Cross-cultural adaptation of instruments assessing breastfeeding determinants: a multi-step approach.
ABSTRACT: BACKGROUND: Cross-cultural adaptation is a necessary process to effectively use existing instruments in other cultural and language settings. The process of cross-culturally adapting, including translation, of existing instruments is considered a critical set to establishing a meaningful instrument for use in another setting. Using a multi-step approach is considered best practice in achieving cultural and semantic equivalence of the adapted version. We aimed to ensure the content validity of our instruments in the cultural context of KwaZulu-Natal, South Africa. METHODS: The Iowa Infant Feeding Attitudes Scale, Breastfeeding Self-Efficacy Scale-Short Form and additional items comprise our consolidated instrument, which was cross-culturally adapted utilizing a multi-step approach during August 2012. Cross-cultural adaptation was achieved through steps to maintain content validity and attain semantic equivalence in the target version. Specifically, Lynn's recommendation to apply an item-level content validity index score was followed. The revised instrument was translated and back-translated. To ensure semantic equivalence, Brislin's back-translation approach was utilized followed by the committee review to address any discrepancies that emerged from translation. RESULTS: Our consolidated instrument was adapted to be culturally relevant and translated to yield more reliable and valid results for use in our larger research study to measure infant feeding determinants effectively in our target cultural context. CONCLUSIONS: Undertaking rigorous steps to effectively ensure cross-cultural adaptation increases our confidence that the conclusions we make based on our self-report instrument(s) will be stronger. In this way, our aim to achieve strong cross-cultural adaptation of our consolidated instruments was achieved while also providing a clear framework for other researchers choosing to utilize existing instruments for work in other cultural, geographic and population settings.
Project description:BACKGROUND:The lack of culturally appropriate instruments to measure hope across cultural settings is a barrier to assessing and addressing the relationship between hope and health outcomes. The study aim was to adapt and evaluate the psychometric properties of the Herth Hope Index (HHI) in Kinyarwanda in a population of healthcare recipients and healthcare workers in Rwanda. METHODS:A transcultural translation and adaptation of the HHI was conducted using qualitative methods (n?=?43) to achieve semantic, content, and technical equivalence. The adapted instrument was administered to a purposive sample (n?=?206) of Rwandan healthcare patients and providers. Temporal reliability, internal reliability using Cronbach's alpha, and construct validity using confirmatory factor analysis (CFA) were assessed. RESULTS:The Herth Hope Index-Kinyarwanda (HHI-K) was found to have strong internal consistency (??=?0.85) and test-retest reliability (r?=?0.85). The original HHI three-factor structure fit the data well in CFA (normed chi-square?=?1.53; root mean square error of approximation?=?0.05; standardized root mean square residual?=?0.05; comparative fit index?=?0.96; Tucker-Lewis Index?=?0.95). CONCLUSION:This article presents the first rigorous cultural adaptation of the HHI in a low-income country. The HHI-K has acceptable psychometric properties, resulting in a new useful tool for research, program development, and evaluation in Rwandan healthcare settings. The HHI-K instrument can be used to assess the effectiveness of programs that aim to promote hope and health outcomes across health system- and individual-levels. The process also provides a feasible model for adaptation of a positive psychosocial tool for both patients and providers in low-resource settings.
Project description:Background:The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. Methods:This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. Results:The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg?=?0.97 and S-CVI/UA?=?0.86; and S-CVI/Avg?=?0.96 and S-CVI/UA?=?0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa?=?0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7?=?almost perfect, 2?=?substantial, and 2?=?moderate). Conclusions:The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.
Project description:BACKGROUND: A rigorous cross-cultural adaptation process of an existing instrument could be the best option for measuring health in different cultures, instead of developing a new tool, and prior to psychometric and validation testing. The Dental Discomfort Questionnaire (DDQ), a validated instrument for assessing toothache in young children, has not been cross-culturally adapted so far. This study aimed to explore the detailed phases of the cross-cultural adaptation process of a pain assessment tool, presenting the example of the DDQ Brazilian-Portuguese adapted version. METHODS: The study design was based on the universalist approach, which consists of a sequential analysis to assess the relevant phases of a cross-cultural process before testing the measures of the instrument: conceptual, item, semantic, and operational equivalences. Systematic information was gathered from the literature, expert discussions, translations, and pre-testing through cognitive interviews with Brazilian population. RESULTS: Detailed description of the three major phases for a cross-cultural adaptation process was given. Notes of the changes done in the structure of the presented instrument (DDQ) were specifically pointed out at each phase. Conceptual and item analyses showed that there are similarities in the DDQ construct between the original and Brazilian cultures that require minor modifications. Translations and back-translations allowed the development of the preliminary Brazilian-Portuguese version of the DDQ, which was tested and underwent other minor changes to improve its comprehensibility. CONCLUSIONS: Describing the phases was important to show how changes are made in a cross-cultural adaptation process of an instrument. This also could help researchers in adapting similar pediatric pain assessment tools to different cultures. A Brazilian-Portuguese version of the DDQ was presented.
Project description:BACKGROUND: Consideration of the quality of life in relation to individual health status is crucial for planning and maintaining a system of patient-centered care. Until recently, there have been no suitable instruments to assess health-related quality of life (HRQoL,) of children and adolescents with severe, non-ambulant cerebral palsy (GMFCS functional levels IV and V). The "Caregiver Priorities and Child Health Index of Life with Disabilities Questionnaire" (CPCHILD) was developed in English specifically for this population, and has been validated in Canada. The aim of this study was to translate and adapt the CPCHILD Questionnaire into Brazilian Portuguese, thus permitting researchers in Brazil to access this important tool for measuring HRQoL in this population, as well as the possibility of making comparisons with other studies that use the same questionnaire in other languages. METHOD: The cross-cultural adaptation included two forward translations by independent translators, their synthesis, two back-translations by independent translators, an assessment of the versions by an expert committee and the development of a pre-final version, which was tested on 30 caregivers of children (5 -18) with severe cerebral palsy (GMFCS IV & V). RESULTS: Despite the relative equivalence between the two translations, some items required adaptations for the synthesized version. Certain modifications were necessary in the pre-final version to achieve idiomatic equivalence. The modifications were required to account for the socioeconomic and cultural levels of the target population. CONCLUSION: The translation and cross-cultural adaptation of the CPCHILD questionnaire provides a Brazilian Portuguese equivalent to measure the HRQoL of children with severe developmental disabilities, with the potential to measure the benefits of various procedures that are indicated for these patients. This adaptation exhibited a satisfactory level of semantic equivalence between the Portuguese target and the original English source versions. The validity of the Brazilian version of the instrument must be established in the future by assessing its psychometric properties on Brazilian epidemiological samples.
Project description:BACKGROUND:Culturally sensitive, reliable and valid cultural belief scales for colorectal cancer (CRC) screening in Koreans in the Republic of Korea are not available in the literature. The purpose of this study was to adapt and validate existing cultural belief scales for CRC screening in Koreans. METHODS:Individual interviews, expert reviews, and a pilot test were conducted for instrument adaptation, and a cross-sectional survey with 884 Koreans was conducted for instrument validation. Construct validity using exploratory and confirmatory factor analyses and reliability of the Korean version of the instruments were examined. RESULTS:Exploratory factor analysis using c four factors that accounted for 48.12% of the variance. The validity and reliability of the cultural belief scales were supported by confirmatory factor analysis and Cronbach's alpha. CONCLUSIONS:The results of the present study showed that the four-factor cultural belief scales were culturally sensitive, reliable and valid in Koreans. The final cultural belief scales could be used to identify cultural beliefs more accurately and specifically, as well as to develop effective interventions to increase CRC screening in Koreans in the Republic of Korea.
Project description:INTRODUCTION:Instrumental activities of daily living (IADL) are cognitively complex activities related to independent living in the community. Robust IADL scales are needed, however the psychometric properties of instruments have been little evaluated. There is no validated instrument for Sri Lankan older populations. Sri Lanka has the highest proportion of older people in South Asia with rapid population ageing. Therefore, it is essential to have standard instruments to assess activity limitations. We aimed to cross-culturally adapt the original Lawton Instrumental Activities of Daily Living Scale from English to Sinhala and evaluate the psychometric properties of the Sinhala version. METHODS:Cross-cultural adaptation of the instrument was performed. The instrument was validated in a sample of 702 community-dwelling older adults aged 60 years and above in Sri Lanka. Reliability (internal consistency and inter-rater reliability) was assessed. Construct validity of the scale was evaluated by performing exploratory and confirmatory factor analysis and testing convergent and divergent validity. RESULTS:The Lawton IADL scale was successfully adapted to Sri Lankan context. Internal consistency of the scale was very high (Cronbach's alpha = 0.91). Very good inter-rater reliability was observed with very good agreement for all items. Inter-class correlations for overall IADL score ranged from 0.57 to 0.91. Results of the exploratory and confirmatory factor analyses supported the unidimensionality of the scale. Goodness of fit indices in confirmatory factor analysis were in acceptable range (CFI = 0.98, SRMR = 0.06, NNFI = 0.97). Strength of associations were significant and in the expected direction. Results of the known group validity were also significant, confirming the convergent and divergent validity. CONCLUSION:The Lawton IADL scale was successfully translated and culturally adapted to Sinhala language. The Sinhala version demonstrated excellent reliability and construct validity. Given good psychometric properties, this scale would be recommended for use in future research.
Project description:This paper describes the development of a Japanese version of the Perceived Stress Scale (PSS), and examines the equivalence between the original and translated version. The PSS is one of the few instruments to measure a global level of perceived stress, and has been widely used in a range of clinical and research settings. The PSS has already been translated into several languages, but there is no validated Japanese version.A forward-backward procedure was implemented. Multiple forward and backward translations were produced, and a panel of reviewers verified conceptual and semantic equivalence between the source and final versions. Non-professional translators who were not brought up in bilingual families were used in order to enhance representativeness of language in the target populations. The PSS was administered to 222 native English speakers and the Japanese version (PSS-J) to 1320 native Japanese speakers.Factor analysis showed similar factor loadings of the items and satisfactory factorial agreement between the PSS and PSS-J. Cronbach's alpha coefficient was high for both versions and for each factor.It is concluded that the PSS and PSS-J are substantially equivalent and suited for use in comparative cross-cultural studies.
Project description:BACKGROUND:The Standardised Nordic Questionnaire (SNQ) is an instrument to analyse the musculoskeletal symptoms in an ergonomic or occupational health context. We aimed to cross-culturally adapt and evaluate the psychometric properties of the SNQ among Spanish musicians. METHODS:Cross-cultural adaptation and psychometric validation (reliability, validity, and feasibility) was performed. Reliability was analysed by test-retest reliability (Cohen's Kappa) and internal consistency (Kuder-Richardson). Content and face validity were measured by the Expert Committee and the opinion of participants. Construct validity (Mann-Whitney U test) was measured by comparing with questionnaires used to assess pain and disability in neck, shoulders, upper back, and low back regions. Feasibility was calculated with the average response time. RESULTS:A total of 312 Spanish musicians were included. The Spanish version of SNQ achieved good semantic, conceptual, idiomatic, and content equivalence. For most of the variables, test-retest reliability was good to very good (k = 0.60-0.81). The internal consistency showed good to acceptable (Kuder-Richardson 20 (KR20) = 0.737-0.873). Participants with versus without musculoskeletal problems in a related region showed significantly higher disability/pain, indicating a good construct validity. About the feasibility, the average response time of the questionnaire was 6 min (±2). CONCLUSIONS:The results show that the Spanish SNQ is reliable, valid, and feasible screening tool to assess musculoskeletal problems among musicians.
Project description:The validity of physical activity (PA) self-report measures can be a problem when using these measures with target populations that differ from the population for which the measures were originally developed.Describe an approach to further tailor PA self-report measures to a target community, and report on focus group and cognitive interview findings.Topics relevant to culturally tailoring measures are discussed, including translation, focus groups, and cognitive interviews. We describe examples from our own work, including focus groups and cognitive interviews conducted to assess Latinos' interpretations of PA questions derived from various epidemiological surveys that were developed in White communities.Findings from focus groups and cognitive interviews provide valuable information about the comprehension, interpretation, and cultural relevance of the PA questions to Latino communities.It is recommended that investigators collect formative data to better assess the equivalence of items being applied to a different cultural group. Guidelines for cultural attunement of self-report instruments are described to promote more uniform and rigorous processes of adaptation and facilitate cross-cultural investigations.
Project description:BACKGROUND:Cleft lip and/or palate (CL/P) is a common congenital craniofacial anomaly that may negatively affect an individual's appearance, health-related quality of life, or speech. In Spain, Colombia, and Chile the overall prevalence of CL/P ranges from 0.53 to 1.59 cases per 1000 live births. Currently, there is no patient-reported outcome (PRO) instrument that is specific for patients with CL/P. The CLEFT-Q is a new PRO instrument developed to measure outcomes of treatment in patients 8 to 29 years of age with CL/P. The aim of this study was to translate and culturally adapt the CLEFT-Q for use in Colombia, Chile, and Spain. METHODS:The CLEFT-Q was translated from English to 3 Spanish language varieties (Colombian, Chilean, and Spanish (Spain)) and Catalan. Translation and cultural adaptation guidelines set forth by the International Society for Pharmacoeconomics and Outcomes Research were followed. RESULTS:The field- test version of the CLEFT-Q consisted of 13 scales (total 154 items) measuring appearance, health-related quality of life, and facial function. Forward translations revealed 10 (7%) items that were difficult to translate into Chilean, and back translations identified 34 (22%) and 21 (13%) items whose meaning differed from the English version in at least 1 of the 3 Spanish varieties and Catalan respectively. Twenty-one participants took part in cognitive debriefing interviews. Participants were recruited from plastic surgery centres in Bogotá, Colombia (n?=?4), Santiago, Chile (n?=?7), and Barcelona, Spain (n?=?10). Most participants were males (n?=?14, 67%) and were diagnosed with CL/P (n?=?17, 81%). Participants reported difficulty understanding 1 item in the Colombian, 1 item in the Spanish (Spain), and 11 items from the Catalan version. Comparison of the 3 Spanish varieties revealed 61 (40%) of the 154 items whose wording differed across the 3 Spanish versions. CONCLUSION:Translation and cultural adaptation processes provided evidence of transferability of the CLEFT-Q scales into 3 Spanish varieties and Catalan, as semantic, idiomatic, experiential, and conceptual equivalence of the items, instructions, and response options were achieved.