Abstract
BackgroundWhile Indigenous Australians are believed to be at a high risk of psychological illness, few screening instruments have been designed to accurately measure this burden. Rather than simply transposing western labels of symptoms, this paper describes the process by which a screening tool for depression was specifically adapted for use across multiple Indigenous Australian communities.MethodPotential depression screening instruments were identified and interrogated according to a set of pre-defined criteria. A structured process was then developed which relied on the expertise of five focus groups comprising of members from primary Indigenous language groups in central Australia. First, focus group participants were asked to review and select a screening measure for adaptation. Bi-lingual experts then translated and back translated the language within the selected measure. Focus group participants re-visited the difficult items, explored their meaning and identified potential ways to achieve equivalence of meaning.ResultsAll five focus groups independently selected the Primary Health Questionnaire 9, several key conceptual differences were exposed, largely related to the construction of hopelessness. Together with translated versions of each instrument for each of the five languages, a single, simplified English version for use across heterogeneous settings was negotiated. Importantly, the ‘code’ and specific conceptually equivalent words that could be used for other Indigenous language groups were also developed.ConclusionsThe extensive process of adaptation used in this study has demonstrated that within the context of Indigenous Australian communities, across multiple language groups, where English is often a third or fourth language, conceptual and linguistic equivalence of psychological constructs can be negotiated. A validation study is now required to assess the adapted instrument’s potential for measuring the burden of disease across all Indigenous Australian populations.
Highlights
While Indigenous Australians are believed to be at a high risk of psychological illness, few screening instruments have been designed to accurately measure this burden
The extensive process of adaptation used in this study has demonstrated that within the context of Indigenous Australian communities, across multiple language groups, where English is often a third or fourth language, conceptual and linguistic equivalence of psychological constructs can be negotiated
Despite a lack of empirical data, Indigenous Australians are considered to be at high risk of psychological illness [1]: rates of self-harm and suicide are higher [2,3] and national data suggests that Aboriginal people are more likely to be hospitalised for or die from mental and behavioral disorders than their non-Aboriginal counterparts [4]
Summary
While Indigenous Australians are believed to be at a high risk of psychological illness, few screening instruments have been designed to accurately measure this burden. Whilst Indigenous Australians experience poorer health than other Australians, there exists little representative data to outline the burden and consequences of mental illness. This is problematic given the national focus on overcoming Indigenous health disadvantage, which will require consideration of the contribution of psychological illness to entrenched health inequalities. Despite a lack of empirical data, Indigenous Australians are considered to be at high risk of psychological illness [1]: rates of self-harm and suicide are higher [2,3] and national data suggests that Aboriginal people are more likely to be hospitalised for or die from mental and behavioral disorders than their non-Aboriginal counterparts [4].
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