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Papola D, Prina E, Ceccarelli C, Cadorin C, Gastaldon C, Ferreira MC, Tol WA, van Ommeren M, Barbui C, Purgato M. Psychological and social interventions for the promotion of mental health in people living in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2024; 5:CD014300. [PMID: 38770799 PMCID: PMC11106803 DOI: 10.1002/14651858.cd014300.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Because of wars, conflicts, persecutions, human rights violations, and humanitarian crises, about 84 million people are forcibly displaced around the world; the great majority of them live in low- and middle-income countries (LMICs). People living in humanitarian settings are affected by a constellation of stressors that threaten their mental health. Psychosocial interventions for people affected by humanitarian crises may be helpful to promote positive aspects of mental health, such as mental well-being, psychosocial functioning, coping, and quality of life. Previous reviews have focused on treatment and mixed promotion and prevention interventions. In this review, we focused on promotion of positive aspects of mental health. OBJECTIVES To assess the effects of psychosocial interventions aimed at promoting mental health versus control conditions (no intervention, intervention as usual, or waiting list) in people living in LMICs affected by humanitarian crises. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, and seven other databases to January 2023. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies, and checked the reference lists of relevant studies and reviews. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing psychosocial interventions versus control conditions (no intervention, intervention as usual, or waiting list) to promote positive aspects of mental health in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure). DATA COLLECTION AND ANALYSIS We used standard Cochrane methods. Our primary outcomes were mental well-being, functioning, quality of life, resilience, coping, hope, and prosocial behaviour. The secondary outcome was acceptability, defined as the number of participants who dropped out of the trial for any reason. We used GRADE to assess the certainty of evidence for the outcomes of mental well-being, functioning, and prosocial behaviour. MAIN RESULTS We included 13 RCTs with 7917 participants. Nine RCTs were conducted on children/adolescents, and four on adults. All included interventions were delivered to groups of participants, mainly by paraprofessionals. Paraprofessional is defined as an individual who is not a mental or behavioural health service professional, but works at the first stage of contact with people who are seeking mental health care. Four RCTs were carried out in Lebanon; two in India; and single RCTs in the Democratic Republic of the Congo, Jordan, Haiti, Bosnia and Herzegovina, the occupied Palestinian Territories (oPT), Nepal, and Tanzania. The mean study duration was 18 weeks (minimum 10, maximum 32 weeks). Trials were generally funded by grants from academic institutions or non-governmental organisations. For children and adolescents, there was no clear difference between psychosocial interventions and control conditions in improving mental well-being and prosocial behaviour at study endpoint (mental well-being: standardised mean difference (SMD) 0.06, 95% confidence interval (CI) -0.17 to 0.29; 3 RCTs, 3378 participants; very low-certainty evidence; prosocial behaviour: SMD -0.25, 95% CI -0.60 to 0.10; 5 RCTs, 1633 participants; low-certainty evidence), or at medium-term follow-up (mental well-being: mean difference (MD) -0.70, 95% CI -2.39 to 0.99; 1 RCT, 258 participants; prosocial behaviour: SMD -0.48, 95% CI -1.80 to 0.83; 2 RCT, 483 participants; both very low-certainty evidence). Interventions may improve functioning (MD -2.18, 95% CI -3.86 to -0.50; 1 RCT, 183 participants), with sustained effects at follow-up (MD -3.33, 95% CI -5.03 to -1.63; 1 RCT, 183 participants), but evidence is very uncertain as the data came from one RCT (both very low-certainty evidence). Psychosocial interventions may improve mental well-being slightly in adults at study endpoint (SMD -0.29, 95% CI -0.44 to -0.14; 3 RCTs, 674 participants; low-certainty evidence), but they may have little to no effect at follow-up, as the evidence is uncertain and future RCTs might either confirm or disprove this finding. No RCTs measured the outcomes of functioning and prosocial behaviour in adults. AUTHORS' CONCLUSIONS To date, there is scant and inconclusive randomised evidence on the potential benefits of psychological and social interventions to promote mental health in people living in LMICs affected by humanitarian crises. Confidence in the findings is hampered by the scarcity of studies included in the review, the small number of participants analysed, the risk of bias in the studies, and the substantial level of heterogeneity. Evidence on the efficacy of interventions on positive mental health outcomes is too scant to determine firm practice and policy implications. This review has identified a large gap between what is known and what still needs to be addressed in the research area of mental health promotion in humanitarian settings.
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Affiliation(s)
- Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Eleonora Prina
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Caterina Ceccarelli
- Global Program Expert Group on Mental Health and Psychosocial Support, SOS Children's Villages, Milan, Italy
| | - Camilla Cadorin
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Madalena C Ferreira
- Public Health Unit, Médio Ave Local Health Unit, Vila Nova de Famalicão, Portugal
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mark van Ommeren
- Department of Mental Health, Brain Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
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Flynn MA, Eggerth DE, Jacobson CJ, Lyon SM. Heart Attacks, Bloody Noses, and Other "Emotional Problems": Cultural and Conceptual Issues With the Spanish Translation of Self-Report Emotional Health Items. FAMILY & COMMUNITY HEALTH 2021; 44:1-9. [PMID: 32842005 PMCID: PMC7869970 DOI: 10.1097/fch.0000000000000279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This article examines how respondents understood items in the Spanish versions of the Short-Form 36 (SF-36v2). Cognitive interviews of the SF-36 were conducted in 2 phases with 46 Spanish speakers living in the United States. Roughly one-third (17/46) of respondents had difficulty understanding the Role Emotional items upon their initial reading, and almost half (21/46) provided examples that were inconsistent with the intended meaning of the items. The findings of this study underscore the importance of conducting cognitive testing to ensure conceptual equivalence of any instrument regardless of how well validated it appears to be.
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Affiliation(s)
- Michael A Flynn
- Division of Science Integration, National Institute for Occupational Safety and Health, Cincinnati, Ohio (Mr Flynn and Dr Eggerth); Consortium for Multicultural Psychology Research, Michigan State University, East Lansing (Mr Flynn and Dr Eggerth); Departments of Anthropology (Dr Jacobson) and Family and Community Medicine (Dr Jacobson), University of Cincinnati, Cincinnati, Ohio; and Department of Anthropology, University of Kentucky, Lexington (Dr Lyon)
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Chen Z, Aryadoust V. Testing the measurement invariance of the work motivation scale for training and adult education in a nationwide study of Singapore. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Papola D, Purgato M, Gastaldon C, Bovo C, van Ommeren M, Barbui C, Tol WA. Psychological and social interventions for the prevention of mental disorders in people living in low- and middle-income countries affected by humanitarian crises. Cochrane Database Syst Rev 2020; 9:CD012417. [PMID: 32897548 PMCID: PMC8094402 DOI: 10.1002/14651858.cd012417.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND People living in 'humanitarian settings' in low- and middle-income countries (LMICs) are exposed to a constellation of physical and psychological stressors that make them vulnerable to developing mental disorders. A range of psychological and social interventions have been implemented with the aim to prevent the onset of mental disorders and/or lower psychological distress in populations at risk, and it is not known whether interventions are effective. OBJECTIVES To compare the efficacy and acceptability of psychological and social interventions versus control conditions (wait list, treatment as usual, attention placebo, psychological placebo, or no treatment) aimed at preventing the onset of non-psychotic mental disorders in people living in LMICs affected by humanitarian crises. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMD-CTR), the Cochrane Drugs and Alcohol Review Group (CDAG) Specialized Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (OVID), Embase (OVID), PsycINFO (OVID), and ProQuest PILOTS database with results incorporated from searches to February 2020. We also searched the World Health Organization's (WHO) International Clinical Trials Registry Platform and ClinicalTrials.gov to identify unpublished or ongoing studies. We checked the reference lists of relevant studies and reviews. SELECTION CRITERIA All randomised controlled trials (RCTs) comparing psychological and social interventions versus control conditions to prevent the onset of mental disorders in adults and children living in LMICs affected by humanitarian crises. We excluded studies that enrolled participants based on a positive diagnosis of mental disorder (or based on a proxy of scoring above a cut-off score on a screening measure). DATA COLLECTION AND ANALYSIS We calculated standardised mean differences for continuous outcomes and risk ratios for dichotomous data, using a random-effects model. We analysed data at endpoint (zero to four weeks after therapy) and at medium term (one to four months after intervention). No data were available at long term (six months or longer). We used GRADE to assess the quality of evidence. MAIN RESULTS In the present review we included seven RCTs with a total of 2398 participants, coming from both children/adolescents (five RCTs), and adults (two RCTs). Together, the seven RCTs compared six different psychosocial interventions against a control comparator (waiting list in all studies). All the interventions were delivered by paraprofessionals and, with the exception of one study, delivered at a group level. None of the included studies provided data on the efficacy of interventions to prevent the onset of mental disorders (incidence). For the primary outcome of acceptability, there may be no evidence of a difference between psychological and social interventions and control at endpoint for children and adolescents (RR 0.93, 95% CI 0.78 to 1.10; 5 studies, 1372 participants; low-quality evidence) or adults (RR 0.96, 95% CI 0.61 to 1.50; 2 studies, 767 participants; very low quality evidence). No information on adverse events related to the interventions was available. For children's and adolescents' secondary outcomes of prevention interventions, there may be no evidence of a difference between psychological and social intervention groups and control groups for reducing PTSD symptoms (standardised mean difference (SMD) -0.16, 95% CI -0.50 to 0.18; 3 studies, 590 participants; very low quality evidence), depressive symptoms (SMD -0.01, 95% CI -0.29 to 0.31; 4 RCTs, 746 participants; very low quality evidence) and anxiety symptoms (SMD 0.11, 95% CI -0.09 to 0.31; 3 studies, 632 participants; very low quality evidence) at study endpoint. In adults' secondary outcomes of prevention interventions, psychological counselling may be effective for reducing depressive symptoms (MD -7.50, 95% CI -9.19 to -5.81; 1 study, 258 participants; very low quality evidence) and anxiety symptoms (MD -6.10, 95% CI -7.57 to -4.63; 1 study, 258 participants; very low quality evidence) at endpoint. No data were available for PTSD symptoms in the adult population. Owing to the small number of RCTs included in the present review, it was not possible to carry out neither sensitivity nor subgroup analyses. AUTHORS' CONCLUSIONS Of the seven prevention studies included in this review, none assessed whether prevention interventions reduced the incidence of mental disorders and there may be no evidence for any differences in acceptability. Additionally, for both child and adolescent populations and adult populations, a very small number of RCTs with low quality evidence on the review's secondary outcomes (changes in symptomatology at endpoint) did not suggest any beneficial effect for the studied prevention interventions. Confidence in the findings is hampered by the scarcity of prevention studies eligible for inclusion in the review, by risk of bias in the studies, and by substantial levels of heterogeneity. Moreover, it is possible that random error had a role in distorting results, and that a more thorough picture of the efficacy of prevention interventions will be provided by future studies. For this reason, prevention studies are urgently needed to assess the impact of interventions on the incidence of mental disorders in children and adults, with extended periods of follow-up.
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Affiliation(s)
- Davide Papola
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Marianna Purgato
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Chiara Bovo
- Direzione Sanitaria, Azienda ULSS 20, Verona, Italy
| | - Mark van Ommeren
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Corrado Barbui
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
- Cochrane Global Mental Health, University of Verona, Verona, Italy
| | - Wietse A Tol
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
- Section of Global Health, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Peter C. Alderman Program for Global Mental Health, HealthRight International, New York, NY, USA
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Rapisarda F, Corbière M, Lesage AD, De Benedictis L, Pelletier JF, Felx A, Leblanc Y, Vallarino M, Miglioretti M. Development and validation of the mental health professional culture inventory. Epidemiol Psychiatr Sci 2019; 29:e80. [PMID: 31839026 PMCID: PMC8061147 DOI: 10.1017/s2045796019000787] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 10/02/2019] [Accepted: 10/30/2019] [Indexed: 12/03/2022] Open
Abstract
AIMS No instrument has been developed to explicitly assess the professional culture of mental health workers interacting with severely mentally ill people in publicly or privately run mental health care services. Because of theoretical and methodological concerns, we designed a self-administered questionnaire to assess the professional culture of mental health services workers. The study aims to validate this tool, named the Mental Health Professional Culture Inventory (MHPCI). The MHPCI adopts the notion of 'professional culture' as a hybrid construct between the individual and the organisational level that could be directly associated with the professional practices of mental health workers. METHODS The MHPCI takes into consideration a multidimensional definition of professional culture and a discrete number of psychometrically derived dimensions related to meaningful professional behaviour. The questionnaire was created and developed by a conjoint Italian-Canadian research team with the purpose of obtaining a fully cross-cultural questionnaire and was pretested in a pilot study. Subsequently, a validation survey was conducted in northern Italy and in Canada (Montreal area, Quebec). Data analysis was conducted in different steps designed to maximise the cross-cultural adaptation of the questionnaire through a recursive procedure consisting of performing a principal component analysis (PCA) on the Italian sample (N = 221) and then testing the resulting factorial model on the Canadian sample (N = 237). Reliability was also assessed with a test-retest design. RESULTS Four dimensions emerged in the PCA and were verified in the confirmatory factor analysis: family involvement, users' sexuality, therapeutic framework and management of aggression risk. All the scales displayed good internal consistency and reliability. CONCLUSIONS This study suggests the MHPCI could be a valid and reliable instrument to measure the professional behaviour of mental health services workers. The content of the four scales is consistent with the literature on psychosocial rehabilitation, suggesting that the instrument could be used to evaluate staff behaviour regarding four crucial dimensions of mental health care.
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Affiliation(s)
- F. Rapisarda
- Department of Psychology, University of Milano-Bicocca, 1 Piazza dell'Ateneo Nuovo, 20126, Milano, Italy
| | - M. Corbière
- Department of Education – Career Counselling, Université du Québec à Montréal, Montréal, Canada
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - A. D. Lesage
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - L. De Benedictis
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - J. F. Pelletier
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
- Department of Psychiatry, Yale University School of Medicine, Yale Program for Recovery & Community Health, New Haven, CT, USA
| | - A. Felx
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - Y. Leblanc
- CIUSSS de l'Est-de-l’Île-de-Montréal, Institut Universitaire de Santé Mentale de Montréal, Montréal, Canada
| | - M. Vallarino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - M. Miglioretti
- Department of Psychology, University of Milano-Bicocca, 1 Piazza dell'Ateneo Nuovo, 20126, Milano, Italy
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Bruyneel L, Lesaffre E, Meuleman B, Sermeus W. Power Distance and Physician–Nurse Collegial Relations Across 14 European Countries: National Culture is Not Merely a Nuisance Factor in International Comparative Research. J Nurs Scholarsh 2019; 51:708-716. [DOI: 10.1111/jnu.12514] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Luk Bruyneel
- Post‐doctoral researcher KU Leuven–University of Leuven, Institute for Healthcare Policy Leuven Belgium
| | - Emmanuel Lesaffre
- Full Professor KU Leuven–University of Leuven, Leuven Biostatistics and Statistical Bioinformatics Centre Leuven Belgium
| | - Bart Meuleman
- Associate Professor KU Leuven–University of Leuven, Centre for Sociological Research Leuven Belgium
| | - Walter Sermeus
- Full Professor KU Leuven–University of Leuven, Institute for Healthcare Policy Leuven Belgium
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Squires A, Sadarangani T, Jones S. Strategies for overcoming language barriers in research. J Adv Nurs 2019; 76:706-714. [PMID: 30950104 DOI: 10.1111/jan.14007] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 12/26/2018] [Accepted: 01/09/2019] [Indexed: 01/26/2023]
Abstract
AIM This paper seeks to describe best practices for conducting cross-language research with individuals who have a language barrier. DESIGN Discussion paper. DATA SOURCES Research methods papers addressing cross-language research issues published between 2000-2017. IMPLICATIONS FOR NURSING Rigorous cross-language research involves the appropriate use of interpreters during the research process, systematic planning for how to address the language barrier between participant and researcher and the use of reliably and validly translated survey instruments (when applicable). Biases rooted in those who enter data into "big data" systems may influence data quality and analytic approaches in large observational studies focused on linking patient language preference to health outcomes. CONCLUSION Cross-language research methods can help ensure that those individuals with language barriers have their voices contributing to the evidence informing healthcare practice and policies that shape health services implementation and financing. Understanding the inherent conscious and unconscious biases of those conducting research with this population and how this may emerge in research studies is also an important part of producing rigorous, reliable, and valid cross-language research. IMPACT This study synthesized methodological recommendations for cross-language research studies with the goal to improve the quality of future research and expand the evidence-base for clinical practice. Clear methodological recommendations were generated that can improve research rigor and quality of cross-language qualitative and quantitative studies. The recommendations generated here have the potential to have an impact on the health and well-being of migrants around the world.
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Affiliation(s)
- Allison Squires
- Rory Meyers College of Nursing, New York University, New York City, New York.,School of Medicine, New York University, New York City, New York
| | - Tina Sadarangani
- Rory Meyers College of Nursing, New York University, New York City, New York
| | - Simon Jones
- Population Health, School of Medicine, New York University, New York City, New York
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Martinez Tyson D, Medina-Ramirez P, Vázquez-Otero C, Gwede CK, Bobonis M, McMillan SC. Cultural adaptation of a supportive care needs measure for Hispanic men cancer survivors. J Psychosoc Oncol 2018; 36:113-131. [PMID: 28857692 PMCID: PMC6225784 DOI: 10.1080/07347332.2017.1370763] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Research with ethnic minority populations requires instrumentation that is cultural and linguistically relevant. The aim of this study was to translate and culturally adapt the Cancer Survivor Unmet Needs measure into Spanish. METHODS We describe the iterative, community-engaged consensus-building approaches used to adapt the instrument for Hispanic male cancer survivors. We used an exploratory sequential mixed method study design. Methods included translation and back-translation, focus groups with cancer survivors (n = 18) and providers (n = 5), use of cognitive interview techniques to evaluate the comprehension and acceptability of the adapted instrument with survivors (n = 12), ongoing input from the project's community advisory board, and preliminary psychometric analysis (n = 84). RESULTS The process emphasized conceptual, content, semantic, and technical equivalence. Combining qualitative and quantitative approaches offered a rigorous, systematic, and contextual approach to translation alone and supports the cultural adaptation of this measure in a purposeful and relevant manner. CONCLUSION Our findings highlight the importance of going beyond translation when adapting measures for cross-cultural populations and illustrate the importance of taking culture, literacy, and language into consideration.
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Affiliation(s)
- Dinorah Martinez Tyson
- a Department of Community and Family Health , University of South Florida , Tampa , Florida , United States
| | - Patricia Medina-Ramirez
- a Department of Community and Family Health , University of South Florida , Tampa , Florida , United States
| | - Coralia Vázquez-Otero
- a Department of Community and Family Health , University of South Florida , Tampa , Florida , United States
| | - Clement K Gwede
- b Health Outcomes & Behavior , Moffitt Cancer Center & Research Institute , Tampa , Florida , United States
| | - Margarita Bobonis
- c Supportive Care Medicine Department , Moffitt Cancer Center & Research Institute , Tampa , Florida , United States
| | - Susan C McMillan
- d College of Nursing , University of South Florida , Tampa , Florida , United States
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Bayesian Multilevel MIMIC Modeling for Studying Measurement Invariance in Cross-group Comparisons. Med Care 2017; 55:e25-e35. [PMID: 25170773 DOI: 10.1097/mlr.0000000000000164] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent methodological advancements should catalyze the evaluation of measurement invariance across groups, which is required for conducting meaningful cross-group comparisons. OBJECTIVE The aim of this study was to apply a state-of-the-art statistical method for comparing latent mean scores and evaluating measurement invariance across managers' and frontline workers' ratings of the organization of hospital care. METHODS On the 87 nursing units in a single institution, French-speaking and Dutch-speaking nursing unit managers' and staff nurses' ratings of their work environment were measured using the multidimensional 32-item practice environment scale of the nursing work index (PES-NWI). Measurement invariance and latent mean scores were evaluated in the form of a Bayesian 2-level multiple indicators multiple causes model with covariates at the individual nurse and nursing unit level. Role (manager, staff nurse) and language (French, Dutch) are of primary interest. RESULTS Language group membership accounted for 7 of 11 PES-NWI items showing measurement noninvariance. Cross-group comparisons also showed that covariates at both within-level and between-level had significant effects on PES-NWI latent mean scores. Most notably, nursing unit managers, when compared with staff nurses, hold more positive views of several PES-NWI dimensions. CONCLUSIONS Using a widely used instrument for measuring nurses' work environment, this study shows that precautions for the potential threat of measurement noninvariance are necessary in all stages of a study that relies on survey data to compare groups, particularly in multilingual settings. A Bayesian multilevel multiple indicators multiple causes approach can accommodate for detecting all possible instances of noninvariance for multiple covariates of interest at the within-level and between-level jointly.
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Purgato M, Gastaldon C, Papola D, van Ommeren M, Barbui C, Tol WA. Psychological and social interventions for the prevention of mental disorders in people living in low- and middle-income countries affected by humanitarian crises. Hippokratia 2016. [DOI: 10.1002/14651858.cd012417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Marianna Purgato
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Hampton House Baltimore Maryland USA 21205
- University of Verona; Department of Public Health and Community Medicine, Section of Psychiatry; Piazzale LA Scuro, 10 Verona Italy 37134
| | - Chiara Gastaldon
- University of Verona; Department of Public Health and Community Medicine, Section of Psychiatry; Piazzale LA Scuro, 10 Verona Italy 37134
| | - Davide Papola
- University of Verona; Department of Public Health and Community Medicine, Section of Psychiatry; Piazzale LA Scuro, 10 Verona Italy 37134
| | - Mark van Ommeren
- World Health Organization; Department of Mental Health and Substance Abuse; Avenue Appia Geneva Switzerland CH-1211
| | - Corrado Barbui
- University of Verona; Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry; Verona Italy
| | - Wietse A Tol
- Johns Hopkins Bloomberg School of Public Health; Department of Mental Health; 624 North Broadway, Hampton House Baltimore Maryland USA 21205
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Tietschert MV, Angeli F, van Raak AJA, Singer SJ, Ruwaard D. Translating the Patient Perception of Integrated Care Survey to Measure Integrated Care in the Netherlands: Combining Equivalence and Contextualization Approaches for Optimal Results. Int J Integr Care 2016; 16:11. [PMID: 28435421 PMCID: PMC5350639 DOI: 10.5334/ijic.2022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 08/03/2016] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION An increase in initiatives to improve integration of care provides the need for instruments that assess the degree of integrated care as perceived by patients across cultural contexts. This article aims to explain the relevance of equivalence and contextualization approaches in translating and adapting the Patient Perception of Integrated Care Survey developed in the US for use in the Netherlands. THEORY AND METHODS The World Health Organization guidelines guided the translation and adaptation, including a forward-backward translation and patient-feedback through informal contacts (N4) and cognitive interviews (N14). RESULTS The forward-backward translation produced a Dutch version of the Patient Perception of Integrated Care Survey with minor adaptations. Patients evaluated the survey as very relevant. Alterations resulted from structural and cultural differences and specificities of patients with chronic conditions. CONCLUSIONS AND DISCUSSION A context-sensitive translation process is key to developing instruments for cross-cultural health research. Our results show that equivalence- and contextualization methods provide equally relevant, yet substantially different contributions to the translation outcome and should both be incorporated when translating instruments for different cultural contexts. The results support the applicability of the Patient Perception of Integrated Care Survey in the Netherlands and are promising for its adoption in other cultural contexts.
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Affiliation(s)
- Maike V. Tietschert
- Maastricht University, Department of Health Services Research, Room 0.043, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Federica Angeli
- Maastricht University, Department of Health Services Research, Room 0.073, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Arno J. A. van Raak
- Maastricht University, Department of Health, Services Research, Room 0.063, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
| | - Sara J. Singer
- Harvard T. H. Chan School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue Kresge, Room 407, Boston, Massachusetts 02115, USA
| | - Dirk Ruwaard
- Maastricht University, Department of Health Services Research, Room 0.083, Duboisdomein 30, 6229 GT Maastricht, The Netherlands
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Patel N, Kellezi B, Williams ACDC. Psychological, social and welfare interventions for psychological health and well-being of torture survivors. Cochrane Database Syst Rev 2014; 2014:CD009317. [PMID: 25386846 PMCID: PMC11026826 DOI: 10.1002/14651858.cd009317.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Torture is widespread, with potentially broad and long-lasting impact across physical, psychological, social and other areas of life. Its complex and diverse effects interact with ethnicity, gender, and refugee experience. Health and welfare agencies offer varied rehabilitation services, from conventional mental health treatment to eclectic or needs-based interventions. This review is needed because relatively little outcome research has been done in this field, and no previous systematic review has been conducted. Resources are scarce, and the challenges of providing services can be considerable. OBJECTIVES To assess beneficial and adverse effects of psychological, social and welfare interventions for torture survivors, and to compare these effects with those reported by active and inactive controls. SEARCH METHODS Randomised controlled trials (RCTs) were identified through a search of PsycINFO, MEDLINE, EMBASE, Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Specialised Register (CCDANCTR), the Latin American and Caribbean Health Science Information Database (LILACS), the Open System for Information on Grey Literature in Europe (OpenSIGLE), the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and Published International Literature On Traumatic Stress (PILOTS) all years to 11 April 2013; searches of Cochrane resources, international trial registries and the main biomedical databases were updated on 20 June 2014. We also searched the Online Library of Dignity (Danish Institute against Torture), reference lists of reviews and included studies and the most frequently cited journals, up to April 2013 but not repeated for 2014. Investigators were contacted to provide updates or details as necessary. SELECTION CRITERIA Full publications of RCTs or quasi-RCTs of psychological, social or welfare interventions for survivors of torture against any active or inactive comparison condition. DATA COLLECTION AND ANALYSIS We included all major sources of grey literature in our search and used standard methodological procedures as expected by The Cochrane Collaboration for collecting data, evaluating risk of bias and using GRADE (Grades of Recommendation, Assessment, Development and Evaluation) methods to assess the quality of evidence. MAIN RESULTS Nine RCTs were included in this review. All were of psychological interventions; none provided social or welfare interventions. The nine trials provided data for 507 adults; none involved children or adolescents. Eight of the nine studies described individual treatment, and one discussed group treatment. Six trials were conducted in Europe, and three in different African countries. Most people were refugees in their thirties and forties; most met the criteria for post-traumatic stress disorder (PTSD) at the outset. Four trials used narrative exposure therapy (NET), one cognitive-behavioural therapy (CBT) and the other four used mixed methods for trauma symptoms, one of which included reconciliation methods. Five interventions were compared with active controls, such as psychoeducation; four used treatment as usual or waiting list/no treatment; we analysed all control conditions together. Duration of therapy varied from one hour to longer than 20 hours with a median of around 12 to 15 hours. All trials reported effects on distress and on PTSD, and two reported on quality of life. Five studies followed up participants for at least six months.No immediate benefits of psychological therapy were noted in comparison with controls in terms of our primary outcome of distress (usually depression), nor for PTSD symptoms, PTSD caseness, or quality of life. At six-month follow-up, three NET and one CBT study (86 participants) showed moderate effect sizes for intervention over control in reduction of distress (standardised mean difference (SMD) -0.63, 95% confidence interval (CI) -1.07 to -0.19) and of PTSD symptoms (SMD -0.52, 95% CI -0.97 to -0.07). However, the quality of evidence was very low, and risk of bias resulted from researcher/therapist allegiance to treatment methods, effects of uncertain asylum status of some people and real-time non-standardised translation of assessment measures. No measures of adverse events were described, nor of participation, social functioning, quantity of social or family relationships, proxy measures by third parties or satisfaction with treatment. Too few studies were identified for review authors to attempt sensitivity analyses. AUTHORS' CONCLUSIONS Very low-quality evidence suggests no differences between psychological therapies and controls in terms of immediate effects on post-traumatic symptoms, distress or quality of life; however, NET and CBT were found to confer moderate benefits in reducing distress and PTSD symptoms over the medium term (six months after treatment). Evidence was of very low quality, mainly because non-standardised assessment methods using interpreters were applied, and sample sizes were very small. Most eligible trials also revealed medium to high risk of bias. Further, attention to the cultural appropriateness of interventions or to their psychometric qualities was inadequate, and assessment measures used were unsuitable. As such, these findings should be interpreted with caution.No data were available on whether symptom reduction enabled improvements in quality of life, participation in community life, or in social and family relationships in the medium term. Details of adverse events and treatment satisfaction were not available immediately after treatment nor in the medium term. Future research should aim to address these gaps in the evidence and should include larger sample sizes when possible. Problems of torture survivors need to be defined far more broadly than by PTSD symptoms, and recognition given to the contextual influences of being a torture survivor, including as an asylum seeker or refugee, on psychological and social health.
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Affiliation(s)
- Nimisha Patel
- University of East LondonSchool of PsychologyRomford Road, StratfordLondonUKE15 4LZ
- International Centre for Health and Human RightsLondonUK
| | - Blerina Kellezi
- University of NottinghamSchool of Medicine, Division of Primary CareTower Building, University ParkNottinghamUKNG7 2RD
- Univeristy of OxfordCentre for CriminologyOxfordUK
| | - Amanda C de C Williams
- International Centre for Health and Human RightsLondonUK
- University College LondonResearch Department of Clinical, Educational & Health PsychologyGower StreetLondonUKWC1E 6BT
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Olson K, Jacobson K. Cross-Cultural Considerations in Pediatric Neuropsychology: A Review and Call to Attention. APPLIED NEUROPSYCHOLOGY-CHILD 2014; 4:166-77. [DOI: 10.1080/21622965.2013.830258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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A comparison of neuropsychological performance between US and Russia: preparing for a global clinical trial. Alzheimers Dement 2014; 10:760-768.e1. [PMID: 25066497 DOI: 10.1016/j.jalz.2014.02.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Revised: 02/05/2014] [Accepted: 02/11/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND Understanding regional differences in cognitive performance is important for interpretation of data from large multinational clinical trials. METHODS Data from Durham and Cabarrus Counties in North Carolina, USA and Tomsk, Russia (n = 2972) were evaluated. The Montreal Cognitive Assessment (MoCA), Trail Making Test Part B (Trails B), Consortium to Establish a Registry for Alzheimer's Disease Word List Memory Test (WLM) delayed recall, and self-report Alzheimer's Disease Cooperative Studies Mail-In Cognitive Function Screening Instrument (MCFSI) were administered at each site. Multilevel modeling measured the variance explained by site and predictors of cognitive performance. RESULTS Site differences accounted for 11% of the variation in the MoCA, 1.6% in Trails B, 1.7% in WLM, and 0.8% in MCFSI scores. Prior memory testing was significantly associated with WLM. Diabetes and stroke were significantly associated with Trails B and MCFSI. CONCLUSIONS Sources of variation include cultural differences, health conditions, and exposure to test stimuli. Findings highlight the importance of local norms to interpret test performance.
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Using quantitative methods within the Universalist model framework to explore the cross-cultural equivalence of patient-reported outcome instruments. Qual Life Res 2014; 24:115-24. [PMID: 24894383 DOI: 10.1007/s11136-014-0722-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The cross-cultural equivalence of patient-reported outcome (PRO) instruments is critical when they are used in international settings. The Universalist model of equivalence was proposed as a framework to investigate cross-cultural equivalence. The purpose of this paper was to illustrate how quantitative methods can be used to investigate cross-cultural equivalence within this framework. METHODS The six types of equivalence of the Universalist model were reviewed from a statistical perspective and statistical techniques allowing addressing the underlying question were identified. These methods are described and examples are provided of how they can be applied. An integrated pragmatic approach to the exploration of cross-cultural equivalence was developed based on these methods. RESULTS The statistical techniques identified were factor analysis to explore conceptual equivalence, differential item functioning to explore semantic and item equivalence, and comparison of measurement properties for the measurement equivalence. The statistical techniques addressing operational equivalence were found to be diverse and highly specific to the operational aspect under investigation. Functional equivalence involves a comprehensive appraisal of the potential impact of the results of the other equivalences on the conclusions of the research. This structured appraisal of functional equivalence offers a framework for a comprehensive, but flexible, approach for the efficient application of statistical analyses to explore cross-cultural equivalence of PRO instruments. CONCLUSION The different types of equivalence of the Universalist model can be investigated using quantitative methods. An integrated approach, which could be used in a variety of settings, was developed to allow the whole notion of cross-cultural equivalence to be comprehensively and efficiently addressed.
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Prady SL, Miles JNV, Pickett KE, Fairley L, Bloor K, Gilbody S, Kiernan K, Mann R, Wright J. The psychometric properties of the subscales of the GHQ-28 in a multi-ethnic maternal sample: results from the Born in Bradford cohort. BMC Psychiatry 2013; 13:55. [PMID: 23414208 PMCID: PMC3610276 DOI: 10.1186/1471-244x-13-55] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 12/04/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Poor maternal mental health can impact on children's development and wellbeing; however, there is concern about the comparability of screening instruments administered to women of diverse ethnic origin. METHODS We used confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) to examine the subscale structure of the GHQ-28 in an ethnically diverse community cohort of pregnant women in the UK (N = 5,089). We defined five groups according to ethnicity and language of administration, and also conducted a CFA between four groups of 1,095 women who completed the GHQ-28 both during and after pregnancy. RESULTS After item reduction, 17 of the 28 items were considered to relate to the same four underlying concepts in each group; however, there was variation in the response to individual items by women of different ethnic origin and this rendered between group comparisons problematic. The EFA revealed that these measurement difficulties might be related to variation in the underlying concepts being measured by the factors. CONCLUSIONS We found little evidence to recommend the use of the GHQ-28 subscales in routine clinical or epidemiological assessment of maternal women in populations of diverse ethnicity.
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Affiliation(s)
| | | | - Kate E Pickett
- Department of Health Sciences, University of York, York, UK
| | - Lesley Fairley
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - Karen Bloor
- Department of Health Sciences, University of York, York, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
| | - Kathleen Kiernan
- Department of Social Policy and Social Work, University of York, York, UK
| | - Rachel Mann
- Department of Health Sciences, University of York, York, UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
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Squires A, Aiken LH, van den Heede K, Sermeus W, Bruyneel L, Lindqvist R, Schoonhoven L, Stromseng I, Busse R, Brzostek T, Ensio A, Moreno-Casbas M, Rafferty AM, Schubert M, Zikos D, Matthews A. A systematic survey instrument translation process for multi-country, comparative health workforce studies. Int J Nurs Stud 2013; 50:264-73. [PMID: 22445444 PMCID: PMC3395768 DOI: 10.1016/j.ijnurstu.2012.02.015] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 02/04/2012] [Accepted: 02/09/2012] [Indexed: 12/18/2022]
Abstract
BACKGROUND As health services research (HSR) expands across the globe, researchers will adopt health services and health worker evaluation instruments developed in one country for use in another. This paper explores the cross-cultural methodological challenges involved in translating HSR in the language and context of different health systems. OBJECTIVES To describe the pre-data collection systematic translation process used in a twelve country, eleven language nursing workforce survey. DESIGN AND SETTINGS We illustrate the potential advantages of Content Validity Indexing (CVI) techniques to validate a nursing workforce survey developed for RN4CAST, a twelve country (Belgium, England, Finland, Germany, Greece, Ireland, Netherlands, Norway, Poland, Spain, Sweden, and Switzerland), eleven language (with modifications for regional dialects, including Dutch, English, Finnish, French, German, Greek, Italian, Norwegian, Polish, Spanish, and Swedish), comparative nursing workforce study in Europe. PARTICIPANTS Expert review panels comprised of practicing nurses from twelve European countries who evaluated cross-cultural relevance, including translation, of a nursing workforce survey instrument developed by experts in the field. METHODS The method described in this paper used Content Validity Indexing (CVI) techniques with chance correction and provides researchers with a systematic approach for standardizing language translation processes while simultaneously evaluating the cross-cultural applicability of a survey instrument in the new context. RESULTS The cross-cultural evaluation process produced CVI scores for the instrument ranging from .61 to .95. The process successfully identified potentially problematic survey items and errors with translation. CONCLUSIONS The translation approach described here may help researchers reduce threats to data validity and improve instrument reliability in multinational health services research studies involving comparisons across health systems and language translation.
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Affiliation(s)
- Allison Squires
- New York University College of Nursing-Global Health Division, New York, NY 10003, USA.
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Squires A, Bruyneel L, Aiken LH, Van den Heede K, Brzostek T, Busse R, Ensio A, Schubert M, Zikos D, Sermeus W. Cross-cultural evaluation of the relevance of the HCAHPS survey in five European countries. Int J Qual Health Care 2012; 24:470-5. [PMID: 22807136 PMCID: PMC3441096 DOI: 10.1093/intqhc/mzs040] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/09/2012] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To describe the systematic language translation and cross-cultural evaluation process that assessed the relevance of the Hospital Consumer Assessment of Healthcare Providers and Systems survey in five European countries prior to national data collection efforts. DESIGN An approach involving a systematic translation process, expert review by experienced researchers and a review by 'patient' experts involving the use of content validity indexing techniques with chance correction. SETTING Five European countries where Dutch, Finnish, French, German, Greek, Italian and Polish are spoken. PARTICIPANTS 'Patient' experts who had recently experienced a hospitalization in the participating country. Main OutcomeMeasure(s) Content validity indexing with chance correction adjustment providing a quantifiable measure that evaluates the conceptual, contextual, content, semantic and technical equivalence of the instrument in relationship to the patient care experience. RESULTS All translations except two received 'excellent' ratings and no significant differences existed between scores for languages spoken in more than one country. Patient raters across all countries expressed different concerns about some of the demographic questions and their relevance for evaluating patient satisfaction. Removing demographic questions from the evaluation produced a significant improvement in the scale-level scores (P= .018). The cross-cultural evaluation process suggested that translations and content of the patient satisfaction survey were relevant across countries and languages. CONCLUSIONS The Hospital Consumer Assessment of Healthcare Providers and Systems survey is relevant to some European hospital systems and has the potential to produce internationally comparable patient satisfaction scores.
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Affiliation(s)
- Allison Squires
- New York University College of Nursing, New York, NY 10003, USA.
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Stewart AL, Thrasher AD, Goldberg J, Shea JA. A framework for understanding modifications to measures for diverse populations. J Aging Health 2012; 24:992-1017. [PMID: 22495768 PMCID: PMC3768261 DOI: 10.1177/0898264312440321] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Research on health disparities and determinants of health disparities among ethnic minorities and vulnerable older populations necessitates use of self-report measures. Most established instruments were developed on mainstream populations and may need adaptation for research with diverse populations. Although information is increasingly available on various problems using these measures in diverse groups, there is little guidance on how to modify the measures. A framework of issues to consider when modifying measures for diverse populations is presented. METHODS The authors describe reasons for considering modifications, the types of information that can be used as a basis for making modifications, and the types of modifications researchers have made. Recommendations are made to test modified measures to assure their appropriateness, and suggestions are provided on reporting modifications in publications using the measures. DISCUSSION The issues open a dialogue about what appropriate guidelines would be for researchers adapting measures in studies of ethnically diverse populations.
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Affiliation(s)
- Anita L Stewart
- Institute for Health & Aging, University of California San Francisco, 3333 California St. Suite 340, San Francisco, CA 94118, Phone: 415 502-5207,
| | - Angela D Thrasher
- Department of Health Behavior and Health Education, University of North Carolina Gillings School of Global Public Health, 315 Rosenau Hall, CB #7440, Chapel Hill, NC 27599-7440, Phone: 919-843-9293,
| | - Jack Goldberg
- Vietnam Era Twin Registry, Seattle VA and the University of Washington School of Public Health, Box 359780, 1730 Minor Avenue, Suite 1760, Seattle, WA 98105-1597, Phone: 206 543-4667,
| | - Judy A. Shea
- University of Pennsylvania, School of Medicine, Division of General Internal Medicine, 1223 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, Phone: 215 573-5111,
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Teresi JA, Ramirez M, Jones RN, Choi S, Crane PK. Modifying measures based on differential item functioning (DIF) impact analyses. J Aging Health 2012; 24:1044-76. [PMID: 22422759 PMCID: PMC4030595 DOI: 10.1177/0898264312436877] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Measure modification can impact comparability of scores across groups and settings. Changes in items can affect the percent admitting to a symptom. METHODS Using item response theory (IRT) methods, well-calibrated items can be used interchangeably, and the exact same item does not have to be administered to each respondent, theoretically permitting wider latitude in terms of modification. RESULTS Recommendations regarding modifications vary, depending on the use of the measure. In the context of research, adjustments can be made at the analytic level by freeing and fixing parameters based on findings of differential item functioning (DIF). The consequences of DIF for clinical decision making depend on whether or not the patient's performance level approaches the scale decision cutpoint. High-stakes testing may require item removal or separate calibrations to ensure accurate assessment. DISCUSSION Guidelines for modification based on DIF analyses and illustrations of the impact of adjustments are presented.
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A Systematic Review of Cross-Cultural Comparison Studies of Child, Parent, and Health Professional Outcomes Associated With Pediatric Medical Procedures. THE JOURNAL OF PAIN 2012; 13:207-19. [DOI: 10.1016/j.jpain.2011.12.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 12/05/2011] [Accepted: 12/13/2011] [Indexed: 11/17/2022]
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Loke AY, Mak YW, Lau PY. Predictors of spontaneous smoking cessation among Chinese men whose wives are pregnant. Matern Child Health J 2011; 16:1247-56. [PMID: 21928116 DOI: 10.1007/s10995-011-0884-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This is an exploratory study to identify the predictors that Chinese men will spontaneously quit smoking during their wives' pregnancy. Smoking husbands who accompanied their non-smoking pregnant wives to an antenatal clinic were invited to complete a questionnaire soliciting information regarding their smoking behaviours, perceptions of support received from their wives, and motivating factors for quitting smoking. A total of 74 men were recruited. Two-thirds (67.6%) were daily smokers, had started smoking under the age of 18 (66.2%), and smoked 6-15 cigarettes (48.6%) a day. Nearly one-third of the smoking husbands (n = 50, 67.6%) reported that their wife was the person who provided them with the necessary main support in quitting. Nearly a quarter (18 out of 74, 24.3%) of the husbands indicated that they quit smoking during their wives' pregnancy. Those more likely to quit were the 'occasional smokers' (61.1% vs. 38.9%), those who craved cigarettes a few hours after getting up (0% vs. 100%), those who were confident in their ability to quit (77.8% vs. 22.2%), and those who had previously attempted to quit (88.9% vs. 11.1%). The level of negative support from wives to quit smoking was significantly related to men's quitting (55.6% vs. 44.4%). The results of this study identified the husbands most likely to spontaneously quit smoking during their wives' pregnancy as those who were occasional smokers, were confident about smoking cessation, and reported their wives as being bothered by smoke.
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Affiliation(s)
- Alice Yuen Loke
- Family and Community Health Division, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
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Daniel M, Miller A, Wilbur J. Multiple instrument translation for use with South Asian Indian immigrants. Res Nurs Health 2011; 34:419-32. [PMID: 21818758 DOI: 10.1002/nur.20450] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2011] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to describe translation of five measures (physical activity, acculturation, discrimination, self-efficacy, and depression) from English into Hindi using the committee translation method, focus group, and think-aloud interviews. Two South Asian Indian (SAI) immigrant bilingual translators and a moderator reached consensus on 93 of 102 items, using the committee method. Discrepancy in nine items was resolved with a focus group conducted with five bilingual SAI immigrants. Ten other bilingual SAI immigrants participated in think-aloud interviews to assess understanding and interpretation of the questions. More than 10 additional changes were made following the think-aloud interviews. Sequential use of multiple translation techniques improved translation with culturally acceptable language, thereby maintaining equivalence with original versions.
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Affiliation(s)
- Manju Daniel
- College of Nursing, Rush University, Chicago, IL, USA
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de C Williams AC, Rajput-Ray M, Lassalle X, Crombie I, Lacoux P. Assessing pain and mood in a poorly resourced country in a post-conflict setting. J Pain Symptom Manage 2011; 42:301-7. [PMID: 21444187 DOI: 10.1016/j.jpainsymman.2010.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/26/2010] [Accepted: 11/06/2010] [Indexed: 10/18/2022]
Abstract
CONTEXT Accurate pain assessment is important but presents problems in poorly resourced countries. A civil war in Sierra Leone resulted in civilian casualties with pain from deliberate amputation and other injuries. OBJECTIVES To examine the quality of simple pain and mood scales. METHODS Within a pain treatment project, pain was assessed using numerical and verbal descriptor scales, and mood using visual analogue and verbal descriptor scales. The relationships between these scales (translated where necessary) were examined by comparison of pairs of measures. RESULTS The overwhelming majority (99%) used the scales consistently. The verbal pain scale showed substantial discrimination between the pain words mild/small, moderate/half and half, and severe/serious (F=41.80, P<0.001). Numerical and verbal pain scales were related at a modest level (Kendall's tau-b=0.39, P<0.001, n=272) and not dependent on the level of education. A smaller sample (n=30) provided pain data across three assessment occasions, and both pain scales appeared sensitive to change. The 5-point verbal mood scale collapsed into three categories, with reasonable distinction between mood words (F=14.75, P<0.001). The visual analogue scale proved difficult to explain to civilian casualties in this setting. CONCLUSION Verbal pain and mood scales and numerical pain scales appeared to yield useful information in a post-conflict situation. This suggests that adapting these established rating scales for pain, and for mood, was useful to clinicians and acceptable to patients.
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Affiliation(s)
- Amanda C de C Williams
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK.
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Liu K, Squires A, You LM. A pilot study of a systematic method for translating patient satisfaction questionnaires. J Adv Nurs 2011; 67:1012-21. [PMID: 21261694 DOI: 10.1111/j.1365-2648.2010.05569.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper is a report of a descriptive comparative pilot study of use of a method that simultaneously tests the content validity and quality of translation of English-to-Chinese translations of two patient satisfaction questionnaires: the La Monica-Oberst Patient Satisfaction Scale and Hospital Consumer Assessment of Healthcare Providers and Systems. BACKGROUND Patient satisfaction is an important indicator of the quality of healthcare services. In China, however, few good translations of patient satisfaction instruments sensitive to nursing services exist. METHODS The descriptive pilot study took place in 2009 and used content validity indexing techniques to evaluate the content, context and criterion relevance of a survey question. The expert raters were 10 nursing faculty and 10 patients who evaluated the two patient satisfaction questionnaires. The experts evaluated the relevance of each item on a scale of 1-4 and the research team compared their responses to choose the most appropriate. Only the nurse faculty experts, who were bilingual, evaluated the quality of the translation using a binary rating. RESULTS The 'Nurse Rater' relevance scores of the LaMonica-Oberst Patient Satisfaction Scale and the Hospital Consumer Assessment of Healthcare Providers and Systems were 0·96 and 0·95 respectively, whereas the patient's overall relevance scores were 0·89 and 0·95. A Mann-Whitney U-test demonstrated that results between the two groups were statistically significantly different (P = 0·0135). CONCLUSIONS Using content validity indexing simultaneously with translation processes was valuable for selecting and evaluating survey instruments in different contexts.
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Affiliation(s)
- Ke Liu
- School of Nursing, Sun Yat-sen University Guangzhou, China
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Abstract
OBJECTIVE To describe measurement challenges and strategies in identifying and analyzing health disparities and inequities. METHODS We discuss the limitations of existing data sources for measuring health disparities and inequities, describe current strategies to address those limitations, and explore the potential of emerging strategies. PRINCIPAL FINDINGS Larger national sample sizes are necessary to identify disparities for major population subgroups. Collecting self-reported race and granular ethnicity data may reduce some measurement errors, but it raises other methodological questions. The assessment of health inequities presents particular challenges, requiring analysis of the interactive effects of multiple determinants of health. Indirect estimation and modeling methods are likely to be important tools for estimating health disparities and inequities for the foreseeable future. CONCLUSIONS Interdisciplinary training and collaborative research models will be essential for future disparities research. Evaluation of evolving methodologies for assessing health disparities should be a priority for health services researchers in the next decade.
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Affiliation(s)
- Linda T Bilheimer
- Office of Analysis and Epidemiology, Centers for Disease Control and Prevention, National Center for Health Statistics, 3311 Toledo Rd, Hyattsville, MD 20782, USA.
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Sidani S, Guruge S, Miranda J, Ford-Gilboe M, Varcoe C. Cultural adaptation and translation of measures: an integrated method. Res Nurs Health 2010; 33:133-43. [PMID: 20069612 DOI: 10.1002/nur.20364] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Differences in the conceptualization and operationalization of health-related concepts may exist across cultures. Such differences underscore the importance of examining conceptual equivalence when adapting and translating instruments. In this article, we describe an integrated method for exploring conceptual equivalence within the process of adapting and translating measures. The integrated method involves five phases including selection of instruments for cultural adaptation and translation; assessment of conceptual equivalence, leading to the generation of a set of items deemed to be culturally and linguistically appropriate to assess the concept of interest in the target community; forward translation; back translation (optional); and pre-testing of the set of items. Strengths and limitations of the proposed integrated method are discussed.
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Affiliation(s)
- Souraya Sidani
- Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, Ontario, Canada
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Fujishiro K, Gong F, Baron S, Jacobson CJ, DeLaney S, Flynn M, Eggerth DE. Translating questionnaire items for a multi-lingual worker population: the iterative process of translation and cognitive interviews with English-, Spanish-, and Chinese-speaking workers. Am J Ind Med 2010; 53:194-203. [PMID: 19650081 DOI: 10.1002/ajim.20733] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The increasing ethnic diversity of the US workforce has created a need for research tools that can be used with multi-lingual worker populations. Developing multi-language questionnaire items is a complex process; however, very little has been documented in the literature. METHODS Commonly used English items from the Job Content Questionnaire and Quality of Work Life Questionnaire were translated by two interdisciplinary bilingual teams and cognitively tested in interviews with English-, Spanish-, and Chinese-speaking workers. RESULTS Common problems across languages mainly concerned response format. Language-specific problems required more conceptual than literal translations. Some items were better understood by non-English speakers than by English speakers. De-centering (i.e., modifying the English original to correspond with translation) produced better understanding for one item. CONCLUSIONS Translating questionnaire items and achieving equivalence across languages require various kinds of expertise. Backward translation itself is not sufficient. More research efforts should be concentrated on qualitative approaches to developing useful research tools.
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Affiliation(s)
- Kaori Fujishiro
- Division of Surveillance, Hazard Evaluation, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio 45226, USA.
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Regnault A, Marfatia S, Louie M, Mear I, Meunier J, Viala-Danten M. Satisfactory cross-cultural validity of the ACTG symptom distress module in HIV-1-infected antiretroviral-naive patients. Clin Trials 2009; 6:574-84. [PMID: 19933717 DOI: 10.1177/1740774509352515] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Multinational clinical trials commonly include different language versions of patient-reported outcomes (PRO) instruments without considering the question of their cross-cultural validity. The inclusion of a PRO instrument, the Adult AIDS Clinical Trial Group Symptom Distress Module (SDM), in an multinational clinical trial in HIV-1 antiretroviral-naive patients offered an opportunity to explore the methods to assess cross-cultural validity of PRO instruments in the context of clinical trials. PURPOSE To assess the cross-cultural validity of the SDM across seven cultural groups in the setting of a multinational HIV clinical trial. METHODS Twenty-five language versions of the SDM were included in a Phase IIb/III trial comparing maraviroc with efavirenz (each in combination with zidovudine/ lamivudine) conducted in 12 countries to assess symptoms perceived by HIV-1-infected antiretroviral-naive patients. Differential item functioning (DIF) detection and the STATIS method were combined in a pragmatic approach to assess the cross-cultural validity of the SDM using pre-antiretroviral treatment data from 759 patients. RESULTS Statistically significant DIF between cultural groups was observed for four items: fatigue; fevers; anxiety; and headache. However, examination of these items by linguists did not lead to meaningful explanations for the statistical differences. With the STATIS approach, the Bantu and European Germanic groups were the furthest from the Occidental English group. LIMITATIONS The assessment of cross-cultural validity had to be performed on some very small samples and on data aggregated by cultural groups, which suggests the need for a cautious interpretation of the results. CONCLUSIONS Given the heterogeneity of cultures considered, the absence of meaningful explanations for statistically significant differences between cultural groups supports the cross-cultural validity of the SDM versions included in this trial. Thus, this study demonstrated that it is feasible to conduct assessment of crosscultural validity of PRO instruments using data collected in the setting of multinational clinical trials.
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Ng N, Hakimi M, Van Minh H, Juvekar S, Razzaque A, Ashraf A, Masud Ahmed S, Kanungsukkasem U, Soonthornthada K, Huu Bich T. Prevalence of physical inactivity in nine rural INDEPTH Health and Demographic Surveillance Systems in five Asian countries. Glob Health Action 2009; 2. [PMID: 20027261 PMCID: PMC2785136 DOI: 10.3402/gha.v2i0.1985] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Revised: 07/09/2009] [Accepted: 07/09/2009] [Indexed: 11/18/2022] Open
Abstract
Background Physical inactivity leads to higher morbidity and mortality from chronic non-communicable diseases (NCDs) such as stroke and heart disease. In high income countries, studies have measured the population level of physical activity, but comparable data are lacking from most low and middle-income countries. Objective To assess the level of physical inactivity and its associated factors in selected rural sites in five Asian countries. Methods The multi-site cross-sectional study was conducted in nine rural Health and Demographic Surveillance System (HDSS) sites within the INDEPTH Network in Bangladesh, India, Indonesia, Thailand, and Vietnam. Using the methodology from the WHO STEPwise approach to Surveillance (STEPS), about 2,000 men and women aged 25–64 years were selected randomly from each HDSS sampling frame. Physical activity at work and during leisure time, and on travel to and from places, was measured using the Global Physical Activity Questionnaire version 2 (GPAQ2). The total activity was calculated as the sum of the time spent in each domain of activities in metabolic equivalent-minutes per week, and was used to determine the level of physical activity. Multivariable logistic regression was used to assess demographic factors associated with a low level of physical activity. Results The prevalence of physical inactivity ranged from 13% in Chililab HDSS in Vietnam to 58% in Filabavi HDSS in Vietnam. The majority of men were physically active, except in the two sites in Vietnam. Most of the respondents walked or cycled for at least 10 minutes to get from place to place, with some exceptions in the HDSSs in Indonesia and Thailand. The majority of respondents, both men and women, were inactive during their leisure time. Women, older age, and high level of education were significantly associated with physical inactivity. Conclusion This study showed that over 1/4 men and 1/3 women in Asian HDSSs within the INDEPTH Network are physically inactive. The wide fluctuations between the two HDSS in Vietnam offer an opportunity to explore further urbanisation and environmental impacts on physical activity. Considering the importance of physical activity in improving health and preventing chronic NCDs, efforts need to be made to promote physical activity particularly among women, older people, and high education groups in these settings.
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Affiliation(s)
- Nawi Ng
- Purworejo Health and Demographic Surveillance System, Indonesia
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Pedraza O, Mungas D. Measurement in cross-cultural neuropsychology. Neuropsychol Rev 2008; 18:184-93. [PMID: 18814034 PMCID: PMC2925437 DOI: 10.1007/s11065-008-9067-9] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2008] [Accepted: 07/30/2008] [Indexed: 11/30/2022]
Abstract
The measurement of cognitive abilities across diverse cultural, racial, and ethnic groups has a contentious history, with broad political, legal, economic, and ethical repercussions. Advances in psychometric methods and converging scientific ideas about genetic variation afford new tools and theoretical contexts to move beyond the reflective analysis of between-group test score discrepancies. Neuropsychology is poised to benefit from these advances to cultivate a richer understanding of the factors that underlie cognitive test score disparities. To this end, the present article considers several topics relevant to the measurement of cognitive abilities across groups from diverse ancestral origins, including fairness and bias, equivalence, diagnostic validity, item response theory, and differential item functioning.
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Affiliation(s)
- Otto Pedraza
- Department of Psychiatry and Psychology, Mayo Clinic, Jacksonville, FL 32224, USA.
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Willis G, Lawrence D, Hartman A, Stapleton Kudela M, Levin K, Forsyth B. Translation of a tobacco survey into Spanish and Asian languages: the Tobacco Use Supplement to the Current Population Survey. Nicotine Tob Res 2008; 10:1075-84. [PMID: 18584471 PMCID: PMC3803133 DOI: 10.1080/14622200802087572] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Because of the vital need to attain cross-cultural comparability of estimates of tobacco use across subgroups of the U.S. population that differ in primary language use, the National Cancer Institute (NCI) Tobacco Use Special Cessation Supplement to the Current Population Survey (TUSCS-CPS) was translated into Spanish, Chinese (Mandarin and Cantonese), Korean, Vietnamese, and Khmer (Cambodian). The questionnaire translations were extensively tested using an eight-step process that focused on both translation procedures and empirical pretesting. The resulting translations are available on the Internet at http://riskfactor.cancer.gov/studies/tus-cps/translation/questionnaires.html for tobacco researchers to use in their own surveys, either in full, or as material to be selected as appropriate. This manuscript provides information to guide researchers in accessing and using the translations, and describes the empirical procedures used to develop and pretest them (cognitive interviewing and behavior coding). We also provide recommendations concerning the further development of questionnaire translations.
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Affiliation(s)
- Gordon Willis
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7344, USA.
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Ravens-Sieberer U, Erhart M, Gosch A, Wille N. Mental health of children and adolescents in 12 European countries—results from the European KIDSCREEN study. Clin Psychol Psychother 2008; 15:154-63. [DOI: 10.1002/cpp.574] [Citation(s) in RCA: 92] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Teresi JA, Stewart AL, Morales LS, Stahl SM. Measurement in a multi-ethnic society. Overview to the special issue. Med Care 2007; 44:S3-4. [PMID: 17060831 PMCID: PMC1634762 DOI: 10.1097/01.mlr.0000245437.46695.4a] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jeanne A Teresi
- Columbia University Stroud Center and Research Division, Hebrew Home for the Aged at Riverdale, 5901 Palisade Avenue, Riverdale, NY 10471, USA.
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Nápoles-Springer AM, Stewart AL. Overview of qualitative methods in research with diverse populations. Making research reflect the population. Med Care 2007; 44:S5-9. [PMID: 17060835 DOI: 10.1097/01.mlr.0000245252.14302.f4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anna M Nápoles-Springer
- University of California San Francisco, 3333California Street, Suite 335, San Francisco, California 94118-1944, USA.
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Affiliation(s)
- Denny Borsboom
- Department of Psychology, Faculty of Social and Behavioral Sciences, University of Amsterdam, Amsterdam, The Netherlands.
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Affiliation(s)
- Neal Krause
- Department of Health Behavior and Health Education School of Public Health and Institute of Gerontology, University of Michigan, Ann Arbor, Michigan 48109-2029, USA.
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Ramirez M, Teresi JA, Holmes D, Gurland B, Lantigua R. Differential Item Functioning (DIF) and the Mini-Mental State Examination (MMSE). Med Care 2006; 44:S95-S106. [PMID: 17060840 DOI: 10.1097/01.mlr.0000245181.96133.db] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Various forms of differential item functioning (DIF) in the Mini-Mental State Examination (MMSE) have been identified. Items have been found to perform differently for individuals of different educational levels, racial/ethnic groups, and/or of groups whose first language is not English. The articles in this section illustrate the use of different methods to examine DIF in relation to English and Spanish language administration of the MMSE. OBJECTIVES The aim of this article is to provide a context for interpretation of the findings contained in the following set of papers examining DIF in the MMSE. METHODS The performance of the MMSE, when administered in English and Spanish, was reviewed. "Translation" has been discussed in the context of measurement bias, illustrating the variability in Spanish translations. Presented are the readability of the MMSE, description of the translation method, the study design and sample for the data set used, together with treatment of missing data, and model assumptions related to the analyses described in the accompanying set of papers examining DIF. CONCLUSIONS The examination of item bias in cognitive impairment assessment instruments has practical and theoretical implications in the context of health disparities. Considerable DIF has been identified in the MMSE. A critical factor that may contribute to measurement bias is language translation and conversion. Once DIF has been established consistently in a measure, decisions regarding adjustments proceed. Perhaps the development of guidelines for appropriate adjustments for DIF correction in self-reported measures represents the next challenge in addressing measurement equivalence in crosscultural research.
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Affiliation(s)
- Mildred Ramirez
- Research Division, Hebrew Home for the Aged at Riverdale, 5901 Palisade Avenue, Riverdale, New York 10471, USA.
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