chilean and probably Latin-American Spanish speakers.

Electronic supplementary material

The online version of this article (10.1186/s13018-018-0882-2) contains supplementary material, which is available to authorized users.

Development of an Autism Subtyping Questionnaire Based on Social Behaviors

Autism spectrum disorder can be differentiated into three subtypes (aloof, passive, and active-but-odd) based on social behaviors according to the Wing Subgroups Questionnaire (WSQ). However, the correlations between the scores on some individual items and the total score are poor. In the present study, we translated the WSQ into Chinese, modified it, validated it in autistic and typically-developing Chinese children, and renamed it the Beijing Autism Subtyping Questionnaire (BASQ). Our results demonstrated that the BASQ had improved validity and reliability, and differentiated autistic children into these three subtypes more precisely. We noted that the autistic symptoms tended to be severe in the aloof, moderate in the passive, and mild in the active-but-odd subtypes. The modified questionnaire may facilitate etiological studies and the selection of therapeutic regimes.

Measuring Functional and Patient-Reported Outcomes After Treatment of Mutilating Hand Injuries: A Global Health Approach

Understanding the global burden of trauma, particularly upper extremity trauma, is necessary in addressing the need for surgical services. Critical to that mission is to understand, and accurately measure, disability and related disability-adjusted life-years from massive upper extremity trauma. The impact of these injuries is magnified when considering that they frequently occur to young people in prime working years. This article discusses these social and medical system issues and reviews components of a comprehensive approach to measuring outcomes after these injuries. Patient-reported outcomes are highlighted. Methods of optimizing outcomes measurements and studies, disability assessments, and associated research are also discussed.

Cultural adaptation and validation of Stroke Impact Scale 3.0 version in Uganda: A small-scale study

BACKGROUND

Knowledge is scarce about the impact of stroke in Uganda, and culturally adapted, psychometrically tested patient-reported outcome measures are lacking. The Stroke Impact Scale 3.0 is recommended, but it has not been culturally adapted and validated in Uganda.

OBJECTIVE

To culturally adapt and determine the psychometric properties of the Stroke Impact Scale 3.0 in the Ugandan context on a small scale.

METHOD

The Stroke Impact Scale 3.0 was culturally adapted to form Stroke Impact Scale 3.0 Uganda (in English) by involving 25 participants in three different expert committees. Subsequently, Stroke Impact Scale 3.0 Uganda from English to Luganda language was done in accordance with guidelines. The first language in Uganda is English and Luganda is the main spoken language in Kampala city and its surroundings. Translation of Stroke Impact Scale 3.0 Uganda (both in English and Luganda) was then tested psychometrically by applying a Rasch model on data collected from 95 participants with stroke.

RESULTS

Overall, 10 of 59 (17%) items in the eight domains of the Stroke Impact Scale 3.0 were culturally adapted. The majority were 6 of 10 items in the domain Activities of Daily Living, 2 of 9 items in the domain Mobility, and 2 of 5 items in the domain Hand function. Only in two domains, all items demonstrated acceptable goodness of fit to the Rasch model. There were also more than 5% person misfits in the domains Participation and Emotion, while the Communication, Mobility, and Hand function domains had the lowest proportions of person misfits. The reliability coefficient was equal or larger than 0.90 in all domains except the Emotion domain, which was below the set criterion of 0.80 (0.75).

CONCLUSION

The cultural adaptation and translation of Stroke Impact Scale 3.0 Uganda provides initial evidence of validity of the Stroke Impact Scale 3.0 when used in this context. The results provide support for several aspects of validity and precision but also point out issues for further adaptation and improvement of the Stroke Impact Scale.

Developing a Conceptually Equivalent Type 2 Diabetes Risk Score for Indian Gujaratis in the UK

Aims. To apply and assess the suitability of a model consisting of commonly used cross-cultural translation methods to achieve a conceptually equivalent Gujarati language version of the Leicester self-assessment type 2 diabetes risk score. Methods. Implementation of the model involved multiple stages, including pretesting of the translated risk score by conducting semistructured interviews with a purposive sample of volunteers. Interviews were conducted on an iterative basis to enable findings to inform translation revisions and to elicit volunteers' ability to self-complete and understand the risk score. Results. The pretest stage was an essential component involving recruitment of a diverse sample of 18 Gujarati volunteers, many of whom gave detailed suggestions for improving the instructions for the calculation of the risk score and BMI table. Volunteers found the standard and level of Gujarati accessible and helpful in understanding the concept of risk, although many of the volunteers struggled to calculate their BMI. Conclusions. This is the first time that a multicomponent translation model has been applied to the translation of a type 2 diabetes risk score into another language. This project provides an invaluable opportunity to share learning about the transferability of this model for translation of self-completed risk scores in other health conditions.

Cross-cultural adaptation and psychometric testing of the Arabic version of the Patient-Rated Wrist Hand Evaluation (PRWHE-A) in Saudi Arabia

PURPOSES

The purposes of this study was to 1) perform a cross-cultural Arabic translation for the Patient-Rated Wrist and Hand Evaluation (PRWHE-A) using standardized guidelines and, 2) to test the psychometrics properties of the translated measure.

METHODS

A total of 48 patients with variety of hand disabilities, a mean age of 47 ± 16 years were recruited and assessed two times. The intraclass correlation coefficient (ICC) was used for assessing test-retest reliability of the PRWHE-A and its subscales while Cronbach's alpha (CA) was used for assessing the internal consistency. Construct validity was assessed by examining the strength of the correlation between the PRWHE-A and the Arabic version of the Disability of the Arm, Shoulder and Hand (DASH-A).

RESULTS

The PRWHE-A demonstrated excellent test-retest reliability (ICC= 0.97) and internal consistency (CA= 0.96). The DASH-A demonstrated moderately to low correlation (r= 0.64) with the PRWHE-A.

CONCLUSIONS

The results of this study indicated that PRWHE-A is a reliable and valid assessment tool and can be used in patients with different wrist/hand disabilities whose primary language is Arabic.

Translation, Adaptation, and Validation of Hindi Version of the Pain Catastrophizing Scale in Patients with Chronic Low Back Pain for Use in India

OBJECTIVES : This study translates the Pain Catastrophizing Scale (PCS) into Hindi and examines the psychometric properties of the translated version (Hindi PCS [Hi-PCS]) in patients with chronic low back pain (CLBP). METHODS : Forward and backward translations were performed from English to Hindi according to standard methodology. A final version was evaluated by a committee of clinical experts and Hi-PCS was then pilot-tested in 10 patients with CLBP. Cross-cultural validation of the resulting adapted Hi-PCS was done by administering Hi-PCS at baseline to 100 patients with CLBP (≥ 12 weeks pain) who were able to read and write in Hindi, and re-administering Hi-PCS after 3 days. Construct validity was assessed using factor analysis. Psychometric properties including internal consistency; test-retest reliability; and convergent validity with pain severity, functional disability, and health-related quality of life (HRQoL) were also assessed. RESULTS : Principal component analysis observed a three-factor structure, which explained 58% of the variance. Confirmatory factor analysis elicited the best fit as judged by the model fit indices. Hi-PCS as a whole was deemed to be internally consistent (Cronbach's α = 0.76). Intraclass correlation coefficient for the Hi-PCS is 0.923 (95% CI: 0.875-0.953). Hi-PCS was moderately correlated with pain intensity (r = 0.651) and functional disability (r = 0.352), and negatively correlated with QoL (r = -0.380). CONCLUSIONS : PCS translation and cross-cultural adaptation to Hindi demonstrated good factor structure along adequate psychometric properties and could be recommended for use in CLBP research in India.

Validation of the Chinese Version of the Cognitive Symptom Checklist-Work-21 in Breast Cancer Survivors

PURPOSE

The purpose of this study was to translate the Cognitive Symptom Checklist-Work-21 (CSC-W21), into Chinese, and culturally adapt and validate the Chinese version, a measure of work-related cognitive limitations in occupationally active breast cancer survivors (BCS).

METHODS

The translation of the English version of the CSC-W21 followed a systematic procedure. Exploratory factor analysis was used to identify factor structures. The internal consistency of the factors was assessed by calculating the Cronbach's alpha reliability coefficients. Item- and scale-level content validity was determined. The intra-class correlation coefficient (ICC) was used to analyze test-retest reliability. A total of two hundred and twenty BCS participated in the psychometric testing of the CSC-W21-C. The construct validity of the total score of the CSC-W21-C was determined through convergent validity and an analysis of its relationship with the four subscales of the Work Limitations Questionnaire (WLQ), a measure of four types of job task difficulties.

RESULTS

The CSC-W21-C demonstrated item- and scale-level content validity (>.80). The factor structure of the CSC-W21-C was similar to the original English version. The internal consistency of the subscales of the CSC-W21-C ranged from .84 to .95. The ICC was between .80 and .96 indicating good test-retest reliability. The CSC-W21-C was significantly correlated with the WLQ, particularly the mental-interpersonal subscale, where it accounted for 27.3 % of the total variance.

CONCLUSIONS

The findings indicate that the CSC-W21-C has sound measurement properties that strongly suggest it can be used in future assessment and intervention research to identify cognitive limitations related to specific work tasks in BCS.

Cross-cultural adaptation of the SCATBI instrument for cognitive-linguistic abilities after traumatic brain injury

OBJECTIVE

To perform the cross-cultural adaptation of the "Scales of Cognitive Ability for Traumatic Brain Injury" (SCATBI).

METHOD

After the translation and back-translation phases, a multidisciplinary committee judged and elaborated versions in order to maintain its conceptual equivalence, content, comprehensibility and contextual adjustment for Brazilian population. The final version was tested on 55 healthy subjects.

RESULTS

The individuals' mean age was 41.75 ± 17.40 years (range = 18-81), 69% were women and they had a mean schooling of 12.96 ± 4.55 years. Higher total scores were positively correlated with years of schooling (p < 0.001) and social-economic status (p = 0.001), while older aged individuals performed worse than younger ones (p = 0.001). Both genders performed similarly on all domains of the instrument, except for "organization" ability, where women performed significantly better than men (p = 0.02).

CONCLUSION

The Brazilian version of SCATBI is a useful tool for the diagnosis and monitoring of cognitive impairments after a traumatic brain injury.

Maintaining Research Integrity While Balancing Cultural Sensitivity: A Case Study and Lessons From the Field

Contemporary emphasis on creating culturally relevant and context specific knowledge increasingly drives researchers to conduct their work in settings outside their home country. This often requires researchers to build relationships with various stakeholders who may have a vested interest in the research. This case study examines the tension between relationship development with stakeholders and maintaining study integrity, in the context of potential harms, data credibility and cultural sensitivity. We describe an ethical breach in the conduct of global health research by a arising from the ad-hoc participation of a community stakeholder external to the visiting research group. A framework for reflection is developed from a careful examination of underlying factors and presented with a discussion of consequences and mitigation measures. This framework aims to present lessons learned for researchers working abroad who might face similar situations in their work.

Chinese translation and cross cultural adaptation of the workstyle short form

INTRODUCTION

Workstyle as it is related to symptoms of musculoskeletal symptoms of the upper limbs is the behavioural, cognitive and physical responses that occur in individuals to increases in work demands. A self report measure of this construct was developed that was both associated with and predictive of work related upper extremity symptoms. The aim of this study was to translate, culturally adapt, and validate a Chinese version of the Workstyle Short Form (C-WSF).

METHODS

The C-WSF was translated following a forward and backward translation approach. Content validity was examined by item- and scale-level content validity indices. The intra-class correlation coefficient (ICC) was used to analyze test-retest reliability. Exploratory factor analysis was used to identify factor structures and the internal consistency of these factors was assessed by calculating Cronbach's alpha reliability coefficients. The construct validity of the C-WSF was first determined by convergence in relation to the Cumulative Symptoms Score for Upper Extremity symptoms and then by comparison of those with and without upper extremity pain in Chinese cooks, a work with a high level of exposures to varying levels of work demands coupled with exposure to workplace psychosocial and biomechanical stressors.

RESULTS

The C-WSF demonstrated excellent item- and scale-level content validity index (>0.9). The factor structure of C-WSF was similar to its original English version. The internal consistency of different subscales of C-WSF ranged from 0.65 to 0.91. The ICC was between 0.79 and 0.93 indicating good test-retest reliability. C-WSF was significantly correlated with upper extremity symptoms (r = 0.34, p < 0.001).

CONCLUSIONS

C-WSF is a reliable and valid version of the Workstyle measures for use in Chinese population.

Qualitative validation of the FACIT-Fatigue scale in systemic lupus erythematosus

Objective

Fatigue in systemic lupus erythematosus (SLE) is burdensome and must be assessed using validated scales. Although the psychometric properties of the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-Fatigue) scale in SLE have been evaluated previously, its content validity in this disease remains to be evaluated. The study objective was, therefore, to evaluate content validity of the FACIT-Fatigue in SLE.

Methods

Three SLE focus groups ( n = 21) in the United States were conducted using semi-structured interviews. Participant comments were categorized by response type, and relative response strength was qualitatively assessed.

Results

Participants were mostly female (90%; n = 19), white (57%; n = 12) with a mean age of 43.7 years (range = 28–70). Most scale items were considered relevant with the exception of four items for which participant interpretations varied . Consistent with the scale’s measurement model, “listless” on item 3 (“ I feel listless (‘ washed out’)”) was interpreted as physical or mental impairment. Participant responses to item 8 (“ I am able to do my usual activities”) sometimes included influence of other health conditions, which is acceptable because it is difficult to separate disease-specific and general fatigue. Some participants found item 7 (“ I have energy”) irrelevant and most could not relate to item 10 (“ I am too tired to eat”). However, both items were intended to capture the extreme ends of fatigue (item 7, ceiling; item 10, floor).

Conclusions

From a content perspective, items of the FACIT-Fatigue scale were relevant for measuring fatigue in SLE.

Cross-cultural adaptation and validation of the South African Pain Catastrophizing Scale (SA-PCS) among patients with fibromyalgia

Background

Pain catastrophization has recently been recognized as a barrier to the healthy development of physical functioning among chronic pain patients. Levels of pain catastrophization in chronic pain patients are commonly measured using the Pain Catastrophizing Scale (PCS).

Objective

To cross-culturally adapt and validate the South African PCS (SA-PCS) among English-, Afrikaans- and Xhosa-speaking patients with fibromyalgia living in the Cape Metropole area, Western Cape, South Africa.

Methods

The original PCS was cross-culturally adapted in accordance with international standards to develop an English, Afrikaans and Xhosa version of the SA-PCS using a repeated measures study design. Psychometric testing included face/content validity, internal consistency (Cronbach’s alpha-α), test-retest reliability (intraclass coefficient correlations-ICC), sensitivity-to-change and cross-sectional convergent validity (by comparing the adapted SA-PCS to related constructs).

Results

The cross-culturally adapted English, Afrikaans and Xhosa SA-PCS showed good face and content validity, excellent internal consistency (with Chronbach’s α = 0.98, 0.98 and 0.97 for the English, Afrikaans and Xhosa SA-PCS, as a whole, respectively), excellent test-retest reliability (with ICC’s of 0.90, 0.91 and 0.89 for the English, Afrikaans and Xhosa SA-PCS, respectively); as well as satisfactory sensitivity-to-change (with a minimum detectable change of 8.8, 9.0 and 9.3 for the English, Afrikaans and Xhosa SA-PCS, respectively) and cross-sectional convergent validity (when compared to pain severity as well as South African versions of the Tampa scale for Kinesiophobia and the revised Fibromyalgia Impact Questionnaire).

Conclusion

The SA-PCS can therefore be recommended as simple, efficient, valid and reliable tool which shows satisfactory sensitivity-to-change and cross-sectional convergent validity, for use among English, Afrikaans and Xhosa-speaking patients with fibromyalgia attending the public health sector in the Western Cape area of South Africa.

Cross-cultural adaptation, reliability, internal consistency and validation of the Spinal Function Sort (SFS) for French- and German-speaking patients with back complaints

INTRODUCTION

Functional subjective evaluation through questionnaire is fundamental, but not often realized in patients with back complaints, lacking validated tools. The Spinal Function Sort (SFS) was only validated in English. We aimed to translate, adapt and validate the French (SFS-F) and German (SFS-G) versions of the SFS.

METHODS

Three hundred and forty-four patients, experiencing various back complaints, were recruited in a French (n = 87) and a German-speaking (n = 257) center. Construct validity was estimated via correlations with SF-36 physical and mental scales, pain intensity and hospital anxiety and depression scales (HADS). Scale homogeneities were assessed by Cronbach's α. Test-retest reliability was assessed on 65 additional patients using intraclass correlation (IC).

RESULTS

For the French and German translations, respectively, α were 0.98 and 0.98; IC 0.98 (95% CI: [0.97; 1.00]) and 0.94 (0.90; 0.98). Correlations with physical functioning were 0.63 (0.48; 0.74) and 0.67 (0.59; 0.73); with physical summary 0.60 (0.44; 0.72) and 0.52 (0.43; 0.61); with pain -0.33 (-0.51; -0.13) and -0.51 (-0.60; -0.42); with mental health -0.08 (-0.29; 0.14) and 0.25 (0.13; 0.36); with mental summary 0.01 (-0.21; 0.23) and 0.28 (0.16; 0.39); with depression -0.26 (-0.45; -0.05) and -0.42 (-0.52; -0.32); with anxiety -0.17 (-0.37; -0.04) and -0.45 (-0.54; -0.35).

CONCLUSIONS

Reliability was excellent for both languages. Convergent validity was good with SF-36 physical scales, moderate with VAS pain. Divergent validity was low with SF-36 mental scales in both translated versions and with HADS for the SFS-F (moderate in SFS-G). Both versions seem to be valid and reliable for evaluating perceived functional capacity in patients with back complaints.

The Process and Challenges in the Translation of World Health Organization Quality of Life (WHOQOL- BREF) to a Regional Language; Malayalam

A lot of research has been directed on wellbeing and disability in many non-communicable disease conditions. In this context, health-related aspects of life and quality of life (QOL) are receiving a lot of focus. Many Quality of Health measures are available, of which World Health Organization Quality of Life (WHOQOL-BREF) is one of the most popular. Translating and adapting this tool is useful in view of research happening in a multicultural arena. Though translations into Hindi and other Indian languages including Tamil and Kannada have been done, a Malayalam version is not available. This paper discusses the steps adopted in this exercise and the challenges in translating WHOQOL-BREF to Malayalam from the original English version.

Cultural competence in outpatient substance abuse treatment: measurement and relationship to wait time and retention

BACKGROUND

Culturally competent practice is broadly acknowledged to be an important strategy to increase the quality of services for racial/ethnic minorities in substance abuse treatment. However, few empirically derived measures of organizational cultural competence exist, and relatively little is known about how these measures affect treatment outcomes.

METHOD

Using a nationally representative sample of outpatient substance abuse treatment (OSAT) programs, this study used item response theory to create two measures of cultural competence-organizational practices and managers' culturally sensitive beliefs-and examined their relationship to client wait time and retention using Poisson regression modeling.

RESULTS

The most common and precisely measured organizational practices reported by OSAT managers included matching providers and clients based on language/dialect; offering cross-cultural training; and fostering connections with community and faith-based organizations connected to racial and ethnic minority groups. The most culturally sensitive belief among OSAT managers was support for language/dialect matching for racial and ethnic minority clients. Results of regression modeling indicate that organizational practices were not related to either outcome. However, managers' culturally sensitive beliefs were negatively associated with average wait time (p<0.05), and positively associated with average retention (p<0.01).

CONCLUSIONS

Managers' culturally sensitive beliefs-considered to be influential for effective implementation of culturally competent practices-may be particularly relevant in influencing wait time and retention in OSAT organizations that treat Latinos and African American clients.

Measurement of social support across women from four ethnic groups: evidence of factorial invariance

To examine whether a multidimensional social support instrument can be used for comparative research in four diverse ethnic groups of women (African American, Latina, Chinese, non-Latina White). The social support instrument was administered as part of a larger survey to 1,137 women. We tested the reliability and validity of this instrument. A confirmatory factor analytic (CFA) framework was used to test for the invariance of the instrument's psychometric properties across ethnic groups. We used multitrait scaling to eliminate items that did not meet the item-convergence criterion (r > 0.30) and where items were non-convergent items in at least three groups. A series of nested CFA models assessed the level of factorial invariance. One thousand seventy-four women completed the survey; Their mean age was 61 years with Chinese and Latinas reporting lower education compared to non-Latino Whites (p <. 001). A four-factor model (Tangible, Informational, Financial, Emotional/Companionship) fit within each ethnic group separately, suggested good fit. Multi-group CFA supported configural and metric invariance across all ethnic groups. Only partial scalar invariance was supported. This 8-item instrument is a reliable and valid tool that can be used as a multidimensional measure of social support. It can used to examine social support within one ethnic group and for comparative research across diverse ethnic groups of women.

Perceptions of unmet healthcare needs: what do Punjabi and Chinese-speaking immigrants think? A qualitative study

Background

Unmet healthcare needs - the difference between healthcare services deemed necessary to deal with a particular health problem and the actual services received - is commonly measured by the question, "During the past 12 months, was there ever a time when you felt that you needed healthcare, but you didn't receive it?" In 2003, unmet needs were reported by 10% of immigrants in Canada, yet, little is known specifically about Chinese- or Punjabi-speaking immigrants' perceptions and reporting of unmet needs. Our study examined: 1) How are unmet healthcare needs conceptualized among Chinese- and Punjabi-speaking immigrants? 2) Are their primary healthcare experiences related to their unmet healthcare needs?

Methods

Twelve focus groups (6 Chinese, 6 Punjabi; n = 78) were conducted in Chinese or Punjabi and socio-demographic and health data were collected. Thematic analysis of focus group data examined the perceptions of unmet needs and any relationship to primary healthcare experiences.

Results

Our analysis revealed two overarching themes: 1) defining an unmet healthcare need and 2) identifying an unmet need. Participants had unmet healthcare needs in relation to barriers to accessing care, their lack of health system literacy, and when the health system was less responsive than their expectations.

Conclusions

Asking whether someone ever had a time when they needed healthcare but did not receive it can either underestimate or overestimate unmet need. Measuring unmet need using single items is likely insufficient since more detail in a revised set of questions could begin to clarify whether the reporting of an unmet need was based on an expectation or a clinical need. Who defines what an unmet healthcare need is depends on the context (insured versus uninsured health services, experience in two or more healthcare systems versus experience in one healthcare system) and who is defining it (provider, patient, insurer).

Measuring outcomes in hand surgery

Outcomes research in hand surgery provides patients and providers with objective, reliable information to assist in making medical decisions. Endpoint measures in outcomes research and the instruments used to evaluate these endpoints are often specific to a particular disease or region. Hand surgery has many different measurable outcomes that can be used to monitor the quality of surgical practice, inform practice guidelines, and aid in the appropriate allocation of healthcare resources. In this article, we review some research techniques available to study the following surgical outcomes of the hand: national trends in surgical care, surgical complications, objective measures of hand function, patient-reported measures of hand function, and economic burden.

Longitudinal validation of the fear-avoidance beliefs questionnaire (FABQ) in a Swiss-German sample of low back pain patients

Work and activity-specific fear-avoidance beliefs have been identified as important predictor variables in relation to the development of, and treatment outcome for, chronic low back pain. The objective of this study was to provide a cross-cultural German adaptation of the Fear-Avoidance Beliefs Questionnaire (FABQ) and to investigate its psychometric properties (reliability, validity) and predictive power in a sample of Swiss-German low back pain patients. Questionnaires from 388 operatively and non-operatively treated patients were administered before and 6 months after treatment to assess: socio-demographic data, disability (Roland and Morris), pain severity, fear-avoidance beliefs, depression (ZUNG) and heightened somatic awareness (MSPQ). Complete baseline and follow-up questionnaires were available from 255 participants. The corrected item-total correlations, coefficients of test-retest reliability and internal consistencies of the two scales of the questionnaire were highly satisfactory. In a confirmatory factor analysis (CFA), all items loaded on the appropriate factor with minor loadings on the other. Cross-sectional regression analysis with disability and work loss as the dependent variables yielded results that were highly comparable with those reported for the original version. Prognostic regression analysis replicated the findings for work loss. The cross-cultural German adaptation of the FABQ was very successful and yielded psychometric properties and predictive power of the scales similar to the original version. The inclusion of fear-avoidance beliefs as predictor variables in studies of low back pain is highly recommended, as they appear to have unique predictive power in analyses of disability and work loss.

Assessing instruments in a Cuban American population with type 2 diabetes mellitus

The purposes of this pilot study were to identify and adapt instruments for future use in assessing diabetes self-management in a sample of Cuban Americans with Type 2 diabetes. Eight instruments were selected from the literature, translated into Spanish, and administered to a sample of 20 Cuban Americans with Type 2 diabetes. Psychometric properties were examined along with clarity of wording, cultural appropriateness, and ease of use. Reliability data were compared, when possible, with original scores generated with non-Cuban populations. Results indicated that reliability scores among populations were similar. Support for using these instruments in clinical practice to assess initial knowledge and beliefs about aspects of diabetes management and to monitor changes is provided.

Translation and validation of the Nursing Outcomes Classification labels and definitions for acute care nursing in Iceland

BACKGROUND

The Nursing Outcomes Classification (NOC), second edition, consists of 260 patient outcomes with definitions. This has been translated into five languages, but has not been clinically validated outside the United States of America (USA).

AIM

The aim of this paper is to describe the translation of the labels and definitions from the NOC, second edition from English to Icelandic and validation for acute-care nursing in Iceland.

METHOD

A survey that has been designed to identify nurses' perception of the percentage of patients' for whom each NOC outcome is relevant in clinical nursing practice was used for clinical validation in this study. The translation procedure involved source to target language translation, parallel comparison, pilot test and field test. Validation included test-retest to measure the reliability for each of the 260 outcome variables. Data collected from 140 clinical nurses from 54 departments within 13 nursing specialties at Landspitali University-Hospital in Iceland, in November 2001, were analysed to establish construct validity by confirmatory factor analysis. Internal consistency was calculated.

RESULTS

Translation was successful. Test-retest showed that 181 of the 260 NOC outcomes were significant (P < 0.05) and moderately or highly correlated (r > 0.50) (Pearson's correlation). The confirmatory factor analysis showed that 22 of the 29 NOC classes had only one factor at the loading criteria > or =0.30. Of the 260 outcomes, 244 had loading on one factor (> or =0.30) within its class. Internal consistency was >0.80 (Cronbach's alpha).

LIMITATIONS

Low response rate was a limitation. The indicators of each NOC outcome were not addressed.

CONCLUSION

The Icelandic version of the NOC survey is a comprehensive tool that can be applied to nursing in acute-care for research purposes as well as to prepare for the implementation of NOC in clinical information systems.

Toward a theoretical model of quality-of-life appraisal: Implications of findings from studies of response shift

Mounting evidence for response shifts in quality of life (QOL) appraisal indicates the need to include direct measurement of the appraisal process itself as a necessary part of QOL assessment. We propose that directly assessing QOL appraisal processes will not only improve our ability to interpret QOL scores in the traditional sense, but will also yield a deeper understanding of the appraisal process in the attribution of and divergence in meaning. The published evidence for response shift is reviewed, and an assessment paradigm is proposed that includes the explicit measurement of QOL appraisal process parameters: 1) induction of a frame of reference; 2) recall and sampling of salient experiences; 3) standards of comparison used to appraise experiences; and 4) subjective algorithm used to prioritize and combine appraisals to arrive at a QOL rating. A QOL Appraisal Profile, which measures key appraisal processes, is introduced as an adjunct to existing QOL scales. The proposed theoretical model, building on the Sprangers and Schwartz (1999) model and highlighting appraisal processes, provides a fully testable theoretical treatment of QOL and change in QOL, suggesting hypothesized causal relationships and explanatory pathways for both cross-sectional and longitudinal QOL research.

Palliative care for patients with end-stage renal failure: reflections from Central Australia

This paper explores palliative care issues for Australian Aboriginal patients with end-stage renal failure. Renal disease is epidemic amongst Aboriginal Australians. The Central Australian Palliative Care Service, based in the remote town of Alice Springs, sees a high proportion of renal patients, with different demographic characteristics to those seen in urban palliative care services. A case history illustrates distinctive concerns for local service provision, including communication issues, cultural requirements for maximizing quality of life, and the need to provide care in remote locations. Palliation for end-stage renal failure (ESRF) patients should be based on standard principles, but modified in accordance with local practical requirements and community needs.

Cultural sensitivity in physician-patient relationships: perspectives of an ethnically diverse sample of low-income primary care patients

BACKGROUND

Health care providers and health care training institutions need more specific, relevant, and useful information for providing culturally sensitive health care.

OBJECTIVE

We sought to determine what patients considered to be culturally sensitive health care.

RESEARCH DESIGN AND PARTICIPANTS

We conducted 20 focus group interviews with 135 mostly low-income primary care patients from three different ethnic/cultural groups (African American, European American, and Latino American). Focus group interviews were recorded, transcribed, and analyzed into themes by two researchers using the constant comparative method.

MEASURES

Participants' responses were grouped into primary and secondary themes.

RESULTS

Results revealed the following universal themes of health care delivery by physicians that all three racial or ethnic groups identified as indicators of culturally sensitive health care: people skills, individualized treatment, effective communication, and technical competence. Results also revealed some ethnic group-specific themes. Other factors including physical environment characteristics (eg, culturally sensitive art, pictures, music, and reading materials) and office staff behaviors were unique indicators of culturally sensitive health care identified by African American and Latino American participants but not by European American participants.

CONCLUSIONS

These findings can be incorporated into training programs for health care providers, possibly resulting in more effective health care delivery to patients from diverse cultural backgrounds. Future research is needed to evaluate the impact of incorporating patient-identified cultural sensitivity into health care delivery on important outcome measures such as patient satisfaction and treatment adherence.

Experience of menopausal symptoms by Chinese and Canadian women

OBJECTIVE

This study examines the differences in frequency and distress caused by menopausal symptoms experienced by Canadian and Chinese women.

DESIGN

Cross-sectional surveys were conducted in Canada and China.

SETTING

The Canadian studies were conducted in Toronto. The Chinese data were collected in Guangzhou City.

PARTICIPANTS

Women, 47-62 years old, 2-7 years after a natural menopause, were recruited.

METHODS

Two hundred and eighty-two Canadians were recruited for two menopause studies. Data from 297 Chinese were obtained through a household survey. From a 105-item symptom questionnaire, women indicated the frequency and distress caused by symptoms in the previous month.

MAIN OUTCOME MEASURES

Frequency and mean distress score of problems were ranked and compared. Using the importance score method, a Chinese questionnaire was constructed and compared with the Menopause-Specific Quality of Life questionnaire.

RESULTS

The frequency of symptoms and distress experienced by Canadian and Chinese women differed markedly. Fourteen of the 29 items differed between the Chinese questionnaire and the Menopause-Specific Quality of Life questionnaire.

CONCLUSIONS

There are striking differences between Chinese and Canadian women in the frequency and distress caused by menopausal symptoms. The Canadian questionnaire may not be relevant for Chinese women.

Translation to Spanish, reproducibility, and cross-cultural adaptation of the Miller-Rahe Recent Life Change Questionnaire in Venezuela

OBJECTIVE

To translate into Spanish a version of the Miller-Rahe Recent Life Change Questionnaire and to adapt it to Venezuelan cultural values.

METHODS

The Spanish version and cross-cultural adaptation of the Miller-Rahe Recent Life Change Questionnaire was done following recently proposed guidelines to preserve semantic, idiomatic, and conceptual equivalence in translations of health assessment instruments. We performed one or more translations into the new language, as well as back-translation, test-retest reliability, and weighting score for the translated instrument.

RESULTS

A Spanish version of the Recent Life Change Questionnaire was obtained. Validity of translations was demonstrated with a significant agreement for the nonliteral translations (kappa value = 0.97, P < 0.05). The conceptual equivalence was demonstrated by significant agreement in the back-translations (kappa value = 0.84, P < 0.05). The translated instrument met acceptable levels of reliability, as assessed by Spearman's rank correlation coefficients (> 0.60 for all categories of the questionnaire). The cross-cultural adaptation of the translated instrument required addition and exclusion of items as well as changes of the ranking and scaling of life units in the original questionnaire.

CONCLUSION

A valid and reliable Spanish version of the Miller-Rahe Recent Life Change Questionnaire was produced and adapted to Venezuelan cultural values.