Psychometric testing of an Arabic version of the Illness Perception Questionnaire for heart disease

Cross-cultural adaptation and psychometric properties of patient-reported outcome measures in Arabic speaking countries: A scoping review

BACKGROUND

Patient-reported outcome measures (PROMs) are increasingly recognized as an indicator of healthcare quality and safety. Over the past decades, there has been a growing interest in using PROMs in Arabic-speaking populations. However, there is a paucity of data regarding the quality of their cross-cultural adaptation (CCA) and measurement properties.

OBJECTIVES

To identify PROMs that have been developed, validated or cross-culturally adapted to Arabic and evaluate methodological qualities of CCA and measurement properties.

METHODS

MEDLINE, EMBASE, CINAHL, PsycINFO, IPA, and ISI Web of Science were searched using search terms 'PROMs', 'Arabic countries', 'CCA', and 'psychometric properties'. Measurement properties were evaluated using COSMIN quality criteria and CCA quality was assessed using the Oliveria rating method.

RESULTS

This review included 260 studies with 317 PROMs, focusing on psychometric testing (83.8%), CCA (75.8%), utilizing PROMs as outcome measures (13.4%), and developing PROMs (2.3%). Out of the 201 cross-culturally adapted PROMs, forward translation was the most frequently reported component of CCA (n = 178), followed by back translation (n = 174). Out of the 235 PROMs that reported measurement properties, internal consistency was the most frequently reported measurement property (n = 214), followed by reliability (n = 160) and hypotheses testing (n = 143). Other measurement properties were less reported, including responsiveness (n = 36), criterion validity (n = 22), measurement error (n = 12), and cross-cultural validity (n = 10). The strongest measurement property was hypotheses testing (n = 143), followed by reliability (n = 132).

CONCLUSION

There are several caveats regarding the quality of CCA and measurement properties of PROMs included in this review. Only 1 out of 317 Arabic PROMs met CCA and psychometric optimal quality criteria. Therefore, there is a need to improve the methodological quality of CCA and measurement properties of PROMs. This review provides valuable information for researchers and clinicians when choosing PROMs for practice and research. There were only 5 treatment-specific PROMs, indicating the necessity for more research focusing on development and CCA of such measures.

Beliefs About Causes and Cures of Prolonged Grief Disorder Among Arab and Sub-Saharan African Refugees

Background

Many refugees have experienced the death of a loved one under traumatic circumstances. Accordingly, the prevalence of Prolonged Grief Disorder (PGD) among refugees is high. Culture-specific symptoms of PGD have been described previously, but beliefs about causes and cures of PGD among refugees remain unknown. We therefore aimed at identifying illness beliefs and treatment expectations regarding PGD among refugees.

Method

We focused on refugees from Arab countries (n = 14) and from Sub-Sahara Africa (n = 9) and applied qualitative and quantitative methods. In a semi-structured interview, participants first answered questions about assumed causes and potential cures for prototypical PGD symptoms according to ICD-11 that were presented in a vignette as representatives of their own culture. In the quantitative part, they completed the Cause Subscale of the Illness Perception Questionnaire (IPQ-R) that included additional culture-specific items. Interviews were analyzed with Qualitative Content Analysis.

Results

In both groups of refugees, PGD symptoms were predominantly attributed to a close relationship to the deceased, lack of social support, personal vulnerabilities, and circumstances of the death. Participants also named a number of flight-related causes (e.g., inability to perform or participate in rituals, feeling isolated in the host country). None of the participants attributed PGD symptoms to supernatural causes. Descriptive analyses of responses on the IPQ-R indicated that participants predominantly attributed PGD symptoms to psychological causes. Participants believed that PGD can be cured and predominantly mentioned social and religious support. Psychological help was only mentioned by a minority of participants. In both groups, participants emphasized that a therapist must be familiar with the patient's culture and rituals. Participants also mentioned stigma associated with seeking psychological help.

Conclusion

Results suggest specific beliefs of refugees regarding causes and cures of PGD as well as similarities with Western conceptualizations. A culture-sensitive approach to the treatment of PGD in refugees that can include knowledge of culture-specific rituals and incorporating religious beliefs as well as decreasing stigma and increasing mental health literacy seem important. The study is limited by its focus on only two groups of refugees and its small sample size.

"It's That Route That Makes Us Sick": Exploring Lay Beliefs About Causes of Post-traumatic Stress Disorder Among Sub-saharan African Asylum Seekers in Germany

Many asylum seekers have been confronted with traumatizing events, leading to high prevalence rates of post-traumatic stress disorder (PTSD). Within the diagnostic context, clinicians should take into account patients' culturally shaped presentation of symptoms. Therefore, we sought to provide insights into beliefs about causes of PTSD held by Sub-Saharan African asylum seekers living in Germany. To this aim, we used a quantitative and qualitative methodological triangulation strategy based on a vignette describing symptoms of PTSD. In the first part of the study, asylum seekers (n = 119), predominantly from Eritrea (n = 41), Somalia (n = 36), and Cameroon (n = 25), and a German comparison sample without a migration background (n = 120) completed the Revised Illness Perception Questionnaire (IPQ-R). In the second part, asylum seekers reviewed the results within eight focus group discussions (n = 26), sampled from groups of the three main countries of origin. Descriptive analyses of the first part demonstrated that asylum seekers predominantly attributed PTSD symptoms to psychological and religious causes, and rather disagreed with supernatural causes. In comparison to the German sample without a migration background, asylum seekers attributed symptoms less strongly to terrible experiences, but more strongly to religious and supernatural causes. Within the focus group discussions, six attribution categories of participants' causal beliefs were identified: (a) traumatic life experiences, (b) psychological causes, (c) social causes, (d) post-migration stressors, (e) religious causes, and (f) supernatural causes. Our findings suggest that the current Western understanding of PTSD is as relevant to migrants as to non-migrants in terms of psychological causation, but might differ regarding the religious and supernatural realm. While awareness of culture-specific belief systems of asylum seekers from Sub-Saharan Africa regarding PTSD is important, our findings do underline, at the same time, that cultural differences should not be overstated.

Confirmatory factor analysis of the causal illness attribution scale in Chinese patients with multiple somatic symptoms

Causal illness attributions influence how individuals cope with somatic symptoms and illnesses. Dimensions of causal symptom attributions have been examined in Western cultures with the subscale 'causes' of the revised Illness Perception Questionnaire (IPQ-R). Some previous studies have identified a stronger somatic attribution style in Asian patients. In this study it was examined if the factorial structure of causal attributions identified in Western populations can be identified in a large Chinese sample of patients presenting with somatic symptoms. We recruited 665 patients aged at least 18 who were visiting the hospital for reasons of treatment from departments of traditional Chinese medicine (TCM), neurology (Biomedicine), and psychosomatic medicine in six hospitals across China. All subjects completed the Patient Health Questionnaire (PHQ) and the causes subscale of the IPQ-R. We split the data-set by chance in two parts. On the first subsample, we conducted a confirmatory factor analysis (CFA) to check the fit of the originally proposed 4-factor structure and an exploratory factor analysis (EFA). The factor structure indentified in the EFA was rechecked with a CFA in the second subsample. The originally proposed 4-factor-model of the IPQ-R subscale causes showed no adequate fit in the first subsample. The EFA revealed two factors, psychological attributions and risk factors. The CFA in the second sample showed mediocre fit indices (RMSEA = .098, CFI = .923). For the Chinese sample we propose a two-factor structure for IPQ-R causes scale. As in other studies, we identified the relatively stable factor psychological attributions, indicating no fundamental differences in illness attributions between Western and Chinese samples.

Cross-cultural adaptation and psychometric properties of an Arabic language version of the Brief Illness Perception Questionnaire in Lebanon

BACKGROUND

Patients' positive illness perceptions (IPs) significantly contribute to treatment success. The Brief Illness Perception Questionnaire (Brief IPQ) is widely used in various diseases for assessing IPs. It was developed in English-speaking countries and studies on it in Arab countries are scarce.

OBJECTIVES, SETTING AND DESIGN

This observational cross-sectional study aimed to cross-culturally adapt the Brief IPQ English version into a modern Arabic language version and determine its psychometric properties in a sample of Lebanese cardiac disease patients. This study was approved by the Institutional Review Board of Saint Joseph University of Beirut, Lebanon.

PARTICIPANTS

A convenience sample of 30 patients with cardiac disease were recruited during routine visits to cardiologists' offices in Beirut, Lebanon. Inclusion criteria were at least one cardiac disease for at least 6 months with no acute episode or exacerbation of the disease during the 6 preceding months, age ≥ 18 years, and the ability to read and comprehend Arabic. The pre-final version of the Brief IPQ Arabic version was tested for face and content validity. The meaning, comprehensibility, and acceptability were studied by individual interviews. For discriminant validity and internal consistency of the Brief IPQ Arabic version (Brief IPQ-Ar), 100 patients were recruited in a similar manner using the same inclusion criteria. To assess reproducibility, 30 patients, selected randomly from the 100 patients, filled the questionnaire a second time, 3-4 weeks after its first administration and under the same conditions.

MAIN OUTCOME MEASURES

Psychometric properties of the Brief IPQ-Ar among Lebanese patients suffering from cardiac diseases.

RESULTS

Semantic equivalence between the Brief IPQ-Ar questions and patients' descriptions was 100%. Cronbach's alpha was 0.717, which shows good internal consistency. Reproducibility was satisfactory (ICC values>0.776). Moreover, the Brief IPQ-Ar discriminated participants according to the type of cardiac disease and treatment-related characteristics.

CONCLUSIONS

We confirm that the Brief IPQ-Ar is appropriate for exploring IPs in cardiac disease patients whose first language is Arabic. Further research should be conducted to test this Arabic version in other types of diseases.

The effect of a telephone follow-up intervention on illness perception and lifestyle after myocardial infarction in China: a randomized controlled trial

BACKGROUND

Lifestyle modification is an integral component of cardiac secondary prevention, while it has been confirmed that myocardial infarction (MI) patients' health-related behaviors are heavily influenced by their illness perception.

OBJECTIVES

To evaluate the effect of a telephone follow-up intervention for improving MI patients' illness perception and lifestyle.

DESIGN

A randomized controlled trial, longitudinal research design was employed.

SETTINGS

Cardiac care units in four major general hospitals in Guangzhou, China.

PARTICIPANTS

Inclusion criteria were being diagnosed with an initial acute MI, being able to communicate orally in Mandarin or Cantonese and read in Chinese, and living in Guangzhou. Exclusion criteria were with continuing uncontrolled arrhythmias or heart failure, being illiteracy, or with a history of major psychiatric illness, exercise-induced asthma, uncontrolled diabetes, or evidence of dementia.

METHOD

124 patients admitted with the first acute MI were randomized to receive either routine care or routine care plus a telephone follow-up intervention, which consist of a pre-discharge education and three telephone follow-up instructions. Data were collected before discharge, at the 6th and the 12th week after discharge from hospital, respectively.

RESULTS

At the 6th and the 12th week after discharge, patients in the intervention group had significantly positive perceptions about symptoms of MI (mean difference 3.27, 95% confidence interval 2.48-4.07, p<.001; mean difference 2.12, 95% confidence interval 1.34-2.89, p<.001 respectively) and how long their illness would last (mean difference -0.69, 95% confidence interval -0.91 to -0.47, p<.001; mean difference -0.74, 95% confidence interval -0.96 to -0.51, p<.001 respectively) compared with the control group. The intervention group also had more positive beliefs about the controllability (F=4.23, p=.04) and more improved beliefs about the causes of MI than the control group. Moreover, the intervention improved the patients' nutrition (F=5.16, p=.03) and physical activity at the 12-week follow-up (mean difference 0.37, 95% confidence interval 0.17-0.58, p<.001).

CONCLUSION

This telephone follow-up intervention can result in improved illness perception and lifestyle after MI. It could be incorporated into current hospital treatment regimens for MI to improve patients' quality of life.