Translation of questionnaires and issues of equivalence

Translation and validation of the Chinese version of the menstrual distress questionnaire

BACKGROUND

The Menstrual Distress Questionnaire (MDQ) is a commonly used questionnaire that assesses various symptoms and distress associated with the menstrual cycle in women. However, the questionnaire has not been completely translated into Chinese with rigorous reliability and validity testing.

METHODS

This study translated the Menstrual Distress Questionnaire Form Cycle (MDQC) from English into Chinese: MDQCC in two stages. First, it was translated forward and backward using Jones' model; second, to test the validity and reliability, 210 Chinese-speaking women were recruited through online announcements and posters posted between June 2019 and May 2020. Expert validity, construct validity, convergent validity, and factorial validity were determined using content validity index (CVI), intraclass correlation coefficient (ICC), composite reliability (CR), and exploratory factor analysis, respectively. For concurrent criterion validity, MDQCC score was compared with three existing pain scales. Reliability was evaluated using internal consistency across items and two-week test-retest reliability over time.

RESULTS

The CVI for content validity was .92. Item-CVI for expert validities among the 46 items ranged from .50 - 1; scale-CVI for the eight subscales, from .87 - 1; ICC, from .650 - .897; and CRs, from .303 - .881. Pearson correlation coefficients between MDQCC and short-form McGill pain questionnaire, present pain intensity, and visual analog scale scores were .640, .519, and .575, respectively. Cronbach's α for internal consistency was satisfactory (.932). ICC for test-retest reliability was .852 for the entire MDQCC.

CONCLUSION

MDQCC was valid and reliable for Mandarin Chinese-speaking women. It can be used to evaluate female psychiatric symptoms related to the menstrual cycle in future work.

Validity and Reliability of the Turkish Adaptation of the Assessment of Positive Occupation-15 (APO-15) in Serious Mental Illness

The concept of positive occupations that enhance physical, mental, and social well-being is a novel idea that integrates positive psychology and occupational therapy. Valid and reliable scales are required to assess positive occupations for well-being in mental health settings. In this regard, the Assessment of Positive Occupation-15 (APO-15) is unique, as it evaluates positive occupations that promote health and well-being. This study aimed to investigate the validity and reliability of and determine the cutoff value of the Turkish version of the APO-15 in individuals with serious mental illness (SMI). The study was conducted with 106 individuals with SMI. The structural validity of the scale items was determined using confirmatory factor analysis, while the reliability of the scale was analyzed with Cronbach's alpha (α) and McDonald's omega (ω) coefficients. The comparative fit index (0.964) and the Tucker-Lewis index (0.955) demonstrated a good fit. Cronbach's alpha coefficients were .826, .814, .707, and .674, and the total scale score was 0.924. McDonald's ω coefficients for the four scale dimensions were 0.832, 0.818, 0.716, and 0.727. The cutoff point of 49.50 for the APO-15 for point sensitivity (0.727) and specificity (0.766) yielded good results. The Turkish version of the APO-15 is an effective and reliable tool for assessing well-being in mental health settings.

Facial Assessment and Cosmetic Enhancement Quality of Life Questionnaire (FACE-Q) Arabic Validation

Background  Rhinoplasty, a common cosmetic surgery, improves aesthetic appearance and nasal function. Outcomes are typically measured by patient satisfaction and quality of life impact. However, a gap exists in validated non-English assessment tools, especially in Arabic, which hinders accurately capturing patient experiences in Arabic-speaking populations. To fill this gap, this study aims to translate and validate the "Rhinoplasty" module of the Facial Assessment and Cosmetic Enhancement Quality of Life Questionnaire (FACE-Q) self-questionnaire into Arabic. Methods A cross-sectional study was conducted at the Otorhinolaryngology Department of the National Guard Health Affairs in Riyadh, Saudi Arabia. Adults who underwent rhinoplasty from 2017 to 2021 were included if they had at least one year of follow-up and were contactable. A sample size of 109 was determined, and the participants were selected using probability cluster sampling. A 33-item FACE-Q scale was administered via telephone, with scores converted to a 0-100 scale for analysis. Translation involved a two-way process with independent translations and back-translations, followed by review and pilot testing. Results The study included 137 participants (mean age, 32.5 years; 53 men, 84 women), predominantly electing cosmetic surgery, with an average of four years post-surgery. The internal consistency of the scales varied, with the self-acceptance/love scale showing acceptable reliability (Cronbach's alpha = 0.73) and other scales suggesting item redundancy (Cronbach's alpha for aesthetic scales > 0.94). The self-rated complications scale did not meet the acceptability threshold, indicating a need for scale revision. Conclusions The Arabic translation of the FACE-Q Rhinoplasty module shows potential as a reliable tool for evaluating patient satisfaction and quality of life after rhinoplasty in Arabic-speaking patients. Further refinement is necessary to address item redundancy and enhance cultural specificity. This work underscores the importance of culturally sensitive tools for global applicability in cosmetic surgery outcomes research.

Validation of Chinese version of the 5-item WHO well-being index in type 2 diabetes mellitus patients

BACKGROUND

For better disease management and improved prognosis, early identification of co-morbid depression in diabetic patients is warranted. the WHO-5 well-being index (WHO-5) has been used to screen for depression in diabetic patients, and its Chinese version (WHO-5-C) has been validated. However, its psychometric properties remain to be further validated in the type 2 diabetes patient population. The aim of our study was to examine the reliability and validity of the WHO-5-C in patients with type 2 diabetes mellitus.

METHODS

The cross-sectional study was conducted on 200 patients from July 2014 to March 2015. All patients should complete the WHO-5-C, the Patient Health Questionnaire-9 (PHQ-9), the 20-item Problem Areas in Diabetes Scale (PAID-20), the Mini International Neuropsychiatric Interview (M.I.N.I), and Hamilton Rating Scale for Depression (HAM-D). Internal consistency of WHO-5 was revealed by Cronbach's alpha, and constructive validity by confirmatory factor analysis (CFA). Relationship with PHQ-9, HAM-D, and PAID-20 was examined for concurrent validity, and ROC analysis was performed for criterion validity.

RESULTS

The WHO-5-C presented satisfactory reliability (Cronbach's alpha = 0.88). CFA confirmed the unidimensional factor structure of WHO-5-C. The WHO-5-C had significant negative correlation with HAM-D (r = -0.610), PHQ-9 (r = -0.694) and PAID-20 (r = -0.466), confirming good concurrent validity. Using M.I.N.I as the gold standard, the cut-off value of WHO-5-C was 42, with a sensitivity of 0.83 and specificity of 0.75.

CONCLUSION

The WHO-5-C holds satisfactory reliability and validity that is suitable for depression screening in type 2 diabetes patients as a short and convenient instrument.

Cross-Cultural Adaptation of Lung Cancer Screening Health Belief Scale in Chinese Americans: A Methodological Study

Background and Purpose: The purpose of this study is to report the process of adapting the existing Lung Cancer Screening Health Belief Scale to be used in Chinese Americans. Methods: Guided by Flaherty et al.'s cross-cultural equivalency model, the methodology used in the adaptation process consists of four steps, including preliminary modification after a comprehensive literature review, forward and backward translation, expert review, and cognitive interviews among participants. Results: The modified culturally fitted Lung Cancer Screening Health Belief Scale included 57 items and 6 subscales, which proved highly reliable and valid through the expert review and participants' review. Conclusions: This study provided an example for a novice cross-cultural researcher to adapt an instrument to be used in another population with a different language. Further research is needed to work out a standard guideline for cross-cultural instrument adaptation.

A brief questionnaire for measuring alarm fatigue in nurses and physicians in intensive care units

When exposed to hundreds of medical device alarms per day, intensive care unit (ICU) staff can develop "alarm fatigue" (i.e., desensitisation to alarms). However, no standardised way of quantifying alarm fatigue exists. We aimed to develop a brief questionnaire for measuring alarm fatigue in nurses and physicians. After developing a list of initial items based on a literature review, we conducted 15 cognitive interviews with the target group (13 nurses and two physicians) to ensure that the items are face valid and comprehensible. We then asked 32 experts on alarm fatigue to judge whether the items are suited for measuring alarm fatigue. The resulting 27 items were sent to nurses and physicians from 15 ICUs of a large German hospital. We used exploratory factor analysis to further reduce the number of items and to identify scales. A total of 585 submissions from 707 participants could be analysed (of which 14% were physicians and 64% were nurses). The simple structure of a two-factor model was achieved within three rounds. The final questionnaire (called Charité Alarm Fatigue Questionnaire; CAFQa) consists of nine items along two scales (i.e., the "alarm stress scale" and the "alarm coping scale"). The CAFQa is a brief questionnaire that allows clinical alarm researchers to quantify the alarm fatigue of nurses and physicians. It should not take more than five minutes to administer.

Assessing factor structure and reliability of the career adaptability scale in students with special educational needs

Despite the importance of career guidance and life planning education in helping students' career development, considerably limited research has been done to provide a good educational assessment to identify SEN students' strengths and weaknesses of career adaptability. This study aimed to assess the factor structure of the career adaptability scale in mainstream secondary students with special educational needs. The results support adequate reliabilities of the total scale and subscales of the CAAS-SF among over 200 SEN students. The results also support the four-factor structure of the career adaptability construct in assessing career concern, control, curiosity and confidence. We also found its measurement invariance across gender at the scalar invariance level. The positive and significant correlation patterns between boys' and girls' career adaptability and its sub-dimensions with self-esteem are similar. Overall, this study support that the CAAS-SF is a good measure with adequate psychometric properties for assessing and developing practical career guidance and life planning activities and programs for SEN students to support their career development needs.

'It's really important to be collaborating': Experiences of participatory research for Chinese and Vietnamese parents of autistic children

Background and aims

Participatory research involves academic partners working together with the community that is affected by research to make decisions about that research. Such approaches often result in research that is more respectful of, and responsive to, community preferences - and is vital in the context of autism research with culturally and linguistically diverse (CALD) communities. Whilst participatory approaches are becoming more commonplace within CALD autism research, no studies have explored the experiences of being involved in autism research from the perspectives of CALD community partners over the course of a study. This paper intended to address this gap by reporting on the experiences of CALD parents of autistic children who were community partners in a 1-year Australian research project exploring home-school partnerships for CALD parents of autistic children. We aimed to: (1) report on how parents' involvement in the research process shaped the home-school partnerships study over time and (2) understand their experiences of being community partners on the home-school partnerships project.

Methods

Using key principles of participatory approaches, we established Chinese and Vietnamese parent advisory groups to contribute to a project exploring home-school partnerships for parents of autistic children from CALD backgrounds in Australia. Advisory groups included parents of autistic children from Chinese/Vietnamese backgrounds, as well as interpreters, professionals and researchers. We documented how parents' participation as community partners shaped the home-school partnerships study over the course of the project. We also elicited parents' own views and experiences of being community partners through informal, open-ended questions at the beginning and end of the study.

Results

We found that parents' input fundamentally shaped the broader home-school partnership study, from meaningful, accurate translation of interview schedules through to making decisions regarding community-specific recommendations and dissemination plans. Parents themselves reported being keen to collaborate and to hear and share opinions for the purpose of the home-school partnership study - although they noted how emotionally difficult sharing their stories could be. While they initially had some concerns about combining being involved as a community partner with their existing responsibilities, ultimately, parents were surprised by the scope of the home-school partnership study and their level of involvement as community partners. Through hearing others' stories and sharing their own in advisory group meetings, parents reported ancillary benefits of their involvement, including increased self-advocacy and well-being.

Conclusions

These findings show how research that is conducted in partnership with diverse members of the autism community has the capacity to improve the quality of the research and benefit community partners.

Implications

This study clearly documents the benefits and potential challenges of participatory approaches with CALD communities. These findings emphasise to researchers and funders the importance of including extra time and money within budgets in order to produce meaningful research that is respectful and responsive to communities.

Cross-cultural adaptation and validation of the Chinese version of the revised surveys on patient safety culture™ (SOPS®) hospital survey 2.0

BACKGROUND

Surveys on Patient Safety Culture™ (SOPS®) Hospital Survey (HSOPS 1.0), developed by the U.S. Agency for Healthcare Research and Quality in 2004, has been widely adopted in the United States and internationally. An updated version, the SOPS Hospital Survey 2.0 (HSOPS 2.0), released in 2019, has not yet been applied in China. The aim of the present study was to translate HSOPS 2.0 into Chinese version with cross-cultural adaptations and test its psychometric properties.

METHODS

A convenience sample was used. Hospital nurses (N = 1013) and a sub-set (n = 200) was invited for the re-test. A three-stage study was conducted. Firstly, the HSOPS 2.0 was translated by a panel. Secondly, the content validity was tested using the two-round Delphi method and cognitive interview. Next, the construct validity was tested by the confirmatory factor analysis and further demonstrated by the convergent validity, discriminant validity, and correlations with the outcome of patient safety. Thirdly, the reliability was tested by internal consistency reliability and re-test reliability.

RESULTS

The "float or PRN" and "manager" words were deleted as considered unfitted for the Chinese health care system. The content validity index provided evidence of strong content validity (I-CVI = 0.84 ~ 1.00, S-CVI = 0.98). Confirmatory factor analysis revealed a good model fit (χ²/df = 4.05, RMSEA = 0.06, CFI = 0.94) and acceptable factor loadings (0.41 ~ 0.97). Convergent validity, and discriminant validity supported the factorial structure of the Chinese version of HSOPS 2.0. Further evidence for the construct validity was derived from correlations with the outcome of patient safety (r = 0.10 ~ 0.41). A good internal consistency (Cronbach's α = 0.68 ~ 0.93, McDonald's omega = 0.84 ~ 0.96) and test-retest reliability (ICC = 0.78 ~ 0.95) showed acceptable reliability. Additionally, Chinese nurses reported markedly lower scores for three dimensions, including "Response to Error", "Communication Openness", and "Reporting Patient Safety Events", when comparing the findings of this study with those from U.S. research utilizing the HSOPS 2.0.

CONCLUSION

The Chinese version of HSOPS 2.0 demonstrated good validity and reliability in a Chinese sample of hospital nurses, which suggests that it can be used to measure nurse-perceived patient safety culture in future research and practice. Psychometric properties of the Chinese version of HSOPS 2.0 among other Chinese healthcare professionals remain to be confirmed.

Psychometric Properties of the Turkish Health Enhancement Lifestyle Profile-Screener Questionnaire (T-Help-Screener)

Objective: Healthy ageing is associated with a healthy lifestyle. The aim of this study was to evaluate the validity, reliability, and cultural adaptation of the Turkish version of the Health Enhancement Lifestyle Profile Screener (T-HELP-Screener). Methods: This study included 150 participants aged 65 years and above. Internal consistency of the T-HELP-Screener was measured using Kuder–Richardson. Test-retest reliability was performed with 66 of the 150 participants using intraclass correlation coefficient (ICC). Construct validity of the T-HELP-Screener was analyzed with the Healthy Lifestyle Behavior Scale-II (HLBS-II). Results: This study showed a substantially reliable level (Kuder–Richardson=0.72). The ICC for each of the T-HELP-Screener items ranged from 0.750 (95% CI = 0.590–0.847) to 0.965 (95% CI = 0.942–0.978) indicating acceptable to good test-retest reliability. There was a significant moderate correlation between the T-HELP-Screener and the HLBS-II (rs = 0.488; p =0.001). Conclusion: This study supports the psychometric properties of the T-HELP-Screener. This tool can help quickly identify older adults who need a more comprehensive assessment of their health risk behaviours. Future studies should develop and validate a Turkish version of the comprehensive 56-item Health Enhancement Lifestyle Profile (HELP).

The role of stress responses on engagement in dietary and physical activity behaviors among Latino adults living with prediabetes

OBJECTIVES

Latinos are at a high risk of developing type 2 diabetes (T2D). Prediabetes is a major risk factor for T2D; however, progression to T2D can be slowed with engagement in healthy behaviors. Stress can hinder engagement with health behaviors. Qualitative methods were used to understand how Latinos with prediabetes attempted to modify their diet and physical activity behaviors to slow T2D progression and how stress affected their engagement in these behaviors.

DESIGN

Semi-structured interviews were conducted with 20 Latinos with prediabetes in North Carolina. Participants were asked questions about types of stress they experienced and how stress affected their health. We generated codes on stress and stress responses and used content analysis to organize codes between and within participants.

RESULTS

Behaviors changed after prediabetes diagnosis. Few participants reported changing their physical activity, however, all participants attempted to change their eating patterns by changing food types consumed and reducing portion sizes. The stress participants experienced impacted their ability to self-regulate their diet. They reported overeating or appetite suppression during stressful periods. Stress also affected cognitive responses by compromising healthy decision-making and instigating negative emotional reactions. Overall, stress complicated participants' ability to properly engage in recommended behaviors by negatively impacting participants' behavioral self-regulation and cognitive processes.

CONCLUSIONS

Stress affects behavioral and cognitive progresses that adversely alters primarily dietary behaviors. Tailored plans acknowledging the impact of stress and providing coping and supportive help for dealing with stress may enhance engagement in healthy behaviors for Latinos with prediabetes.

Evaluating the psychometric properties of the Chinese version of the modified Carolina Human Papillomavirus immunisation attitudes and beliefs scale among Chinese adolescent girls

Human Papillomavirus (HPV) vaccine uptake among adolescents is influenced by their views and perceptions of the vaccination. The modified Carolina HPV Immunisation Attitudes and Beliefs Scale (CHIAS) is a well-established instrument to measure adolescents’ views of HPV vaccination. However, there is currently no Chinese version available to inform HPV vaccination promotion efforts among Chinese adolescents. This study aimed to translate and validate the Chinese version of the modified CHIAS (CHIAS-C). A cross-sectional descriptive study was carried out with 212 female adolescents recruited from secondary schools. Internal consistency, convergent validity, and construct validity were examined. Cronbach’s alpha of the five domains ranged from 0.60 to 0.89, suggesting acceptable internal consistency. Both positive and negative correlations were found between CHIAS-C domains and HPV vaccination intention, indicating convergent validity. Factorial validity was established through confirmatory factor analysis. Our findings suggest that adolescents had generally positive perceptions of HPV vaccination and were likely to accept vaccination if given more relevant information. It was found that most adolescents had neither attended any school talks about HPV nor spoken about the vaccination with healthcare providers. This illustrates that adolescents experience a lack of communication and education about HPV vaccination, both of which can be enhanced in order to persuade adolescents to receive the vaccination. The results suggest that the CHIAS-C is a reliable and valid tool to measure adolescents’ views of HPV vaccination. The translated scale may therefore be used in future adolescent research and to inform the development of interventions to increase HPV vaccine uptake.

Identifying the Psychometric Properties of the Malay Version of the WHOQOL-BREF among Employees with Obesity Problem

The Malay version of the WHOQOL-BREF was published approximately 15 years ago. Since then, no known research has been conducted to identify the psychometric properties of the scale using confirmatory factor analysis. This study aimed to establish a model by applying a scientific approach to the translation and adaptation method. The back translation technique was used for the translation process. This cross-sectional study involved 282 employees at Universiti Kebangsaan Malaysia. The instrument received satisfactory Cronbach's alpha reliability values. The data were analysed with SEM using AMOS. Results showed that the model produced is parsimonious, with CMIN/df = 0.23, CFI = 0.93, SRMR = 0.08, RMSEA = 0.08 and PCLOSE = 0.07. Adopting the Malay version of the WHOQOL-BREF for future research is highly recommended due to its properties.

Promotion of Internet Users' Aggressive Participation via the Mediators of Flow Experience and Identification

Social media users have increased rapidly in recent years; however, most are "silent users" who rarely share information online. To maintain social media companies' stable operation and development, this research explored the effects of flow experience and identity formation on users' intrinsic motivation to facilitate aggressive, spontaneous, and habitual participation in virtual communities. A total of 487 valid questionnaires were collected and underwent regression analysis. The results revealed that all three intrinsic motivations had a significant impact on social media participation, with social interaction exerting the strongest influence. Flow experience and identification had significant, partial mediating effects on the relationship between motivation and participation. Several suggestions were provided based on the results to help social media enterprises increase user participation. It is hoped that this research could facilitate in transforming users into habitual participants to keep the operations of the virtual community stable and enduring.

Validity and Psychometric Evaluation of the Chinese Version of the 5-Item WHO Well-Being Index

Aims

This article evaluates the psychometric properties of the Chinese version of the 5-item WHO Well-Being Index (WHO-5) in mainland China.

Methods

Two cross-sectional studies with 1,414 participants from a university in China were conducted. The Chinese version of the WHO-5 was assessed to determine its internal consistency, concurrent validity, factorial validity, and construct validity.

Results

The results indicate that the WHO-5 is unidimensional and has good internal consistency, with Cronbach's a = 0.85 and 0.81 in Study 1 (n = 903) and Study 2 (n = 511), respectively. The findings also demonstrate that the WHO-5 has good concurrent validity with other well-established measures of wellbeing, self-efficacy, self-esteem, and mental wellbeing. The results of confirmatory factor analysis also suggest that the scale has a good model fit.

Conclusions

This study provides empirical data demonstrating that the Chinese version of the WHO-5 has good psychometric properties. The scale can be a useful measure in epistemological studies and clinical research related to wellbeing in Chinese populations.

Adaptation and validation of pediatric peripheral intravenous catheter insertion and care practices audit tools

Objectives

This study aimed to describe the translation process and establish the validity of the three instruments in Indonesian to assess pediatric peripheral intravenous catheter (PIVC) insertion and care practices.

Methods

The six-step forward and backward translation method was used to translate the adapted questionnaires. The English version questionnaires included the point prevalence audit checklist, the nurse survey consisting of the nurse PIVC knowledge questionnaire and the nurse PIVC confidence questionnaire, plus a Patient/parent Experience Survey. Data collection was conducted in Indonesia between October 2019 and February 2020. In total, there were six translators (two for each instrument), nine-panel vascular access experts (three for each instrument), and 30 participants (ten for each instrument) of the target population involved in the translation and validation of the three instruments. Three-panel experts rated the content relevance of each instrument using a four-point rating scale. Item level and scale level content validity index and kappa index were calculated. Ten-panel members of the target population evaluated each questionnaire regarding feasibility, clarity, logical sequence, and formatting. Qualitative comments from the panel were also reviewed.

Results

The translation process indicated relatively low discrepancies between translators except for semantic equivalence. There were nine, eight, and one semantic discrepancies found in the forward translation of the point prevalence audit checklist, nurse survey, and patient/parent experience survey. The semantic discrepancies were less prevalent in the backward translation, with only one, three, and two items reported during the process. The item validity index for all of the three instruments showed relatively high agreement between experts (I-CVI > 0.78, S-CVI/Ave >0.90, S-CVI/UA > 0.70, and kappa index >0.74). The face validity was established with the panel reporting that the three instruments were easy to understand and presented logically. However, some re-formatting of the nurse survey and patient/parent experience survey were needed to avoid ambiguity and confusion for the participants.

Conclusions

The results indicate that the translated three survey instruments that had been widely used in other developed countries show good content validity in the Indonesian context. They can be used as a reference for further testing in different countries and contribute to understanding the pediatric PIVC audit tools used in future clinical research.

Is Abusive Supervision the Last Straw? The Buffering Role of Construal Level in the Association of Abusive Supervision With Withdrawal

Drawing on the theory of cognitive-affective processing system and that of construal level, we propose a moderated mediation model illustrating the relationship among abusive supervision, shame, construal level, and work withdrawal. We tested this model with a two-source time-lagged survey of 387 employees from 129 work teams in central and East China. Results revealed that abusive supervision had a positive association with the emotion of shame and supported the mediating role of shame linking abusive supervision to work withdrawal. Besides, our findings supported the buffering effect of construal level on the shame-work withdrawal relationship as well as the indirect relationship between abusive supervision and work withdrawal channeled through the emotion of shame.

Cross-Cultural Modification Strategies for Instruments Measuring Health Beliefs About Cancer Screening: Systematic Review

Background

Modification is an important process by which to adapt an instrument to be used for another culture. However, it is not fully understood how best to modify an instrument to be used appropriately in another culture.

Objective

This study aims to synthesize the modification strategies used in the cross-cultural adaptation process for instruments measuring health beliefs about cancer screening.

Methods

A systematic review design was used for conducting this study. Keywords including constructs about instrument modification, health belief, and cancer screening were searched in the PubMed, Google Scholar, CINAHL, and PsycINFO databases. Bowling’s checklist was used to evaluate methodological rigor of the included articles. Results were reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach with a narrative method.

Results

A total of 1312 articles were initially identified in the databases. After removing duplications and assessing titles, abstracts, and texts of the articles, 18 studies met the inclusion criteria for the study. Based on Flaherty’s cultural equivalence model, strategies used in the modification process included rephrasing items and response options to achieve semantic equivalence; changing subjects of items, changing wording of items, adding items, and deleting items to achieve content equivalence; adding subscales and items and deleting subscales and items to achieve criterion equivalence. Solutions used to resolve disagreements in the modification process included consultation with experts or literature search, following the majority, and consultation with the author who developed the scales.

Conclusions

This study provides guidance for researchers who want to modify an instrument to be used in another culture. It can potentially give cross-cultural researchers insight into modification strategies and a better understanding of the modification process in cross-cultural instrument adaptation. More research could be done to help researchers better modify cross-cultural instruments to achieve cultural equivalence.

Social Physique Anxiety Scale: Psychometric Evaluation and Development of a Chinese Adaptation

The Social Physique Anxiety Scale (SPAS) is a popular measure of individual anxiety related to body image. This study assessed the psychometric properties of the 12-, 9-, 8- and 7-item versions of the SPAS. Two cross-sectional studies recruited 466 Chinese university students. Study 1 (n = 273) evaluated the construct validity and internal consistency of the SPAS. Study 2 (n = 193) further assessed the construct validity, factorial validity, internal consistency, convergent validity and divergent validity of the SPAS. The results indicated that none of the existing SPAS versions possess good psychometric properties suitable for the Chinese student population. In short, a new 7-item version of the SPAS that is more suitable for measuring social physique anxiety among Chinese university students. The implications of our results and future research directions are discussed.

Cross-Cultural Instrument Adaptation and Validation of Health Beliefs About Cancer Screening: A Methodological Systematic Review

BACKGROUND

The uptake of cancer screening is significantly associated with participants' health beliefs about cancer screening. Scales measuring health beliefs of cancer screening are available; however, the scales that were developed and validated for the US population may lack cultural appropriateness, which could compromise the reliability and validity of the scales when applied to different ethnic groups or populations.

OBJECTIVE

The aim of this study was to summarize, analyze, and compare the methods used in the cross-cultural instrument adaptation and validation processes of health beliefs about cancer screening.

METHODS

A systematic review design with narrative methods was used. Electronic databases, including PubMed, Google Scholar, CINAHL, and PsycINFO, were searched.

RESULTS

A total of 18 articles were eligible. Results showed (1) the translation methods included committee translation and back translation, which were further refined by using professional translators, using professional interpreters and/or involving the first author, using bilingual individuals, and involving bilingual investigators; (2) the modification methods included embedded and afterward modification; and (3) the validation methods included testing construct validity, internal consistency reliability, item-total subscale correlations, test-retest reliability, content validity, predictive validity, and face validity.

CONCLUSIONS

Back translation and afterward modification were most frequently used for translating existing instruments to another language. Validity and reliability were most frequently established by construct validity, content validity, face validity, predictive validity, internal consistency reliability, test-retest reliability, and item-total subscale correlation after instruments were translated.

IMPLICATIONS FOR PRACTICE

Clinicians should evaluate the translation and adaptation process for translated versions of instruments before using them to provide culturally appropriate and sensitive care.

All of That Causes Me Stress: An Exploration of the Sources of Stress Experienced by Latinxs Living with Prediabetes

Latinxs immigrants in the United States experience sources of stress (i.e., stressors) that can limit their ability to engage in healthy behaviors. Stress has been linked to increased type 2 diabetes (T2D) risk in Latinxs living with prediabetes, a group disproportionately affected by T2D. The purpose of this qualitative study is to describe and contextualize the variety of stressors experienced by Latinxs immigrants diagnosed with prediabetes. Semi-structured, in-depth interviews were conducted from March to September 2018 with 20 Latinx immigrants living with prediabetes in North Carolina. We used qualitative content analysis including systematic coding and comparative matrices. The most prominent stressors were those related to health status and healthcare access, finances, interpersonal relationships with family, and loneliness. Participants also identified stressors related to documentation status and discrimination. The stressors Latinx immigrants with prediabetes experience vary, therefore studies and interventions need to specify which sources of stress they are addressing. Multilevel interventions that ameliorate the effects of stressors may facilitate preventive health behaviors among Latinxs with prediabetes.

Validity and Reliability of the Turkish Canadian Occupational Performance Measure (COPM-TR) for People with Multiple Sclerosis

The Canadian Occupational Performance Measure (COPM) is a generic questionnaire based on a semi-structured interview. We aimed to translate a Turkish version of the COPM (COPM-TR) and assess its reliability and validity. The COPM-TR was administered to 82 participants (42.2 ± 11.6 years and 32.9% of the participants were male) with multiple sclerosis (MS) for convergent validity and reliability analysis. The COPM-TR was administered with the Multiple Sclerosis Quality of Life-54 (MSQoL-54), and Expanded Disability Status Scale (EDSS) to determine its convergent validity. Test-retest reliability (a week interval) was assessed by the Intraclass Correlation Coefficient (ICC). There were moderately strong negative correlations between EDSS and performance and satisfaction score of COPM-TR. There were moderately strong positive correlations between MSQoL-54 physical and performance of COPM-TR and moderate positive correlations between MSQoL-54 physical and satisfaction of COPM-TR. Moderate positive correlations found between the MSQoL-54 mental and COPM-TR performance and satisfaction scores. Test re-test reliability of COPM-TR performance indicated excellent reliability. The current study demonstrates that the COPM-TR is a valid and reliable tool for measuring the perceived occupational performance and satisfaction of people with MS.

Evaluation of Psychometric Properties of Professional Quality of Life Scale Among Nurses in Singapore

BACKGROUND AND PURPOSE

Nurses experience compassion fatigue (CF), depression, burnout (BO), and even signs of post-traumatic stress disorder. This study aimed to evaluate the psychometric properties of the Professional Quality of Life Scale (ProQOL) among nurses in the Southeast Asia context.

METHODS

Psychometric testing of interitem correlations and reliability, and both convergent and discriminant validity, as well as construct validity analyses was conducted among 1,338 nurses from two academic centers in Singapore.

RESULTS

Findings demonstrated significant interconstruct correlations among the three subscales of ProQOL, namely compassion satisfaction (CS), BO, and secondary traumatic stress (STS). ProQOL displayed satisfactory internal consistency and discriminant validity.

CONCLUSIONS

Psychometric properties of the CS component were found to be satisfactory. ProQOL may be integrated into strategies in supporting and improving nurses' QoL which could focus to lessen BO and CF at work, as well as improving individual satisfaction in the care of patients.

The Health Literacy Questionnaire: Initial Validity Testing in a Norwegian Sample

BACKGROUND

The Health Literacy Questionnaire (HLQ) is a multidimensional generic questionnaire developed to capture a wide range of health literacy needs. There is a need for validation evidence for the Norwegian version of the HLQ (N-HLQ).

OBJECTIVE

The present study tested an initial version of the Norwegian HLQ by exploring its utility and construct validity among a group of nursing students.

METHODS

A pre-test survey was performed in participants (N = 18) who were asked to consider every item in the N-HLQ (44 items across nine scales). The N-HLQ was then administered to 368 respondents. Scale consistency was identified and extracted in a series of factor analyses (principal component analysis [PCA] with oblimin rotation) demanding a nine-dimension solution performed on randomly drawn 50% of the samples obtained by bootstrapping. Correlations between the nine factors obtained in the 13-factor PCA and the scale scores computed by the scale scoring syntaxes provided by the authors of the original HLQ were estimated.

KEY RESULTS

The pre-test survey did not result in the need to rephrase items. The internal consistency of the nine HLQ scales was high, ranging from 0.81 to 0.72. The best fit for reproduction of the scales from the original HLQ was found for these dimensions: "1. feeling understood and supported by health care providers," "2. having sufficient information to manage my health," and "3. actively managing my health." For the dimensions "7. navigating in the healthcare system" and "8. ability to find good health information," a rather high degree of overlap was found, as indicated by relatively low differences between mean highest correlations and mean next-highest correlations.

CONCLUSIONS

Despite some possible overlap between dimensions 7 and 8, the N-HLQ appeared relatively robust. Thus, this study's results contribute to the evidence validation base for the N-HLQ in Norwegian populations. [HLRP: Health Literacy Research and Practice. 2020;4(4):e190-e199.] PLAIN LANGUAGE SUMMARY: This study tested the Norwegian version of the Health Literacy Questionnaire. The questionnaire (44 items across nine scales) was completed by 368 nursing students. Despite some overlap between scale 7 ("navigating in the health care system") and scale 8 ("ability to find good health information"), the questionnaire appears to serve as a good measurement for health literacy in the Norwegian population.

Theoretical asthma self-management program for Taiwanese adolescents with self-efficacy, outcome-expectancy, health behaviour, and asthma symptoms: A randomized controlled trial

Background

The asthma prevalence of Taiwanese adolescents continued to rise. With physical and psychological changes in adolescents, managing asthma can be quite challenges and affect social, emotional and physical wellbeing. Adolescents with high self-efficacy levels are more likely to be involved in prevention and management activities. The aim of this study was to develop an effective asthma self-management program taking account for adolescents' developmental stages and based on Bandura's self-efficacy model.

Methods

A two-arm, parallel group, randomized controlled trial was used. The outcomes were self-efficacy, outcome-expectancy, asthma prevention and self-management behaviour, and controlling asthma symptoms. Translation and back-translation process were used for original tools in English. Good consistent reliabilities of Chinese versions tools were identified. A t-test or Mann-Whiney U test was employed to determine any mean differences of outcome variables between groups overtime.

Results

A sample of 83 patients completed the study. The mean age was 14.2 years (SD = 1.8). Approximately 56.6% of the participants were males. 73% of participants (n = 61) had a mild to intermittent level of asthma severity. Significant improvements were found on self-efficacy, t = −2.8; outcome-expectancy, U = 646, prevention behaviours, t = −3.5, and management behaviours, t = −3.2, but non-significant results for the outcome of asthma control, U = 716.

Conclusions

The results provided evidence to support the efficacy of the asthma self-management program. The findings indicated the program improved adolescents’ self-confidence in managing their asthma symptoms. Future clinical practice should consider delivering an educational program using multifaceted and interactive learning strategies.

Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research

BACKGROUND

The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument.

METHODS

This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation.

RESULTS

The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate).

CONCLUSIONS

The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

Cross-cultural adaptation and psychometric testing of the Arabic version of the Modified Oswestry Low Back Pain Disability Questionnaire

Background

The Modified Low Back Pain Disability Questionnaire (MLBPDQ) is used for evaluating the functional disability in patients with low back pain (LBP). However, the measurement characteristics of the MLBPDQ among Arab patients are unknown. In this study, we aimed to translate and cross-culturally adapt the MLBPDQ into Arabic and evaluate its psychometric properties.

Methods

An Arabic version of the MLBPDQ was developed through forward translation, translation synthesis, and backward translation. Sixty-eight patients (55 males and 13 females) with a mean age 37.01 ± 7.57 years were recruited to assess its psychometric properties. Reliability was evaluated using internal consistency (Cronbach’s α), test retest reliability (utilizing intraclass correlation coefficient [ICC]), standard error of measurement (SEM), minimal detectable change at 95% confidence level (MDC_95%), and 95% limits of agreement (LOA). The construct validity was investigated by correlating the new translation with four other measures of LBP (using Spearman’s rho). Finally, receiver operating characteristic curve was constructed to compute the sensitivity, using the area under the curve (AUC), and the minimum important change (MIC). An alpha level of 0.05 was set for statistical tests and all the psychometric values were tested against a priori hypotheses.

Results

The culturally aligned MLBPDQ showed good internal consistency (Cronbach’s α = 0.85). The ICC, SEM, MDC_95%, and LOA between baseline and two days later were 0.98, 1.60, 4.43, and -4.23 to 7.70, respectively, while the values between baseline and 14 days later were 0.94, 2.77, 7.67, and -6.59 to 13.53, respectively. The scale also demonstrated moderate to excellent correlation (rho = 0.54–0.86) with the other four questionnaires. The AUC value of the Arabic-MLBPDQ was 0.68, and the MIC was 3 points.

Conclusion

The Arabic version of the MLBPDQ demonstrates adequate psychometric properties and can be used to assess disability level in patients with LBP in Arabic-speaking communities.

Validity of the Brief Resilience Scale and Brief Resilient Coping Scale in a Chinese Sample

This study presents a cross-cultural examination of the psychometric properties of two commonly used brief self-report resilience scales, the 6-item Brief Resilience Scale (BRS) and the 4-item Brief Resilient Coping Scale (BRCS). Five hundred and eleven Chinese university undergraduate students were recruited for this cross-sectional research. Various psychometric evaluation tools were used to evaluate the internal consistency, criterion validity, factorial validity and construct validity of these resilience scales. The results showed that both scales had good criterion validity, with well-established measures of well-being, optimism, self-esteem, self-efficacy and mental health, as suggested in the resilience literature. The BRS (a = 0.71) showed better internal consistency than the BRCS (a = 0.59). The confirmatory factor analysis (CFA) results also indicated that the BRS, with a two-factor structure, had better construct validity than the BRCS. The CFA results for the BRS met all of the criteria for a good model fit. The BRS was found to have better psychometric properties than the BRCS in the Chinese context. The findings will help researchers to select an appropriate resilience measure when conducting epistemological surveys of Chinese university students or the Chinese diaspora in other contexts.

Development and validation of a brief self-assessed wisdom scale

BACKGROUND

This longitudinal study aimed to develop a nine-item Brief Self-Assessed Wisdom Scale (BSAWS) derived from the original 40-item Self-Assessed Wisdom Scale (SAWS).

METHODS

The psychometric properties of the shortened scale were evaluated based on a sample of 157 older adults. The factor structure and dimensionality of the original SAWS were examined using confirmatory factor analysis. Subsequent explorative factor analysis of the BSAWS supported the construct validity of the shortened scale.

RESULTS

The internal consistency, convergent validity and construct validity of the shortened scale were also evaluated and the results indicated that the BSAWS possesses good psychometric properties and is comparable with the full version.

CONCLUSIONS

This scale refinement may help researchers and practitioners conduct epistemological surveys or clinical research related to wisdom.

Development and evaluation of the psychometric properties of a brief parenting scale (PS-7) for the parents of adolescents

This study aimed to develop a seven-item brief parenting scale (PS-7) based on the original parenting scale (PS) and various other shortened versions and with a better factor structure for the parents of adolescents. The scale was tested with a sample of 3,777 parents (2,205 mothers and 1,572 fathers). Confirmatory factor analysis was used to evaluate the dimensionality of the different versions of the PS. Only the PS-7 with a two-factor structure, i.e., laxness (three items) and overreactivity (four items), showed a good model fit based on a representative sample of parents of junior secondary school students. Overall, the results suggest that PS-7 is comparable to the original PS and possesses good psychometric properties in terms of internal consistency, factorial validity, construct validity, criterion validity and discriminant validity. The abbreviated parenting scale also provides a reliable and cost-effective method for assessing parental practices for treatment and assessing treatment outcomes.

Validity and reliability of the Turkish Occupational Balance Questionnaire (OBQ11-T)

Background: Occupational balance (OB) is an important concept in occupational therapy and is considered as an essential component of health and well-being.Aim: The aim of this study was to investigate the validity and reliability of the Turkish version of the Occupational Balance Questionnaire-11 (OBQ11-T).Materials and methods: The OBQ11-T was administered to 116 individuals for construct validity analysis and to 58 individuals for reliability analysis. Validity was determined using explanatory and confirmatory factor analysis. In confirmatory factor analysis, RMSEA (root mean square error of approximation) value, comparative fit index (CFI), and Chi-square to degrees of freedom ratio (CMIN/DF) were analysed. The test-retest method and Cronbach's alpha coefficient were used to assess the reliability and internal consistency of the OBQ11-T, respectively.Results: The model fit the data according to the indices of relative fit (RMSEA = 0.076, CMIN/DF = 1.661, and CFI = 0.875). The correlation coefficient between test and retest OBQ11-T total scores was 0.922. Total scores showed a significant statistical relationship (p < 0.01), indicating good reliability. Cronbach's alpha for OBQ11-T total score was 0.785, indicating acceptable internal consistency.Conclusions and significance: The current study demonstrates that the OBQ11-T is a valid and reliable tool for measuring the self-rated OB of healthy individuals.

Translation, Cross-Cultural Adaptation, and Validation of the Adolescent Pediatric Pain Tool (APPT) for Multidimensional Measurement of Pain in Children and Adolescents

BACKGROUND

Pain is subjective and multidimensional in nature. Its assessment is very challenging especially in the pediatric population. Adequate assessment of pain in children is the keystone for effective management. Accurate and comprehensive evaluation of the child's pain experience requires the use of multidimensional pain assessment tools such as the Adolescent Pediatric Pain Tool (APPT) which measures the intensity, location and quality of pain.

AIMS

The aim of this study was to translate and culturally validate the APPT for use in Lebanese children and adolescents with cancer.

METHODS

The instrument was translated and culturally adapted following the WHO four steps; 1) forward translation and back-translation, 2) expert panel, 3) pre-testing and 4) cognitive interviewing. The semantic validation of the pain quality descriptors was performed by healthy children and children with cancer aged 8-17 years, using the Q-sort method.

RESULTS

A final Arabic version with 31 pain descriptors equivalent to the original tool was produced based on the results from the pilot study and the children's interviews. Children were able to differentiate between the different words they use to describe their pain.

CONCLUSION

Our results showed that the Lebanese version of the APPT is a culturally sensitive tool to assess the location, intensity and quality of pain in Lebanese children with cancer. Health professionals are encouraged to use this tool to assess the pain characteristics in Lebanese children with cancer, hence leading to effective pain management.

German Translation of the Satisfaction With Life Scale for Children and Adolescents

The research in the field of positive psychology is alive for children and adolescents, and especially the effects of intervention studies are promising. While a large number of instruments exist for adults, there is a need for greater attention to basic measurement work of constructs for children. The Satisfaction With Life Scale is one of the most common questionnaires used in the field of positive psychology. Whereas the adult version is translated into many languages, the child version has only been translated into a few languages yet. This is a limitation for countries where young students are not familiar with the English language. The aim of the present study was to translate the Satisfaction With Life Scale–child version (SWLS-C) into German with the use of a backtranslation-proceeding (Study 1) and to validate the questionnaire with a sample of 1,099 students aged 8 to 17 years (Study 2). This included retesting of reliability as well as concurrent and discriminant validity by additionally measuring several established constructs of positive psychology. Model fit indices, internal consistencies, retest reliability as well as concurrent and discriminant validity evidence were satisfying. The German version of the SWLS-C can be used in future studies, but to compare SWLS-C data of different nationalities more translations of the questionnaire as well as crosscultural measurement invariance studies are needed.

Adherence to Antihypertensive Medication in Older Adults With Hypertension

Background/Objectives:

Effective prevention of cardiovascular events in people with hypertension requires optimal control of blood pressure. Despite advances in management, poor adherence to antihypertensive medications is often reported as the major reason attenuating treatment efficacy. Research has provided limited evidence of associations between illness perceptions, satisfaction with consultations, and medication adherence. The aim of this study is to identify factors significantly associated with medication adherence in a group of Chinese older adults with essential hypertension.

Design/Setting/Participants:

A cross-sectional correlational study was conducted. Data were collected from 195 older adults (mean [SD] age, 76 [6.6] years) recruited from 12 community centers.

Measurements:

The Illness Perception Questionnaire–Revised was used to measure illness perceptions, and the Medical Interview Satisfaction Scale was used to measure satisfaction with individual consultations. The Morisky Medication Adherence Scale was used to measure the extent of adherence to antihypertensive medications. Multivariate logistic regression analysis was performed to examine factors, including illness perceptions, consultation satisfaction, and demographic and clinical characteristics, that were significantly associated with medication adherence.

Results:

More than half of the respondents (55.9%) acknowledged some degree of medication nonadherence. Older age, living alone, and perception related to treatment control were independently associated with increased odds of medication adherence, with odds ratios ranging from 1.14 to 1.92 (P < .05).

Conclusion:

The results highlight the importance of cultivating positive beliefs that hypertension is amenable to control by treatment. Furthermore, the adherence behavior of those of younger individuals and living with family should be closely monitored.

A randomized control trial of an asthma self-management program for adolescents in Taiwan: A study protocol

Uncontrolled asthma in adolescents can be explained by developmental changes and lack of priority for self-care activities. Limited reports on asthma self-management programs for adolescents to enhance prevention behaviors in Taiwan were found. The protocol paper presents a two-armed, randomized controlled trial aiming to test the effectiveness of a newly developed self-management program for 112 adolescents with asthma in Taiwan. The primary outcome is asthma self-efficacy. Data will be collected at baseline and the week 4. The findings of this study will determine the extent to which a self-management program for adolescents with asthma in Taiwan enhances asthma management self-efficacy, self-management activities in asthma prevention and management, and achievement of well-controlled asthma.

Trial Registration No: ACTRN12613001294741.

Psychometric Properties of the Chinese Version of the Acceptance of Chronic Health Conditions (Stoma) Scale for Patients With Stoma

BACKGROUND

Formation of a stoma is a common outcome in surgical treatment of colorectal cancer. A higher acceptance of stoma was shown to improve quality of life of patients. No instrument in Chinese is available that can be used to measure the acceptance of stoma among patients with colorectal cancer.

OBJECTIVES

The aims of this study were to translate and test the psychometric properties of Chinese version of Acceptance of Chronic Health Conditions (ACHC) (Stoma) scale.

METHODS

A sample of 100 Chinese-speaking patients with stoma was recruited from a public tertiary care hospital in Singapore. The scale was translated into Chinese and reviewed by an expert panel for semantic equivalence and content validity testing. Convergent validity was established by exploring correlations between scores of the Chinese version of the ACHC (Stoma) scale and those of the 5-level version of European Quality of Life Questionnaire-5 Dimensions. Reliability was assessed by internal consistency and test-retest reliability.

RESULTS

The newly translated scale had high content validity (content validity index = 94%) and acceptable internal consistency (Cronbach's α = .846). The test-retest reliability was satisfactory with an intraclass coefficient of 0.997. A positive correlation was found between both scores on ACHC (Stoma) scale and EQ-5D utility score (r = 0.63, P < .01) and EQ-5D global visual analog scale (r = 0.70, P < .01).

CONCLUSIONS

The Chinese version of the ACHC (Stoma) scale demonstrated satisfactory content validity, good convergent validity, and adequate internal consistency and stability.

IMPLICATIONS FOR PRACTICE

This scale can be used as a convenient screening tool in clinical settings to assess the level of acceptance in Chinese-speaking patients with stoma.

Methodological Challenges in Developing a Youth Questionnaire, Life & Health Young People, for Comparative Studies in Thailand and Sweden: About Bridging the Language Gap Between Two Non-English-Speaking Countries

PURPOSE

To develop a Thai questionnaire ชีวิตและสุขภาพของวัยรุ่นในประเทศไทย (TYQ) to explore girls' and boys' living conditions, lifestyles, and self-reported health with special focus on sexuality, based on a Swedish questionnaire, Liv & Hälsa ung (SYQ). Challenges in developing a youth questionnaire for comparative studies are described.

DESIGN

A multistep translation, sociocultural adaptation procedure, and a mixed-method validation test were performed using English as a common language within the research group. Three versions of SYQ were used as a pool of questions to develop the questionnaire.

FINDINGS

From a field test, unclear questions were identified and minor adjustments made. Life & Health Young People in a Thai version was successfully developed. The English version was used to bridge the language gap.

CONCLUSION

This unique multistep methodology, including mixed-method validation procedure, can be used by researchers in countries where English is not the main language.

Study protocol: a randomised controlled trial of a nurse-led community-based self-management programme for improving recovery among community-residing stroke survivors

BACKGROUND

Recovery after stroke is long-term and demanding. Optimising community-residing stroke survivors' capability to self-manage their health is integral. Recent systematic reviews have shown that stroke self-management programmes were associated with significant improvement in stroke survivors' health-related quality of life and self-efficacy. However some programmes were not designed with an underpinning theoretical framework. The aim of this study is to compare the effectiveness of a nurse-led stroke self-management programme with usual care on recovery of community-residing stroke survivors.

METHODS/DESIGN

A single-blinded, two-arm, randomised controlled trial will be conducted. Patients with a history of first or recurrent ischaemic or haemorrhagic stroke who will be discharged to home settings will be recruited from acute stroke units of three acute public hospitals in Hong Kong. The estimated sample size is 160 (80 participants per group). Eligible participants will be randomised to receive either usual care or a 4-week nurse-led community-based self-management programme plus usual care after discharge. The programme, underpinned by Bandura's constructs of self-efficacy and outcome expectation, includes one individual home visit, two community-based group sessions, and three follow-up phone calls. Primary outcomes include stroke survivors' self-efficacy and outcome expectation of performing self-management behaviours. Secondary outcomes include health-related quality of life, satisfaction with performance of self-management behaviours, depressive symptoms, and community reintegration. Participants will be assessed at baseline and at 8 weeks after randomisation. Generalised estimating equations will be performed to evaluate the significance of changes in outcomes over time by treatment condition. Research ethics approvals were obtained.

DISCUSSION

It is expected that stroke survivors receiving the stroke self-management programme will have improved self-efficacy, outcome expectation, and performance of stroke self-management behaviours. Enhanced quality of life and level of community reintegration, and decreased depressive symptoms are also expected. The study results will provide valuable evidence to inform future identification and evaluation of best approach to deliver stroke self-management programmes to enhance community-residing stroke survivors' recovery.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02112955 ; date of registration: 09/04/2014.

Searching for best practices of youth friendly services - a study protocol using qualitative comparative analysis in Sweden

Background

Swedish youth clinics constitute one of the most comprehensive and consolidated examples of a nationwide network of health care services for young people. However, studies evaluating their ‘youth-friendliness’ and the combination of factors that makes them more or less ‘youth-friendly’ have not been conducted. This protocol will scrutinise the current youth-friendliness of youth clinics in northern Sweden and identify the best combination of conditions needed in order to implement the criteria of youth-friendliness within Swedish youth clinics and elsewhere.

Methods/design

In this study, we will use qualitative comparative analysis to analyse the conditions that are sufficient and/or necessary to implement Youth Friendly Health Services in 20 selected youth-clinics (cases). In order to conduct Qualitative Comparative Analysis, we will first identify the outcomes and the conditions to be assessed. The overall outcome – youth-friendliness – will be assessed together with specific outcomes for each of the five domains – accessible, acceptable, equitable, appropriate and effective. This will be done using a questionnaire to be applied to a sample of young people coming to the youth clinics. In terms of conditions, we will first identify what might be the key conditions, to ensure the youth friendliness of health care services, through literature review, interviews with professionals working at youth clinics, and with young people. The combination of conditions and outcomes will form the hypothesis to be further tested later on in the qualitative comparative analysis of the 20 cases. Once information on outcomes and conditions is gathered from each of the 20 clinics, it will be analysed using Qualitative Comparative Analysis.

Discussion

The added value of this study in relation to the findings is twofold: on the one hand it will allow a thorough assessment of the youth-friendliness of northern Swedish youth clinics. On the other hand, it will extract lessons from one of the most consolidated examples of differentiated services for young people. Methodologically, this study can contribute to expanding the use of Qualitative Comparative Analysis in health systems research.

Mexican Immigrants and the Use of Cognitive Assessment Techniques in Questionnaire Development

The aim of this article is to identify the measurement challenges involved in obtaining sensitive health outcomes from Mexican women in both settled and unsettled segments of the United States population and to suggest how cognitive assessment techniques might be better employed to construct culturally and linguistically appropriate survey instruments. These objectives will be illustrated through a project with recent Mexican immigrants in North Carolina that constructs items to measure last menstrual period—an important indicator in gauging the gestational age of a fetus. Guidelines for conducting focus groups and cognitive interviews with this population are emphasized.

Issues and Challenges of Instrument Translation

The purpose of this article was to discuss the challenges of instrument translation, using the translation of the Medical Outcomes Study Social Support Survey into Chinese as an example. Brislin’s model of translation, which highlights the need for forward and backward translation, was used. Major considerations in conducting translation, and the strategies used to overcome the challenges arising from cultural and linguistic differences between the source and target languages, were discussed. Examples were used to illustrate how difficulties, such as maintenance of the original intent of the questionnaire, maximization of the cultural relevancy of the concept in question, and enhancement of the comprehensibility of the translated questionnaire, were handled. The importance of literal and cultural adaptation of a developed instrument, rather than its simple word translation in the maintenance of an equivalent translation is highlighted.

Establishing equivalence of a Chinese version of the stroke specific quality of life measure for stroke survivors

INTRODUCTION

The Stroke Specific Quality of Life Scale is a stroke-specific measure of health-related quality of life. However, there has been no Chinese (Hong Kong) version of the scale.

METHODS

A descriptive study was conducted to examine the reliability, validity and factor structure of the translated version (SSQOL-C) among stroke survivors. Participants completed SSQOL-C, and the Chinese versions of the Medical Outcomes Study Short-Form Health Survey (SF-36), Stroke Self-Efficacy Questionnaire (SSEQ-C) and Frenchay Activities Index (FAI). Thirty of these participants completed the same questionnaires after 4 weeks.

RESULTS

A total of 135 stroke survivors (mean age 58.90 ± 9.75) were recruited. SSQOL-C had good internal consistency with Cronbach's alphas for each domain ranging from 0.63 to 0.90. Most domains had moderate to high correlations with similar dimensions of SF-36, SSEQ-C, FAI and Barthel ADL Index total scores (Spearman's rho: 0.40-0.77, p < 0.01), suggesting acceptable convergent validity. Principal component analyses suggested an 11-factor model in contrast to the 12-factor model for the original scale with six new factors emerging and five original factors retained.

DISCUSSION

The results suggest SSQOL-C is a reliable and valid tool for measuring Chinese stroke survivors' health-related quality of life. More studies are needed to confirm the 11-factor model of the scale. Implications for rehabilitation The translated Chinese version of the Stroke Specific Quality of Life Scale is a reliable and valid tool for measuring Chinese stroke survivors' health-related quality of life. An 11-factor model in contrast to the 12-factor model for the original scale with six new factors emerging and five original factors retained.

Translation and Validation of a Chinese Version of the Stroke Self-Efficacy Questionnaire in Community-Dwelling Stroke Survivors

BACKGROUND

Self-efficacy is a significant factor influencing stroke survivors' participation in self-care and outcomes. The Stroke Self-Efficacy Questionnaire (SSEQ) is a stroke-specific measure of stroke survivors' self-efficacy in performing daily functional activities and self-management. However, there has been no Chinese version of the questionnaire.

OBJECTIVE

The current study aims to examine the reliability and validity of a translated Chinese version of SSEQ (SSEQ-C).

METHODS

The English version of SSEQ has been translated into Chinese. A descriptive study was conducted. A convenience sample of 135 Chinese stroke survivors (mean age 58.9, SD 9.75) was recruited from three community centers and a stroke support group. Eligible participants completed the SSEQ-C, and the Chinese versions of General Self-Efficacy Scale (GSES), Frenchay Activities Index (FAI), and Stroke-Specific Quality of Life Scale (SSQOL). Thirty of the participants completed the questionnaires at baseline and 4 weeks afterwards.

RESULTS

SSEQ-C had a high internal consistency (Cronbach's α 0.92). Test-retest reliability was satisfactory with the intraclass correlation coefficient of the total scale 0.52. Positive correlations were found between the total scores of SSEQ-C, GSES, FAI, and SSQOL (Spearman's ρ: 0.48-0.68, p < 0.01), suggesting acceptable convergent validity. Principal component analysis suggested a two-factor model, namely "Live with new challenges" and "Activity and exercise engagement" in contrast to the single-factor model for the original questionnaire.

CONCLUSION

The results suggest SSEQ-C is a reliable and valid tool for measuring Chinese community-dwelling stroke survivors' self-efficacy in managing post-stroke condition. More studies are warranted to confirm the two-factor model of the questionnaire.

DEVELOPMENT OF A TURKISH VERSION OF THE SENSORY PROFILE: TRANSLATION, CROSS-CULTURAL ADAPTATION, AND PSYCHOMETRIC VALIDATION

The purpose of this study was to translate and culturally adapt the Sensory Profile (SP), which is used to measure sensory processing abilities of children ages of 3-10 years, and test its reliability and validity for use with Turkish children with autism. A cross-cultural adaptation process was carried out by bilingual experts, following typical guidelines. The test-retest reliability, internal consistency, and construct validity studies of the Turkish SP were done for 144 children with autism. A comparison was also made between results of children with autism and 101 healthy children to test the validity of the Turkish SP. There were significant differences between results of autistic and healthy children on all subsections of the test. The Cronbach's as ranged from .63 to .97 for all subsections except I, J, and N, which had poor internal consistency reliability. Test-retest reliability over a one-week period was excellent (ICC > .90).

Subscales of the vestibular activities and participation questionnaire could be applied across cultures

OBJECTIVES

The objective of this study was to assess the objectivity, cross-cultural validity, and convergent validity of the Vestibular Activities and Participation (VAP) questionnaire among four countries, Germany, United States, Jordan, and Saudi Arabia.

STUDY DESIGN AND SETTING

This was a cross-sectional study conducted in four specialized outpatient dizziness clinics in Germany, United States, Jordan, and Saudi Arabia.

RESULTS

A total of 453 participants were included in the study. The Rasch analysis revealed two separate subscales. Subscale 1 items included focusing attention, lying down, standing, bending, lifting and carrying objects, and sports. Subscale 2 items included walking long distances, climbing, running, moving around within buildings other than home, using transportation, and driving. The Pearson product-moment correlation between the Dizziness Handicap Inventory and the summary score of the VAP subscale 1 was 0.66 and was 0.64 for subscale 2.

CONCLUSION

Owing to its shortness and intercultural adaptability, the new two-scale version of the VAP questionnaire lends itself to clinical practice and research across countries to estimate the effect of vertigo and dizziness on activity limitation and participation restrictions. Psychometrically sound summary scores can be calculated. More extended versions of the VAP can be used for comprehensive clinical assessment where summary scores are not needed or a more detailed documentation is warranted.

Fragrance allergy and quality of life - a case-control study

BACKGROUND

Fragrance ingredients can cause contact allergy, which may affect quality of life (QoL). However, few studies have investigated this topic.

OBJECTIVES

To investigate QoL life among subjects with a fragrance allergy as compared with other eczema patients.

METHODS

A case-control survey was sent to subjects with a positive patch test reaction to a fragrance ingredient/marker (n = 550) and to a control group (n = 1100). It contained questions on eczema and the newly developed fragrance QoL index. Participants had been consecutively patch tested at Gentofte University Hospital (2000-2010). The response rate was 65.7%. Information on patch test data was retrieved from the National Contact Dermatitis Database.

RESULTS

An increase in impairment of QoL was observed in women with fragrance allergy as compared with the control group (p = 0.042), which was not found among men. Several factors played a significant role in impairment of QoL in women: (i) number of fragrance allergies, (ii) severity of the patch test reaction, (iii) age combined with recent diagnosis; and (iv) allergy to specific fragrance ingredients/markers.

CONCLUSION

Fragrance-allergic subjects are just as affected in their QoL as other eczema patients. However, women, and in particular recently diagnosed young women, seem to be more impaired in their QoL than other eczema patients.