Issues in cross‐cultural validity: Example from the adaptation,reliability, and validity testing of a Turkish version of the Stanford Health Assessment Questionnaire

Objective

Guidelines have been established for cross‐cultural adaptation of outcome measures. However, invariance across cultures must also be demonstrated through analysis of Differential Item Functioning (DIF). This is tested in the context of a Turkish adaptation of the Health Assessment Questionnaire (HAQ).

Methods

Internal construct validity of the adapted HAQ is assessed by Rasch analysis; reliability, by internal consistency and the intraclass correlation coefficient; external construct validity, by association with impairments and American College of Rheumatology functional stages. Cross‐cultural validity is tested through DIF by comparison with data from the UK version of the HAQ.

Results

The adapted version of the HAQ demonstrated good internal construct validity through fit of the data to the Rasch model (mean item fit 0.205; SD 0.998). Reliability was excellent (α = 0.97) and external construct validity was confirmed by expected associations. DIF for culture was found in only 1 item.

Conclusions

Cross‐cultural validity was found to be sufficient for use in international studies between the UK and Turkey. Future adaptation of instruments should include analysis of DIF at the field testing stage in the adaptation process.

     

类风湿关节炎患者疼痛评估量表的汉化与信效度检验

目的 引入并汉化类风湿关节炎患者疼痛评估量表（Rheumatoid Arthritis Pain Scale,RAPS）,并检验其信效度。 方法 2020年6月—10月,按照Brislin翻译模式进行翻译、回译、检译,进行文化调试,形成中文版RAPS量表。成立专家委员会检验其内容效度,对上海市某三级甲等医院的236例患者进行调查,测定量表信度。 结果 中文版RAPS共24个条目,各维度Cronbach’s α系数为0.881~0.954,总量表Cronbach’s α系数为0.969。内容效度指数为0.97,各条目均高于0.80,共析出3个公因子,分别为生理维度、感觉维度、情感认知维度,累计方差贡献率为73.582%。 结论 中文版的RAPS具有较好的信效度,适合中国文化背景下类风湿关节炎患者疼痛水平的评估与测量。     

Instruments for measuring mental health recovery: A systematic review

Persons in recovery, providers, and policymakers alike are advocating for recovery-oriented mental health care, with the promotion of recovery becoming a prominent feature of mental health policy in the United States and internationally. One step toward creating a recovery-oriented system of care is to use recovery-oriented outcome measures. Numerous instruments have been developed to assess progress towards mental health recovery. This review identifies instruments of mental health recovery and evaluates the appropriateness of their use including their psychometric properties, ease of administration, and service-user involvement in their development. A literature search using the Medline and Psych-INFO databases was conducted, identifying 21 instruments for potential inclusion in this review, of which thirteen met inclusion criteria. Results suggest only three instruments (25%) have had their psychometric properties assessed in three or more unique samples of participants. Ease of administration varied between instruments, and for the majority of instruments, development included service user involvement. This review updates and expands previous reviews of instruments to assess mental health recovery. As mental health care continues to transform to a recovery-oriented model of service delivery, this review may facilitate selection of appropriate assessments of mental health recovery for systems to use in evaluating and improving the care they provide.     

Validation de l’échelle d’évaluation du vécu de l’accouchement (QEVA) auprès d’une population française

BackgroundA woman's negative perception of her subjective childbirth experience can have consequences on the mother's psychological state and on early mother–baby relationships. To date, there is no validated tool in France allowing to evaluate childbirth experience in a multidimensional way. The aim of this study is to validate the Questionnaire Assessing the Childbirth Experience (QEVA) in a French sample of mothers. This tool was developed in a previous study where the authors combined 25 items into 6 dimensions: representations and expectations, sensory perceptions, feeling of control, perceived social support (medical staff and partner), emotions (positive and negative) and first moments with the baby.MethodsThe sample included 256 women recruited in a maternity ward. Sociodemographic and obstetric characteristics of our sample were compared to those of the French national perinatal survey. The structure of the QEVA with 17 items was explored by an exploratory structural equation modeling (ESEM). An analysis of the internal consistency was conducted on the sub-scores of the identified factors, and the concurrent validity was assessed with the Peri-traumatic Distress Inventory (PDI) through a correlation and its associated t-test.ResultsThe characteristics of our sample and those of the national perinatal survey do not differ on age, marital status, parity, cannabis use, infertility treatment, epidural and baby weight, in favour of the good representativeness of our sample. The study of the QEVA structure revealed a 4-dimensional structure. Analysis of the psychometric qualities showed a good internal consistency, with an observed alpha value ranging from 0.69 to 0.86. The QEVA also shows a good concurrent validity with the peri-traumatic distress scores (r = 0.51).ConclusionTo date, the QEVA is the first standardized tool allowing a multidimensional evaluation of the subjective experience of childbirth. It has been validated on a French population using an exploratory structural equation modeling. This tool, which is simple to use and well accepted by mothers, enables health professionals not only to screen mothers experiencing difficult childbirth and in need of support, but also to adapt health care according to the dimensions of the birth experience and its associated difficulties (emotions during the birth, interactions with health professionals, first moments with the baby, or post-partum emotions).     

The association between health literacy and indicators of cognitive impairment in a diverse sample of primary care patients

Objectives

To confirm the association of health literacy scores as measured by Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) with cognitive ability and education. To determine whether this association differs by cognitive task.

Methods

Cognitive impairment was measured using the Mini-Cog, which combines a delayed word recall task (WRT) and a clock drawing task (CDT) to yield an overall classification of normal versus cognitively impaired. Participants were recruited from primary care clinics that provide care to underserved patients.

Results

Participants (n = 574) were predominantly non-Hispanic black (67%) with a mean age of 46 years, 50% did not have health insurance, 56% had a high school education or less and 21% screened positive for cognitive impairment. Overall cognitive ability and education were significantly associated with health literacy after adjusting for other variables, including race/ethnicity and physical health. We observed a stronger association between the CDT and health literacy than between the WRT and health literacy.

Conclusion

By confirming hypothesized associations, this study provides additional support of the validity of Health LiTT.

Practice implications

Health LiTT is a reliable and valid tool that researchers and clinicians can use to identify individuals who might have difficulty understanding health information.     

医学教育环境评估量表在我国口腔医学生中应用的信度与效度分析

目的：评价医学教育环境评估量表（DREEM）在我国口腔医学生中应用的信度和效度。方法：采用DREEM量表中文版在重庆医科大学口腔医学本科生中进行问卷调查,最终对调查结果进行统计学分析,考评量表的信度和效度。其中信度采用内部一致性信度和分半信度进行分析;效度采用探索性因素分析和收敛效度进行分析。采用SPSS 22.0软件包对数据进行信度和效度检验。结果：共回收有效问卷260份。量表总的Cronbach α系数为0.936,Guttman 分半信度系数为0.816。经过探索性因子分析,提取5个因子,累积贡献率达47.071%,显示量表存在预想的连带关系和逻辑关系。量表的Spearman等级相关系数为0.447~0.556之间。结论：医学教育环境评估量表在我国口腔医学生中应用具有良好的信度和效度,可在我国口腔医学教育环境的评价中进一步推广应用。     

自体牙移植术前难度预判因素的筛选及分析

目的:设计自体牙移植术前难度预判量表,并进行统计学验证。方法:基于文献支持和临床经验总结,对自体牙移植术前难度预判的可能因素进行统计学分析,筛选出相关性较高的11条因素并编制量表,通过96病例进行实际难度判定。采用SPSS 23.0软件包对量表进行信度和效度检验。结果:对96例病例进行难度预判的结果进行统计学分析,量表检测的克隆巴赫系数（信度值）为0.853,皮尔逊相关系数（内容效度值）为0.745,KMO值（结构效度值）为0.704,以上检验均有统计学意义。结论:所设计自体牙移植术前难度预判量表合理可行,适用于初学者进行术前难度预判分析。     

Psychometric Properties of the Self-Report Version of the Strengths and Difficulties Questionnaire in Korea

Objective

To examine the reliability and validity of the self-report Korean version of Strengths and Difficulties Questionnaire (SDQ-Kr) in the community sample.

Methods

The SDQ-Kr was administered to a large sample of school children and adolescents (n=2814) and youth attendees of a psychiatric clinic (n=385) aged 11-16 years. To examine temporal stability, the same questionnaire was administered to a subsample of 167 school youths five to six weeks after the initial assessment. To examine the reliability, we calculated Cronbach''s alpha coefficients for internal consistency and Pearson''s correlations for test-retest stability. In order to evaluate the factorial structure of the SDQ-Kr items, we conducted an exploratory factor analysis (EFA) with varimax rotation. Finally, discriminant validity was examined by using receiver operating characteristic (ROC) curves employing the area under the curve (AUC) as an index of discriminant ability.

Results

Although the internal consistency of some subscales of the SDQ-Kr was somewhat less satisfactory (alpha coefficients; 0.28-0.54) than the English original, coefficients for the total difficulties scores approached sufficient levels (coefficients; 0.69). Other psychometric properties including discriminant validity (AUC for total difficulties and four subscales >0.7) were comparable to those obtained in other language studies.

Conclusion

The self-report SDQ-Kr exhibited a low level of reliability, indicating that some items need to be further evaluated and revised to improve the psychometric properties. We suggest that the total difficulties score could be used with more confidence for screening possible mental health problems in youths.     

The Australian/Canadian Osteoarthritis Hand Index in a community‐dwelling population of older adults: Reliability and validity

Objective

To assess the acceptability and measurement properties of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) applied to a community‐dwelling population of older adults with hand problems.

Methods

Data were obtained from 2 related sources: 2,113 responders to a 2‐stage cross‐sectional postal survey who reported hand problems in the previous 12‐months, and 55 participants with hand problems completing a clinical assessment. The AUSCAN subscales were assessed for data quality and scaling properties. Test–retest reliability was assessed in clinical participants reporting no change in their hand condition at 1 month. Construct and criterion validity were evaluated using other data from the survey and clinical assessment. Internal consistency of the subscales was tested using Cronbach's alpha and item‐total correlations.

Results

AUSCAN subscales had high completion rates in the survey (missing data: 2.3–2.7%). Subscale scores covered the possible range but were skewed towards lower pain, stiffness, and functional problems. Test–retest reliability estimates supported the use of the pain and stiffness subscales (ρ > 0.7), with the estimate for stiffness being slightly lower (ρ = 0.64). The subscales demonstrated both construct validity (significantly higher subscale scores in participants reporting a recent general practitioner consultation for their hand problems and high correlations with hand function performance measures) and criterion validity (high correlations with generic health measures and disease‐specific measures).

Conclusion

The AUSCAN is a valid and reliable measure of hand problems in a community‐dwelling population of older adults. The AUSCAN performs well both in terms of its internal reliability and its relationship with external constructs.