Issues of instrument translation in research on Asian immigrant populations

Adaptation of the Client Diagnostic Questionnaire for East Africa

Research increasingly involves cross-cultural work with non-English-speaking populations, necessitating translation and cultural validation of research tools. This paper describes the process of translating and criterion validation of the Client Diagnostic Questionnaire (CDQ) for use in a multisite study in Kenya and Uganda. The English CDQ was translated into Swahili, Dholuo (Kenya) and Runyankole/Rukiga (Uganda) by expert translators. The translated documents underwent face validation by a bilingual committee, who resolved unclear statements, agreed on final translations and reviewed back translations to English. A diagnostic interview by a mental health specialist was used for criterion validation, and Kappa statistics assessed the strength of agreement between non-specialist scores and mental health professionals' diagnoses. Achieving semantic equivalence between translations was a challenge. Validation analysis was done with 30 participants at each site (median age 32.3 years (IQR = (26.5, 36.3)); 58 (64.4%) female). The sensitivity was 86.7%, specificity 64.4%, positive predictive value 70.9% and negative predictive value 82.9%. Diagnostic accuracy by the non-specialist was 75.6%. Agreement was substantial for major depressive episode and positive alcohol (past 6 months) and alcohol abuse (past 30 days). Agreement was moderate for other depressive disorders, panic disorder and psychosis screen; fair for generalized anxiety, drug abuse (past 6 months) and Post Traumatic Stress Disorder (PTSD); and poor for drug abuse (past 30 days). Variability of agreement between sites was seen for drug use (past 6 months) and PTSD. Our study successfully adapted the CDQ for use among people living with HIV in East Africa. We established that trained non-specialists can use the CDQ to screen for common mental health and substance use disorders with reasonable accuracy. Its use has the potential to increase case identification, improve linkage to mental healthcare, and improve outcomes. We recommend further studies to establish the psychometric properties of the translated tool.

Translation, Adaptation, and Validation of Chronic Kidney Disease Self-Management and Knowledge Instruments for People at Pre-Dialysis Stage in the Arab World

Knowledge is critical for self- management, however there are no measures available in Arabic to effectively assess knowledge and self-management for chronic kidney disease (CKD). The aim of this study was to translate, culturally adapt, and validate Chronic Kidney Disease Self-Management Instrument-29 (CKD-SM-29) and Kidney Disease Knowledge survey (KiKs) for use by Arabic-speaking health professionals and patients. The study was carried out in two phases: translation and cultural adaptation, and validation. Instruments were translated from English to Arabic then adapted and validated using 203 pre-dialysis CKD patients. Face validity and internal consistency were demonstrated for Arabic versions of CKD-SM-29 and KiKs. Cronbach's α for the CKD-SM-29 was .91 for KiKS was .78. Test-retest revealed good stability over a 1-week period. Intra Class Correlation coefficient for CKD-SM-29 was .90 and was .78 for KiKS. Convergent and discriminative validity were also demonstrated for the translated instruments. The validity and reliability of the Arabic CKD-SM-29 and KiKs were demonstrated. The translated instruments are culturally adapted and will support care of patients with CKD in Arabic-speaking countries.

Translation and adaptation of three English tinnitus patient-reported outcome measures to Spanish

Objective: The objective of this study was to improve the range of standardised tinnitus Spanish Patient-Reported Outcome Measures (PROMS) available by translating and ensuring cross-cultural adaptation of three English PROMs to Spanish.Design: The Tinnitus and Hearing Survey, Tinnitus Cognition Questionnaire, and Tinnitus Qualities Questionnaire were translated to Spanish using recently established good practice guidelines.Study sample: The translation process addressed 22 items included in six main steps specified in the guidelines. The translated PROMs were field tested on a sample of tinnitus patients who were recruited through convenience sampling using cognitive debriefing (n = 5) and pilot testing (n = 10) methods.Results: The translation process employed the required steps and provided specific details about the process and procedures. In addition, practical issues encountered while translating and adapting the questionnaires that may influence future translations were revealed.Conclusions: This is the first account of translating and adapting PROMs from one language to another using the good practice guidelines specific to hearing-related questionnaires. Following the rigorous procedures should ensure that the translated PROMs have linguistic and cultural equivalence to the original versions, although psychometric evaluation would remain necessary to confirm the functional equivalence.

Advancing Cancer Control in San Francisco: Cancer Screening in Under-Represented Populations

INTRODUCTION

Cancer risk and screening data are limited in their ability to inform local interventions to reduce the burden of cancer in vulnerable populations. The San Francisco Health Information National Trends Survey was developed and administered to assess the use of cancer-related information among under-represented populations in San Francisco to provide baseline data for the San Francisco Cancer Initiative.

METHODS

The survey instrument was developed through consultation with research and community partners and translated into 4 languages. Participants were recruited between May and September 2017 through community-based snowball sampling with quotas to ensure adequate numbers of under-represented populations. Chi-square tests and multivariate logistic regression were used between 2018 and 2019 to assess differences in screening rates across groups and factors associated with cancer screening.

RESULTS

One thousand twenty-seven participants were recruited. Asians had lower rates of lifetime mammogram (p=0.02), Pap test (p<0.01), and prostate-specific antigen test (p=0.04) compared with non-Asians. Hispanics had higher rates of lifetime mammogram (p=0.02), lifetime Pap test (p=0.01), recent Pap test (p=0.03), and lifetime prostate-specific antigen test (p=0.04) compared with non-Hispanics. Being a female at birth was the only factor that was independently associated with cancer screening participation (AOR=3.17, 95% CI=1.40, 7.19).

CONCLUSIONS

Screening adherence varied by race, ethnicity, and screening type. A collaborative, community-based approach led to a large, diverse sample and may serve as a model for recruiting diverse populations to add knowledge about cancer prevention preferences and behaviors. Results suggest targeted outreach efforts are needed to address disparate cancer screening behaviors within this diverse population.

"Reliability of the Norwegian version of the short physical performance battery in older people with and without dementia"

BACKGROUND

The purpose of the study was to establish the test-retest reliability of the Norwegian version of the Short Physical Performance Battery (SPPB).

METHODS

This was a cross- sectional reliability study. A convenience sample of 61 older adults with a mean age of 88.4(8.1) was tested by two different physiotherapists at two time points. The mean time interval between tests was 2.5 days. The Intraclass Correlation Coefficient model 3.1 (ICC, 3.1) with 95% confidence intervals as well as the weighted Kappa (K) were used as measures of relative reliability. The Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC) were used to measure absolute reliability. The results were also analyzed for a subgroup of 24 older people with dementia.

RESULTS

The ICC reflected high relative reliability for the SPPB summary score and the 4 m walk test (4mwt), both for the total sample (ICC = 0.92, and 0.91 respectively)) and for the subgroup with dementia (ICC = 0.84 and 0.90 respectively). Furthermore, weighted Ks for the SPPB subscales were 0.64 for the chair stand, 0.80 for gait and 0.52 for balance for the total sample and almost identical for the subgroup with dementia. MDC-values at the 95% confidence intervals (MDC95) were calculated at 0.8 for the total score of SPPB and 0.39 m/s for the 4mwt in the total sample. For the subgroup with dementia MDC95 was 1.88 for the total score of SPPB and 0.28 m/s for 4mwt.

CONCLUSIONS

The SPPB total score and the timed walking test showed overall high relative and absolute reliability for the total sample indicating that the Norwegian version of the SPPB is reliable when used by trained physiotherapists with older people. The reliability of the Norwegian SPPB in older people with dementia seems high, but due to a small sample size this needs further investigation.

The impact of service quality, customer engagement and selected marketing constructs on airline passenger loyalty

Purpose

This study aims to empirically analyse the determinants of airline passenger loyalty in the high-frills Indonesian airline industry. The interrelationships among passenger loyalty, customer engagement, customer satisfaction, brand image, perceived value and service quality are identified and discussed.

Design/methodology/approach

The perceptions of 250 Indonesian airline passengers were used to examine the interrelationships among the constructs. The data set was analysed using confirmatory factor analysis and structural equation modelling.

Findings

The empirical results demonstrate that customer engagement has the most influential effect on passenger loyalty, followed by customer satisfaction. Customer satisfaction has the largest total effect on customer engagement. Service quality, perceived value and customer satisfaction also indirectly affect customer loyalty through mediation.

Originality/value

The integration of the customer engagement construct with the other important marketing constructs comprehensively explains the role of customer engagement on customer loyalty. The effects of the important marketing constructs on customer loyalty are not only explained in the direct relationships but also in indirect relationships through mediation.

Structural Equivalence of an Attitude Toward Religion Scale in Mexico, Nicaragua and China

The Attitude toward Catholicism, Judaism, Hinduism, and Islam scales were adapted for this study into a single scale that measures overall attitudes towards religion. The resulting Attitude toward Religion (ATR) Scale was adapted into both Spanish and Chinese and administered in Mexico (n = 265), Nicaragua (n = 296), and China (n = 460) to a total of 1,021 individuals (59% women, 41% men; Mage = 22.4 years, SD = 7.01 years). The scale’s structural equivalence (i.e. Does the instrument measure the same construct in each country?) was assessed using Exploratory Factor Analyses and pairwise comparisons. Strong evidence for structural equivalence was provided by the analyses’ results, as we obtained a one-dimensional solution (labeled Attitude Toward Religion, ATR) in all three countries and Tucker’s Phi test was very close to 1. These findings support the unidimensional solution for attitudes toward religions obtained in previous scales and broaden the scope for these studies in several cultural contexts. Further implications are discussed.

Translation and Adaptation of Five English Language Self-Report Health Measures to South Indian Kannada Language

The objective of this study was to translate and adapt five English self-report health measures to a South Indian language Kannada. Currently, no systematically developed questionnaires assessing hearing rehabilitation outcomes are available for clinical or research use in Kannada. The questionnaires included for translation and adaptation were the hearing handicap questionnaire, the international outcome inventory - hearing aids, the self-assessment of communication, the participation scale, and the assessment of quality of life - 4 dimensions. The questionnaires were translated and adapted using the American Association of Orthopedic Surgeons (AAOS) guidelines. The five stages followed in the study included: i) forward translation; ii) common translation synthesis; iii) backward translation; iv) expert committee review; v) pre-final testing. In this paper, in addition to a description of the process, we also highlight practical issues faced while adopting the procedure with an aim to help readers better understand the intricacies involved in such processes. This can be helpful to researchers and clinicians who are keen to adapt standard self-report questionnaires from other languages to their native language.

The social and community opportunities profile social inclusion measure: Structural equivalence and differential item functioning in community mental health residents in Hong Kong and the United Kingdom

INTRODUCTION

China's future major health problem will be the management of chronic diseases - of which mental health is a major one. An instrument is needed to measure mental health inclusion outcomes for mental health services in Hong Kong and mainland China as they strive to promote a more inclusive society for their citizens and particular disadvantaged groups.

AIM

To report on the analysis of structural equivalence and item differentiation in two mentally unhealthy and one healthy sample in the United Kingdom and Hong Kong.

METHOD

The mental health sample in Hong Kong was made up of non-governmental organisation (NGO) referrals meeting the selection/exclusion criteria (being well enough to be interviewed, having a formal psychiatric diagnosis and living in the community). A similar sample in the United Kingdom meeting the same selection criteria was obtained from a community mental health organisation, equivalent to the NGOs in Hong Kong. Exploratory factor analysis and logistic regression were conducted.

RESULTS

The single-variable, self-rated 'overall social inclusion' differs significantly between all of the samples, in the way we would expect from previous research, with the healthy population feeling more included than the serious mental illness (SMI) groups. In the exploratory factor analysis, the first two factors explain between a third and half of the variance, and the single variable which enters into all the analyses in the first factor is having friends to visit the home. All the regression models were significant; however, in Hong Kong sample, only one-fifth of the total variance is explained.

CONCLUSION

The structural findings imply that the social and community opportunities profile-Chinese version (SCOPE-C) gives similar results when applied to another culture. As only one-fifth of the variance of 'overall inclusion' was explained in the Hong Kong sample, it may be that the instrument needs to be refined using different or additional items within the structural domains of inclusion.

Measuring Career Aspirations Across Cultures

The purposes of this study were to translate the revised version of a measure of career aspirations, the Career Aspiration Scale–Revised (CASR), into Korean and to evaluate the factor structure and psychometric properties of the Korean version of the revised measure. First, the CASR was translated into Korean using multiple translation strategies (Korean version of the Career Aspiration Scale-Revised [K-CASR]). Then, the psychometric properties of the K-CASR were examined with data from 377 college women in Korea. After the removal of several negatively worded items (due to a possible method effect), the 18-item version of the K-CASR demonstrated good model fit with the hypothesized three-factor structure (achievement, leadership, and educational aspirations). The K-CASR also exhibited moderately high internal consistency and stability. Convergent validity was supported by positive correlations with achievement motivation, career orientation, and career goal engagement. Implications for future research and counseling were discussed.

Psychometric Properties of the Korean Versions of Three Sleep Evaluation Questionnaires

Psychometric properties of the Korean versions of three sleep evaluation questionnaires were described to provide tools for practitioners and researchers interested in transcultural studies in Korea. The Pittsburgh Sleep Quality Index (PSQI), the General Sleep Disturbance Scale (GSDS), and the Leeds Sleep Evaluation Questionnaire (LSEQ) were analyzed using data from 959 community-dwelling adults in Korea. Furthermore, cut-off points and prevalence of sleep disturbance were identified. Reliability and concurrent validity for all measures were acceptable. Optimal cut-off points of PSQI, GSDS, and LSEQ with highest Youden’s index were 5, 33, and 66, and prevalence of sleep disturbance was 22.1%, 26.3%, and 25.8%, respectively. The Korean PSQI, GSDS, and LSEQ are all valid and reliable tools for detecting sleep disturbance. We provide suggestions for selecting the right tools according to the purpose, setting, and participants of transcultural studies

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.

Translation barriers in conducting qualitative research with Spanish speakers

Cross-cultural qualitative research is rare and challenging because of difficulties of collecting reliable and valid information when conducting research in a language other than the researcher's primary language. Although standards of rigor exist for the data collection, analysis, interpretation, and reporting of qualitative data, no such standards exist for translation of translinguistic qualitative research. Therefore, a new methodology modeled after Brislin's translation principles was utilized with 60 Latino participants experiencing side effects as a result of prostate cancer treatment. Interviews were conducted in Spanish, transcribed verbatim, and then translated by research staff. By adapting Brislin's process, a new methodology was developed that more accurately conveys the true meaning of the participant's experience, is more appropriate and meaningful, and opens doors to researchers interested in conducting research in a language other than their own, while at the same time ensuring the reliability and validity of study data.

The preliminary effect of a parenting program for Korean American mothers: a randomized controlled experimental study

BACKGROUND

Traditional Korean American discipline is characterized by a lack of expression of affection and use of harsh discipline.

OBJECTIVE

The purpose of this study was to pilot test the effect of the Incredible Years Parenting Program among Korean American mothers.

METHODS

A randomized controlled experimental study design was used; 29 first-generation Korean American mothers of young children (3-8 years old) were randomly assigned to intervention (n=20) and control (n=9) groups. Intervention group mothers received a 12-week parenting program. Control group mothers did not receive the intervention. Mothers reported on discipline styles (positive, appropriate, and harsh), level of acculturation, and their child's outcomes (behavioral problems and social competence) at pre-, post-, and 1-year follow-up intervals.

RESULTS

After completing the program, intervention group mothers significantly increased use of positive discipline as compared to control group mothers. Among intervention group mothers, high-acculturated mothers significantly increased appropriate discipline whereas low-acculturated mothers significantly decreased harsh discipline. In the 1-year follow-up, intervention group mothers maintained the significant effect for positive discipline.

CONCLUSIONS

Providing this program appears to be a promising way of promoting positive discipline among Korean American mothers.

Promoting public health: benefits and challenges of a Europeanwide research consortium on student health

AIMS

The purpose of this paper is to highlight some of the benefits and challenges when undertaking research across several countries comprising diverse ethnic, lingual and historically different communities.

METHODS

Literature review and experiences of the researchers who participated in the Students' Health Inquiry, as regards the benefits and the challenges that can emerge when conducting collaborative research. The Delphi technique was employed to reach consensus on and prioritise the emerging challenges and suggested solutions.

RESULTS

Challenges of research consortia include the preparatory work before the study, the ownership of the data and dissemination of results, as well as methodological, financial, operational, and structural challenges. These are described, each challenge is further broken down in its subcomponents, examples are given, and potential solutions are suggested.

CONCLUSIONS

If challenges can be prevented or solved, the benefits of research consortia include greater generalisability of findings, and more comprehensive understanding of the issues than would be possible with a single-site study. There is also an increased probability to bring about policy changes and programmatic adjustments. Cross-national research consortia can contribute to reduction in the inequality of resources and research opportunities in the collaborating countries. Research consortia deserve the attention of funding agencies. They are capable of bringing about synergies that result from working collaboratively together of large multi-disciplinary team of investigators who share their strengths, disciplines and expertise in order to bear on the same research issue in multiple countries and diverse populations.

First-generation Korean-American parents' perceptions of discipline

Nurses not only need to be familiar with professional guidelines of discipline and but also need to be aware of variances in styles of acceptable discipline across cultural groups. The goal of this study was to explore cultural influences in relation to (1) first-generation Korean-American parents' perceptions of common discipline strategies in the United States, and (2) discipline strategies commonly used among first-generation Korean-American parents. Inductive content analysis was used to analyze interview data from seven first-generation Korean-American parents. Derived themes indicated that parents considered spanking/hitting and less hugging/kissing as Korean style, and time-out, use of sticker charts, hugging/kissing, removing/adding privileges, and giving chores as American style. Recent immigrant parents were not familiar with common positive discipline strategies in the United States. As they adapted to mainstream society, they discontinued what they perceived to be negative aspects of Korean style and adopted positive aspects of American style. They were sensitive to children's views on discipline, and they experienced communication difficulties with children. These findings indicated that Korean-American parents' perceptions of discipline strategies were shaped by living in two cultures and were different from western viewpoints.

Psychometric Testing of the Social Support Survey on a Taiwanese Sample

BACKGROUND

The Medical Outcomes Study Social Support Survey (MOS-SS) is a multidimensional, self-administered instrument used to assess various functional dimensions of social support. Less is known regarding its value for a Chinese population.

OBJECTIVE

The aim of this study was to assess the psychometric properties of the MOS-SS on an adult sample in Taiwan.

METHODS

A total of 265 adult family caregivers of patients with cancer from four different hospitals in the north, middle, and south regions of Taiwan completed the MOS-SS.

RESULTS

In the original five-factor model, unsatisfactory item discriminant validity was found in almost half of the items; the item-own subscale correlation was lower than the item-other subscale correlation. A two-factor model accounting for 68.98% of the variance was found using exploratory factor analysis. The first factor (emotional support) accounted for 62.28% of the total variance, whereas the second factor (tangible support) accounted for 6.7%; the interfactor correlation was .71. The two-factor model seemed to have satisfactory reliability and validity and better discrimination between different subscales than did the original five-factor model.

DISCUSSION

Good reliability and validity were demonstrated in the MOS-SS when applied to an adult sample in Taiwan. A two-factor model, instead of a five-factor model as found in the Western countries, was found for this sample. Confirmation of the two-factor model and exploration of the two-factor model in related concepts are suggested for future studies.