Challenges in adapting a survey: ensuring cross-cultural equivalence

Translation, Cross-Cultural Adaptation, and Validation of Measurement Instruments: A Practical Guideline for Novice Researchers

Cross-cultural validation of self-reported measurement instruments for research is a long and complex process, which involves specific risks of bias that could affect the research process and results. Furthermore, it requires researchers to have a wide range of technical knowledge about the translation, adaptation and pre-test aspects, their purposes and options, about the different psychometric properties, and the required evidence for their assessment and knowledge about the quantitative data processing and analysis using statistical software. This article aimed: 1) identify all guidelines and recommendations for translation, cross-cultural adaptation, and validation within the healthcare sciences; 2) describe the methodological approaches established in these guidelines for conducting translation, adaptation, and cross-cultural validation; and 3) provide a practical guideline featuring various methodological options for novice researchers involved in translating, adapting, and validating measurement instruments. Forty-two guidelines on translation, adaptation, or cross-cultural validation of measurement instruments were obtained from "CINAHL with Full Text" (via EBSCO) and "MEDLINE with Full Text". A content analysis was conducted to identify the similarities and differences in the methodological approaches recommended. Bases on these similarities and differences, we proposed an eight-step guideline that includes: a) forward translation; 2) synthesis of translations; 3) back translation; 4) harmonization; 5) pre-testing; 6) field testing; 7) psychometric validation, and 8) analysis of psychometric properties. It is a practical guideline because it provides extensive and comprehensive information on the methodological approaches available to researchers. This is the first methodological literature review carried out in the healthcare sciences regarding the methodological approaches recommended by existing guidelines.

Dual career through the eyes of university student-athletes in the Republic of Kosovo

Introduction

The successful combination of a sports career and education, known as the dual career, requires cooperation and a multi-dimensional approach. Although extensive research has been conducted on dual career programs and services in developed countries, there is limited information available on the dual-career phenomenon in developing countries. This study aimed to explore the dual career experiences of university student-athletes in the Republic of Kosovo.

Materials and methods

A 30-item online survey was distributed to student-athletes, addressing various aspects of the dual career. A total of 121 student-athletes (males: 63.6%; females: 36.4%) voluntarily participated in the survey.

Results

These student-athletes represented 13 different sports, with 102 (84.3%) participating in team and 19 (15.7%) in individual sports. Between individual and team sports no significant differences were found regarding university and sports engagement, and the time required to travel from the university to the training venue, whereas a significant difference (p = 0.019) emerged for the time needed to travel from home to the training venue. Significant differences (p < 0.05) were found between university majors in terms of sports engagement. The present findings highlight a lack of familiarity with dual career programs among student-athletes (89.3%) and the need for dual-career policies at the university (16.5%), sport (9.9%), and national (13.2%) levels. Student-athletes faced various challenges, mainly related to limited leisure time (62.8%), academic overload (60.3%), frequent absence from classes (59.6%), and financial uncertainty (35.5%). Recommended improvements included increased financial support (66.1%), the availability of sports facilities at or near the university (48.8%), greater educational flexibility (26.4%), tutoring services at the university (25.6%), and sports clubs (19%) levels, as well as improved communication regarding existing initiatives and legal aspects (53.7% and 47.1%, respectively). The study also identified parents (98.3%), coaches (86%), and siblings (60.3%) as important sources of support for student-athletes at personal, sports, and university levels.

Conclusions

In conclusion, to enhance the potential of future student-athletes in the Republic of Kosovo, relevant stakeholders in sports and higher education should collaborate closely and implement programs and services based on international best practices for dual-career support.

Translation and Validation of Low Back Pain Knowledge Questionnaire Among Hindi-Speaking Indian Women

Low back pain (LBP) is a common problem encountered among women worldwide. This research aimed at the cross-cultural translation, adaptation, and equivalence assessment of the Low Back Pain Knowledge Questionnaire (LBPKQ) in the Hindi language. The LBPKQ, originally in English (E-LBPKQ) was translated and validated in the Hindi language (H-LBPKQ). The forward-backward procedure was adapted from the recommended guidelines for cross-cultural adaptation of measures. Psychometric properties of the H-LBPKQ were evaluated among 250 Hindi-speaking Indian women with LBP. Test-retest reliability was evaluated in the first 161 participants of the study sample. The overall LBPKQ scores obtained a mean of 3.1 ± 1.1. The internal consistency was excellent for both E-LBPKQ and H-LBPKQ, with Cronbach's alpha of 0.983 (95% confidence interval [CI], 0.980-0.986) and 0.975 (95% CI, 0.970-0.979), respectively. Construct validity was good, with Kaiser-Meyer-Olkin value of 0.892 for E-LBPKQ and 0.852 for H-LBPKQ. Bartlett's test of sphericity (P < .0001) was significant for E-LBPKQ and H-LBPKQ. Two factors were extracted through principal component analysis. The H-LBPKQ is valid and reliable to assess LBP knowledge among Hindi speaking population. Low LBPKQ scores indicate poor LBP knowledge; hence, LBP sensitization is needed among Indian women.

Psychometric properties of the quality nursing care scale-turkish version: a methodological study

AIM

To analyze the psychometric properties of the Quality Nursing Care Scale in Turkish Language.

BACKGROUND

The quality of health services and nursing care effectively improves safe patient outcomes and reduces costs in healthcare organizations. There is a need for valid and reliable tools in order to use for evaluating the quality of nursing care.

METHODS

The methodological and cross-sectional study included 225 nurses working in a research and training hospital. Content validity, construct validity, item analysis, and internal consistency analysis were used.

RESULTS

The content validity index of the scale was 0.96. The item-total score correlation values of the items were 0.72 and higher. The factor loads of the items ranged from 0.42 to 0.90. Different from the original scale, Turkish form consisted of three sub-dimensions. The fit indices were acceptable or very good. The Cronbach's alpha internal consistency coefficient was 0.99.

CONCLUSION

The Quality Nursing Care Scale was valid and reliable with its three-factor structure in Turkish Language. It may be used for measuring the quality of care in the aspects of nurses.

People infer communicative action through an expectation for efficient communication

Humans often communicate using body movements like winks, waves, and nods. However, it is unclear how we identify when someone’s physical actions are communicative. Given people’s propensity to interpret each other’s behavior as aimed to produce changes in the world, we hypothesize that people expect communicative actions to efficiently reveal that they lack an external goal. Using computational models of goal inference, we predict that movements that are unlikely to be produced when acting towards the world and, in particular, repetitive ought to be seen as communicative. We find support for our account across a variety of paradigms, including graded acceptability tasks, forced-choice tasks, indirect prompts, and open-ended explanation tasks, in both market-integrated and non-market-integrated communities. Our work shows that the recognition of communicative action is grounded in an inferential process that stems from fundamental computations shared across different forms of action interpretation.

Humans can quickly infer when someone’s body movements are meant to be communicative. Here, the authors show that this capacity is underpinned by an expectation that communicative actions will efficiently reveal that they lack an external goal.

Utility of Equivalence and Cognition Models in Enhancing Validity of Translated Questionnaires: A Methodological Example Using the Heart Quality-of-Life Questionnaire

BACKGROUND

The cross-cultural adaptation of questionnaires has tenuous theoretical underpinnings that limit the rigor of data collection and the meaningful analysis of cognitive interview data. An adaptation of existing models of equivalence and cognition provides structure to the comprehensive investigation of various equivalence types in enhancing the validity of translated questionnaires.

PURPOSE

In this study, a framework comprising equivalence and cognition models was used to assess and finalize the Heart Quality-of-Life (HeartQoL)-Bahasa Malaysia (BM) questionnaire, which was derived from both forward-backward (FB) and dual-panel (DP) translation methods.

METHODS

Investigation and finalization of two initial versions of the questionnaire were conducted based on findings from an expert assessment (n = 3 sociolinguists blinded to translation methods) and cognitive interviews with purposively sampled patients (FB: n = 11; DP: n = 11). The equivalence model of Herdman et al. and the question-and-answer model of Collins were adapted to form a "cognition-and-equivalence" model to guide data collection and analysis through modified cognitive interviews. The final HeartQoL-BM was completed by 373 patients with ischemic heart disease from two medical centers, and the data were analyzed using confirmatory factor analysis to assess the evidence of equivalence.

RESULTS

Findings from the expert assessment and cognitive interview showed the existence of semantic and item equivalence on almost all of the FB and DP items, identified some subtle potential equivalence gaps, and guided the process of item finalization. Confirmatory factor analysis, including tests of factorial invariance on the final two-factor model of HeartQoL-BM, confirmed conceptual, item, measurement, and operational equivalence, which supports functional equivalence.

CONCLUSIONS

The potential use of the cognition-and-equivalence model for modified cognitive interviewing and the application of the six equivalence types of Herdman et al. were supported by the HeartQoL-BM showing functional equivalence with its source. HeartQoL-BM is a potentially valid measure of health-related quality of life for patients with ischemic heart disease independent of conditions such as angina, myocardial infarction, and heart failure.

Cross-Cultural Translation of the nChinese Version of Pain Care Quality Surveys (C-PainCQ)

Health disparities in pain care continue to exist among non-English-speaking Chinese-Americans. The Pain Care Quality?© (PainCQ) surveys, a valid instrument measuring the quality of pain care from the patient’s perspective, is available only in English currently. This study generated a Chinese version of the PainCQ (C-PainCQ) following a cross-cultural translation approach to address health equity in pain care. A multicultural, bilingual expert team produced a good quality, prefinal version of C-PainCQ. Chinese-speaking patients (n = 55) evaluated conceptual and content equivalence while bilingual participants (n = 13) reviewed semantic equivalence of C-PainCQ items. Feedback from participants, including adding a new item related to education on medication compliance, was used to revise the tool. This C-PainCQ is ready for future research to examine the reliability and construct validity with a large sample of Chinese-speaking patients.

Using storylines for bilingual dissemination of a grounded theory

BACKGROUND

A storyline in a grounded theory study plays two important roles: an analytical tool and a research product. Using more than one language in a study affects the research, including the dissemination of its findings. Very little literature discusses how to develop and disseminate a storyline.

AIM

This paper offers insight into the crafting of a storyline to disseminate a grounded theory study describing how people in Indonesia with diabetes learn about their disease.

DISCUSSION

This paper explains how the researchers developed the storyline. The authors then address considerations in the storyline's development and explain how they disseminated it, as well as the factors that influenced that dissemination.

CONCLUSION

Disseminating findings through a storyline written in the local language ensures that the target audience all have access to a study's outcomes through an easily readable publication.

IMPLICATION FOR PRACTICE

Sharing a storyline helps to disseminate the outcomes of a grounded theory study. It informs the wider community of new knowledge and enables it to review, understand and apply the outcomes of research.

Translation and validation of body image instruments: Challenges, good practice guidelines, and reporting recommendations for test adaptation

Body image research has grown rapidly to include new cultural and linguistic populations, but this gives rise to a need for measurement instruments that are sensitive to local contextual variations while remaining equivalent across groups. Test adaptation, or the translation and validation of a source instrument for use in a new cultural group, is an important part of this process. Here, we offer an operational framework for conducting effective test adaptation. We cover good-practice guidelines for instrument translation and suggest effective strategies for achieving semantic equivalence of translated instruments. We also focus on measurement invariance and provide good-practice and reporting guidelines for conducting exploratory and confirmatory factor analyses. Finally, we suggest good-practice guidelines for demonstrating that scores on translated measures have good reliability and validity. It is our hope that the availability of this article will assist body image scholars seeking to conduct robust test adaptations of existing measurement tools.

Impact of improved primary care on patient satisfaction: Results of a pilot study in the University of the Philippines

Primary care is generally perceived by the public as an inefficient, low-quality source of health care in the Philippines. Taking a toll on local health policies, the repercussions of these views warrant a more holistic approach in understanding patient experience. This paper evaluates the impact of strengthening primary care services on patient satisfaction at the University of the Philippines Health Service (UPHS). A prevalidated 16-item, 5-scale questionnaire was distributed to 200 eligible patients at the start of the study in 2016 and then again in 2017. A significant increase of highly satisfied patients in 13 of 16 questionnaire items was recorded after primary care services in the facility were strengthened. The highest satisfaction scores were reported for overall wait times, coordination of care, and health advice. Our findings suggest that improvements in primary care services through digitalizing health records, financing laboratory and pharmaceutical services, and retraining staff accounts for significant improvements in patient satisfaction. This ultimately bears potential for better clinical outcomes in form of patient retention and long-term care.