Abstract
BackgroundDisability is a vital public health issue for health care programs. Affluent countries usually prioritize disability-related research, while often it remains neglected in resource-poor countries like Nepal. The aim of this study was to make available a translated and culturally adapted version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) for measuring disability in the Nepalese population.MethodsWHODAS 2.0 (12-items version) was translated into Nepali using a standard forward–backward translation protocol. Purposive and convenience recruitment of participants with psychiatric disabilities was done at the Psychiatry services in a tertiary care hospital. Age and gender-matched participants with physical disabilities were selected from the Internal Medicine department, and participants with no disability were recruited from their accompanying persons. A structured interview in Nepali including the translated WHODAS 2.0 was administered to all participants. Exploratory factor analysis and parallel analysis assessed the construct validity. Content validity was explored, and a quality of life instrument was used for establishing criterion validity. Reliability was measured via Cronbach alpha. Mann–Whitney test explored score differences between the disabled and non-disabled.ResultsIn total, 149 persons [mean age: 40.6 (12.8); 43.6% males, 56.4% females; 61.7% disabled, 38.3% non-disabled] consented to participate. Parallel analysis indicated that a single factor was adequate for the Nepali WHODAS version that captured 45.4% of the total variance. The translated scale got a good Cronbach alpha (= 0.89). Satisfactory construct, content and criterion validity was found. The WHODAS total scores showed a significant difference between the disabled and non-disabled (U = 2002.5; p = 0.015). However, the difference between psychiatric and physical disabilities was not significant, which underscores that the scale is rating disability in general.ConclusionThe one-factor structure of the translated and culturally adapted Nepali-version of WHODAS 2.0 showed acceptable validity and an adequate reliability. For epidemiological research purposes, this version of WHODAS 2.0 is now available for measuring global disability in Nepal.
Highlights
Disability is a vital public health issue for health care programs
The International Classification of Functioning, Disability and Health (ICF) has suggested an operational definition of ‘disability’ as a decrement in domains of functioning at the body, person or societal levels; the concept is considered to be an umbrella covering any kinds of impairment, activity limitations, and restrictions in participation [3, 6]
We aimed to develop a translated and culturally adapted version that can demonstrate adequate psychometric properties of the WHO Disability Assessment Schedule (WHODAS) 2.0, and in this way, we wanted to contribute to the pool of psychometrically sound instruments for epidemiological and clinical use in Nepal
Summary
Disability is a vital public health issue for health care programs. Affluent countries usually prioritize disability-related research, while often it remains neglected in resource-poor countries like Nepal. The instrument gives a general assessment of disability, and it has been used for multiple purposes and in different settings, such as in population surveys, patient related outcome measures, and clinical trials [1, 6, 8]. It has been extensively used in cross-cultural research of general populations, and among those with physical conditions in addition to those with mental, neurological, and substance use disorders [8]
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