Cultural Adaptation Research Articles

Cross-cultural adaptation, reliability, validity and responsiveness of the hand assessment tool (HAT-Sp) in Spain.

The HAT is a questionnaire designed to measure activity limitations in patients with hand and wrist injuries, without assistance. This study aimed to translate, culturally adapt, and validate the psychometric properties of the HAT-validity, reliability, and responsiveness-for different hand conditions in Spain. Cultural adaptation followed recommendations from the American Academy of Orthopaedic Surgeons (AAOS). Validation adhered to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines and involved 262 hand patients. Reliability was assessed with Cronbach's alpha and intraclass correlation coefficient (ICC) (2,1), for test-retest reliability, the standard error of measurement (SEM) and the smallest detectable change (SDC) were used to assess measurement error. Confirmatory factor analysis (CFA) and construct validity using Pearson's correlation coefficient evaluated validity. Responsiveness was measured using effect size (ES) and standardised response mean (SRM). The adaptation process showed no significant changes, with strong expert agreement (Kendall's W=0.81, p<0.001) and patient difficulty below 15%. Reliability was confirmed with an excellent Cronbach's alpha of 0.91, ICC values of 0.99, and low measurement error (SEM of 0.72 and SDC of 1.41). CFA showed a good model fit (RMSEA of 0.04, SRMR of 0.05). HAT showed a high correlation with DASH (r=0.78, p<0.001) and a weak correlation with EQ-5D (r=-0.07, p>0.05). Responsiveness, assessed in 222 patients, yielded a moderate ES of -0.62 and an SRM of -0.72. The HAT-Sp is a well-adapted and widely accepted tool among both Spanish patients and experts. The study demonstrated its strong reliability, validity, and responsiveness in activity limitation without assistance in patients with various hand and wrist injuries following physiotherapy.

Translation, cross-cultural adaptation and validation of the Persian version of the physical workload questionnaire (PWQ)

BackgroundMusculoskeletal disorders in manual workers are often linked to physical workload factors such as heavy lifting, repetitive movements, and awkward postures. These factors can negatively impact health and work efficiency. Simple tools like questionnaires are essential for studying physical workload. This study aimed to translate, culturally adapt, and evaluate the psychometric properties of the Physical Workload Questionnaire for Persian-speaking populations (PWQ-Pr).MethodsThe study involved 255 participants and followed standard guidelines for translation and cultural adaptation. Various psychometric properties were assessed, including face validity through interviews, construct validity via hypothesis testing and factor analysis, content validity using the Content Validity Index (CVI), convergent validity through Pearson’s correlation with the Spine Functional Index (SFI), internal consistency using Cronbach’s alpha, and test-retest reliability assessed through the intra-class correlation coefficient (ICC) and standard measurement error over a 10-day period.ResultsGood internal consistency (α = 0.89) and high test-retest reliability (ICC = 0.90, 95% confidence interval: 0.81–0.94) were obtained. Convergent validity was indicated by a correlation of r = 0.41 (P < 0.001) with the SFI questionnaire. Content Validity (CVI = 0.93) was approved. Factor analysis identified two distinct factors within the PWQ-Pr, explaining 52.07% of the variance. Hypothesis testing indicated significant differences in physical workload across job types and among individuals with and without spinal musculoskeletal disorders (MSDs), with eight hypotheses confirmed out of twelve tested.ConclusionsThe Persian version of the Physical Workload Questionnaire (PWQ-Pr) is a reliable and valid tool for assessing physical workload among Persian-speaking individuals. It is effective in evaluating workload across various job tasks.

The Turkish validity and reliability of Addenbrooke's Cognitive Examination III.

Addenbrooke's Cognitive Examination III (ACE-III) was developed as a screening tool for cognitive disorders. Many countries have proven the cultural adaptation, reliability and validity of ACE-III. To make cultural adaptations of ACE-III for the Turkish population and to examine its validity and reliability. First, ACE-III was translated and adapted into Turkish (ACE-III-TR), then its validity and reliability were examined. The study included 234 people: 93 with dementia (78 Alzheimer's disease (AD) and 15 frontotemporal dementia (FTD)), 46 with mild cognitive impairment (MCI) and 95 healthy. Two blinded speech and language therapists rated the ACE-III-TR simultaneously for interrater validity. The same practitioner retested the same participants 2 weeks later for test-retest reliability. The construct validity of the culturally adapted test was assessed by analysing subsection correlations with the ACE-III-TR total score. The association between the Mini-Mental State Examination (MMSE) total score, relevant subsections and ACE-III-TR total score was examined for criterion validity. Intergroup differences for healthy, MCI and dementia were studied for ACE-III-TR subsections and total score, and cut-off scores were calculated for total score with sensitivity and specificity in differential diagnosis. Attention, memory and ACE-III-TR total scores showed a statistically significant difference between the three groups of dementia, MCI and healthy (p<0.001). Statistically significant positive correlations ranging from 0.571 to 0.929 were found between ACE-III-TR subsections and total scores (p<0.05). A highly significant positive correlation was found between MMSE total score and ACE-III-TR total score (r=0.870). Between the second and first measurements, positive, moderately significant correlations were found for all subsections and ACE-III-TR total (ICC=0.508-0.784, r=0.477-0.646). A high level of agreement was found between two raters for all ACE-III-TR subsections and the ACE-III-TR total score (alpha=0.9296-0.99995). The total ACE-III-TR cut-off score was 79.5 for healthy and MCI and 69.5 for MCI and mild stage dementia. This study found that ACE-III-TR is a sensitive and specific screening test for the diagnosis of MCI and dementia that has high validity and reliability. ACE-III-TR was found to be a valid and reliable tool in dementia, including AD and FTD, and in mild, moderate and advanced dementia. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes. What is already known on the subject ACE was used as a screening tool to detect MCI and to differentiate AD from FTD. ACE was revised by Hsieh etal. in 2013 and updated as ACE-III, which has the advantages of assessing five cognitive domains, not requiring the use of additional materials, and providing an effective and sensitive measurement in a short time. However, the validity and reliability study of the ACE-III in Turkish has not been conducted. What this study adds to the existing knowledge This study demonstrates the validity and reliability of the Turkish ACE-III (ACE-III-TR), which is a sensitive and specific screening test for the diagnosis of MCI and dementia. What are the practical and clinical implications of this work? The ACE-III-TR can provide clinicians and patients with a quick and brief general cognitive screening, indicating both the patient's overall cognitive profile and the measures of each of the assessed domains. By providing a more comprehensive assessment of a person's cognitive profile, it can help the clinician make a differential diagnosis of MCI and dementia. ACE-III-TR may be useful in monitoring the progression of cognitive deficits in clinical practice, research studies and therapy follow-up processes.

Measuring autonomy and respect: a qualitative, cross-cultural adaptation of the Mothers Autonomy in Decision Making scale and Mothers on Respect index instruments in Danish

ObjectiveDecision-making is important in user-involved maternity care and patient experience instruments Mothers Autonomy in Decision Making scale (MADM) and Mothers on Respect index (MORi) are used internationally to measure the user involvement quality and users’ experiences of autonomy and respect. This study aimed to translate and qualitatively adapt the original MADM and MORi instruments to the Danish language and culture. MethodsA forward and backward translation using a standard guideline. Subsequently, qualitative interviews to refine the translation and cultural adaptation by pilot testing the scales. ResultsThe translation process showed cultural differences linked to linguistic variations between Danish and English. Cognitive interviews with 14 diverse pregnant women revealed challenges in women's understanding of decision-making in maternity care. Changes in wording and assisting descriptive texts were made. Further, the order of the MADM items was changed to improve the understanding of decision-making. DiscussionPrimarily, the discussion concerns how decision-making can be understood in the context of maternity care and why women's understanding of decision-making in Danish maternity care in the MADM scale items was challenged. ConclusionThe qualitative pilot test using cognitive interviews after translation of the instruments was a valuable method for cultural adaptation providing important knowledge on women's understanding and perceptions of item contents. The cognitive interviews provided a comprehensive understanding of decision-making and contributed to a thoroughly worked Danish version of the MADM and MORi instruments.

Development and cultural adaptation of text messages for promoting healthy eating among Amazonian schoolchildren.

To develop text messages for a mHealth intervention promoting healthy eating among Amazonian schoolchildren. Two rounds of expert panel analysis and formative research interviews. Western Brazilian Amazon, Cruzeiro do Sul, Acre, Brazil. Included 17 healthcare professionals and 40 caregivers of school-aged children enrolled in the Maternal and Child Health and Nutrition in Acre birth cohort study. Evaluation focused on messages' cultural appropriateness, comprehensibility, and relevance, along with caregivers' understanding and intention to adhere to the recommendations. Quantitative analysis employed the modified Cohen Kappa, the Scale-Content Validity Index Average (S-CVI-Ave), frequency calculations, and a ranking system. Fifty-five text messages were drafted. In the initial stage, eight messages did not achieve a sufficient score and were subsequently revised and reevaluated, ultimately gaining approval. The S-CVI-Ave for each domain was as follows: cultural appropriateness=0.97, comprehensibility=0.96, and relevance=0.97. Formative research indicated a 92% understanding rate and a 70% intention rate to adhere to the proposed suggestions. The final set of messages was successfully culturally adapted and will contribute to the translation and dissemination of Dietary Guidelines for Brazilian Population recommendations to Western Amazon families.

Translation, validation, and reliability of the Modified Occupational Questionnaire into Bahasa Melayu among older persons in Malaysia.

A Modified Occupational Questionnaire (MOQ) is a self-report questionnaire that records the occupational engagement of an individual hourly, focusing on activity category, reason for doing the activity, value to self, and value to society. Understanding the patterns of occupational engagement and meaningful time use in older persons is crucial for predicting physical and psychological health and establishing occupation-based interventions to support healthy aging. However, the MOQ, originally developed in an English-speaking country and may potentially be less suitable for Malaysian older persons, who are predominantly Malay-speaking and have distinct cultural adaptations. This study aimed to translate the MOQ from English to Bahasa Melayu and evaluate its validity and reliability among older persons in Malaysia. The translation, validation, and reliability assessment process followed guidelines from the World Health Organization, with adaptations from Sousa and Rojjanasrirat's recommendations. The process encompassed five steps: forward translation, harmonisation of the forward translation, backward translation, pretesting and cognitive interviews, and psychometric testing to assess the validity and reliability. The Malay version of the MOQ (MOQ-M) demonstrated excellent item-level face validity index (I-FVI) and average scale-level face validity index (S-FVI/Ave), both scoring a perfect 1.00. Additionally, it exhibited excellent item-level content validity index (I-CVI) and average scale-level content validity (S-CVI/Ave), with scores ranging from 0.90 to 1.00 and 0.99 to 1.00, respectively. Internal consistency, measured using Cronbach's alpha, surpassed the minimum threshold for good reliability, with all three average scales in MOQ-M scoring between 0.84 and 0.99. Weighted average Cohen's Kappa coefficient revealed substantial agreement in the test-retest reliability across the three scales. The MOQ-M is a valid and reliable instrument for assessing meaningful time use among Malay-speaking older persons in Malaysia. There was no consumer and community involvement in this study. This study aimed to translate the Modified Occupational Questionnaire (MOQ) into Bahasa Melayu (MOQ-M). The MOQ is a tool used by occupational therapists to understand how unemployed people spend their time and the reasons they are doing it. The translation was necessary because the original version of the MOQ was developed in an English-speaking country and might not be suitable for the Malay-speaking population in Malaysia due to cultural differences. A careful process was followed to make sure the translation was accurate and reliable. The translated version, MOQ-M, was then tested with older persons, most of whom were unemployed, to learn about their daily activities and the reasons for doing them. Understanding their daily routines is important for predicting their health and well-being. The results showed that the MOQ-M worked well, providing useful and consistent information. This means that the tool is reliable and can be trusted to measure how older persons spend their time and what activities are important to them. With this information, programmes can be created to better support older persons, helping them live healthier and happier lives as they age. However, it is important to note that most of the study participants were Malay, so this may not fully represent the different cultural groups in Malaysia.

Reliability and validity of the Spanish version of the Breastfeeding Motivation Scale (BMS). An approach to maternal mental health through psychological factors

BackgroundThe decision to breastfeed can be complex due to the significant benefits of breastfeeding and the various barriers that mothers have to face. In this context, it is important to have adequate instruments that provide insight into a mother's motives for breastfeeding. AimGiven the absence of instruments in this language, this study focuses on translating and validating the Breastfeeding Motivation Scale (BMS) in Spanish mothers. MethodAfter cultural adaptation and an item clarity assessment with a pilot sample (n = 28), exploratory factor analysis was conducted with a preliminary sample (n = 118). The main study involved 193 Spanish primiparous mothers, aged 24-48 (M = 34.5; SD = 4.2), recruited within two months postpartum, where confirmatory factor analysis, internal consistency, group comparisons, and validity measures were explored. ResultsThe findings (χ2=358.925, df=183, p<0.001, CFI=0.971, TLI=0.967, SRMR=0.079, and RMSEA=0.071 [90% CI: 0.060-0.081]) supported the existence of four motivational factors for breastfeeding: i) external and identified, ii) intrinsic, iii) integrated, and iv) introjected motivation. The four factors of the scale showed excellent internal consistency (ωo ranging from 0.77 to 0.92), as well as good convergent and discriminant validity regarding theoretically-related variables (breastfeeding self-efficacy, positive attitude towards breastfeeding, and postpartum depression). Additionally, the scale showed incremental validity with respect to breastfeeding self-efficacy, but not regarding postpartum depression. DiscussionThe BMS evidenced good psychometric properties in Spanish primiparous mothers. The findings are discussed in the context of Ryan and Deci's self-determination theory, also reviewing the study's limitations and implications.

Exploring Cultural Adaptations: A Scoping Review on Adolescent Mental Health and Substance Use Prevention Programs.

Adolescence is a critical period for developing risk behaviors such as substance use, which can impact health in adulthood. Culturally adapted evidence-based programs (EBPs) are promising for prevention. This review explores the processes for culturally adapting EBPs targeting alcohol, tobacco, or cannabis use, and/or anxiety or depression in adolescents. We searched multiple databases, grey literature, and relevant websites for studies detailing the cultural adaptation process of EBPs. We then categorized common adaptation steps, classified adaptations using the cultural sensitivity model, identified prevalent adaptation techniques, and determined effectiveness assessment methods. We reviewed the cultural adaptation processes of 43 EBPs. These programs were implemented in schools (51%), followed by family settings (30%), community settings (14%), and multi-component settings (5%). Eleven key steps were identified across the documents: local needs assessment, program selection, understanding of the program's curriculum, advisory group establishment, first draft of initial adaptation changes, staff selection and training, pilot study, enhanced cultural adaptation, implementation, evaluation and monitoring, and dissemination. Most programs integrated both surface (e.g., use of local images, material translation) and deep adaptations (e.g., incorporation of cultural values like "familismo"). Despite the common use of the cultural sensitivity model, detailed adaptation frameworks were often lacking. The field has advanced, but clearer documentation is needed to improve research and practical application.

Assessing the validity and reliability of the Indonesian version of Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale v1.2

BackgroundThe assessment of Health-Related Quality of Life (HRQoL) is essential in clinical outcomes, focusing on the subjective perception of individuals regarding the physical, mental, and social aspects of health status. However, conducting a large-scale HRQoL assessment poses various challenges that necessitate the development of a non-burdensome instrument. One promising solution is adapting Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health Scale v1.2 through translation, validation, and cross-cultural testing for non-English populations. Therefore, this study aimed to evaluate the validity and reliability of the Indonesian version of PROMIS Global Health Scale for comprehensive HRQoL assessment.MethodThis cross sectional study involved a total of 343 participants, comprising patients, caregivers, and residents of Physical Medicine and Rehabilitation. PROMIS Global Health Scale v1.2 was subjected to translation and cultural adaptation using the Functional Assessment of Chronic Illness Therapy (FACIT) method. Content validity was tested by five experts using the Scale-Content Validity Index (S-CVI), and structural validity was evaluated through Confirmatory Factor Analysis (CFA). Internal consistency and test–retest reliability were examined using Cronbach's Alpha and intraclass correlation coefficient (ICC), respectively.ResultThe Indonesian version of PROMIS Global Health Scale v1.2 showed strong validity and reliability. Content validity analysis produced a S-CVI/Universal Agreement of 0.90 with item analysis factor loading’s of > 0.3. Structural validity results were χ2/df (1.53), RMSEA (0.04), RMR (0.03), and CFI (0.99). The reliability results showed that Cronbach's Alpha for Global Physical Health (GPH) and Global Mental Health (GMH) was 0.61 and 0.77, respectively. Test–retest reliability assessment performed using intraclass correlation coefficients generated values of 0.72 for GPH (95% CI, [0.65,0.78])and 0.70 (95% CI [0.63,0.76]) for GMH.ConclusionThe Indonesian version of PROMIS Global Health Scale v1.2 showed sufficient content validity, structural validity, internal consistency, and reliability, which supported the application of this tool for HRQoL assessment in clinical and research settings.

Persian Version of the Modified Constant Score in Overhead Athletes: A Reliability and Validation Study.

Shoulder impingement syndrome (SIS) is the most common shoulder injury among overhead athletes. The Constant score (CS) is a combined scoring system to evaluate functional status of the shoulder in patients with shoulder pain. Cross-sectionalstudy. Cultural adaptation of the Persian version of CS was conducted using Beaton's guideline. Sixty-three overhead athletes (23.57 [7.50] y old) with SIS completed the final version for psychometric assessment. After 5 to 7 days, a group of 33 patients completed the Persian CS again to assess test-retest reliability. Internal consistency, floor/ceiling effects, and item-total correlation were evaluated in patients with SIS. Concurrent validity was assessed through comparison with the disability of the arm, shoulder, and hand questionnaire scores. Twenty-five healthy athletes (31.80 [7.32] y old) participated for determining discriminant validity. The Persian CS demonstrated good test-retest reliability, with subjective and objective intraclass correlation coefficients of .79 and .80, respectively. The internal consistency was satisfactory (Cronbach alpha = .74). No ceiling or floor effects were noted. The Pearson correlation coefficient between CS and disability questionnaire was -.68. The mean total score for patients was 67.02, while for the healthy group was 96.99 (P = .000). The standard error of measurement was 1.51 for patients and 0.7 for healthy group. The smallest detectable change was 16.95 for patients and 5.71 for healthy group. The translation and cross-cultural adaptation of CS into Persian were successful. The Persian version demonstrates sufficient reliability and validity to evaluate shoulder function in overhead athletes with SIS.

2815 Cross-cultural adaptation and psychometric properties of the Yoruba version of the clinical frailty scale

Abstract Background This cross-sectional study aimed to assess the socio-demographic, anthropometric, and patient characteristics of 94 Yoruba speakers aged 60 years and older, and to validate the Yoruba version of the Clinical Frailty Scale (CFS). Methods This study used a cross-sectional design with a purposive sampling technique and a sample size of 94 participants. This study also made use of the World Health Organisation methodologic guidelines on cultural adaptation of clinical scales. Convergent validity was assessed by evaluating the context that the Clinical frailty scale (CFS) relates to the Edmonton frailty scale, using the Spearman rank correlation coefficient. The known group validity was assessed using one-way ANOVA. Results The mean age of participants was 70.81 ± 8.11 years, with a mean BMI of 27.04 ± 5.61. The cohort included 38 males (44.4%) and 56 females (59.6%). Educational attainment varied, with 20.2% having no education and 9.6% holding postgraduate degrees. The validated CFS has excellent content validity (S-CVI/AVE = 0.96; S-CVI-UA = 0.78). Convergent validity demonstrated a moderate correlation between the CFS and the Edmonton Frail Scale (Spearman’s rho = 0.61, p &amp;lt; 0.01). Known-group validity indicated significant associations between frailty, age (p = 0.02), and BMI (p = 0.007). Conclusion The Yoruba version of the CFS is a valid tool for assessing frailty in elderly Yoruba-speaking populations.

Turkish validity and reliability study of the psychological food involvement scale: PFIS-TR

BackgroundThis study aimed to adapt the Psychological Food Involvement Scale (PFIS) to Turkish culture and test its validity and reliability. The PFIS measures individuals’ psychological, emotional, and social relationships with food, which significantly impact eating behaviors and health.MethodsThe study was conducted with 478 participants aged 18–65. The PFIS underwent a six-stage translation and cultural adaptation process. Data collection was carried out via Google Forms, with participants completing a general information form, PFIS, and the Addiction-like Eating Behavior Scale (ALEBS). Reliability was assessed using the test-retest method. SPSS 24 was used for statistical evaluation, including internal consistency coefficient calculations, factor analysis, and correlation tests.ResultsThe Kaiser-Meyer-Olkin value was 0.94, indicating an adequate sample size, and Bartlett’s test of sphericity was significant (p < 0.05). Exploratory factor analysis revealed a four-factor structure explaining 79% of the variance, with factor loadings > 0.40 and eigenvalues > 1. Confirmatory factor analysis showed good fit indices: χ2 /sd = 2.28, GFI = 0.95, AGFI = 0.93 CFI = 0.98, NFI = 0.94, RMSEA = 0.05, SRMR = 0.04). Internal consistency analysis showed high reliability, with Cronbach’s Alpha coefficients ranging from 0.86 to 0.94 across subscales.ConclusionThe Turkish version of the PFIS was found to be a valid and reliable tool for assessing psychological food involvement in the studied sample of the Turkish adult population.

Convening Hispanic/Latino Caregiving Advisors for Inclusive Research in Dementia Palliative Care.

Background: Dementia clinical trials often fail to include diverse and historically minoritized groups. Objective: We sought to adapt the Alzheimer's Disease and Related Dementias-Palliative Care (ADRD-PC) clinical trial to improve enrollment and address the cultural needs of people with late-stage ADRD who identify as Hispanic or Latino and their family caregivers. Design: Bilingual, bicultural research team members adapted study materials and processes using the Cultural Adaptation Process Model. Investigators and research staff held three meetings with eight Hispanic/Latino advisors-seven dementia caregivers and one health care professional. The first two meetings informed linguistic and cultural adaptation of study materials and processes. After piloting the adapted materials with Hispanic/Latino patient-caregiver dyads in the ADRD-PC study, the third meeting focused on refining protocols for recruitment. Results: Key reflections from advisor meetings guided cultural adaptation: lived experiences on dementia caregiving; patient, caregiver, and clinician interactions in the health care system; and limited knowledge and misconceptions of palliative care. Adaptations to the ADRD-PC study materials included specific consideration of preferred language, word choices (i.e., "palliative care" and "caregiver"), and recruitment considerations related to potential barriers to palliative care or research in general. Conclusions: Cultural adaptation of the ADRD-PC dementia palliative care clinical trial protocol depended on participatory methods and collaboration between Hispanic/Latino caregiver advisors and researchers, including bilingual, bicultural team members. Comparable methods may inform future culturally inclusive approaches to clinical research and thus improve representation of minoritized groups in dementia care research.

Translation and linguistic validation of the Glasgow Benefit Inventory into Danish

Background The Glasgow Benefit Inventory (GBI) is a widely used patient-reported outcome measure in otorhinolaryngology. A Danish version would serve as a validated tool for assessing quality of life among Danish patients after otorhinolaryngological interventions, enabling both cross-intervention, cross-country and cross-cultural comparisons. Aims/objectives This study aimed to translate, culturally adapt and linguistically validate the GBI into Danish. Materials and methods We followed the guidelines of the Quality of Life Special Interest Group – Translation and Cultural Adaptation Group established by ISPOR, to ensure a rigorous adaptation process. Results A Danish version of the GBI was developed in accordance with the guidelines. Minor adjustments were made to enhance clarity, consistency, and ease of use for Danish respondents. These modifications were carefully considered to preserve the original concepts and intent of the original questionnaire. Conclusions and significance The GBI has been successfully translated, culturally adapted, and linguistically validated for use in Danish. This version provides a valuable tool for evaluating the impact of otorhinolaryngological operations/treatments by measuring the patient-reported outcomes in Danish otorhinolaryngology patients.

Mental Health Outcomes Among Female Ukrainian Refugees in Germany—A Mixed Method Approach Exploring Resources and Stressors

Background: Mental health outcomes among female refugees are complex and multifaceted. This study examines the mental health outcomes and coping resources of female Ukrainian refugees in Germany using a mixed methods approach with qualitative focus groups and quantitative assessments. Methods: This study employs a mixed methods approach, combining qualitative and quantitative methodologies. Three focus group discussions with fifteen participants were conducted in Hamburg in April 2023. A stepwise qualitative data analysis was done using a deductive coding technique. The quantitative analysis focused on descriptive statistics to summarize the data and provide an overview of participants’ mental health and well-being. Results: Our findings show that 43% of participants reported anxiety symptoms, and 21% showed signs of depression—many experienced isolation and disconnection and were struggling with cultural adaptation and the emotional toll of displacement. Despite challenges, participants utilized various coping strategies, such as staying active, volunteering, and seeking community support. However, significant barriers to accessing mental health services, especially for children, were identified. Conclusions: The study underscores the need for tailored interventions, including language support, accessible mental health resources, and community engagement, to foster resilience and well-being. It highlights the importance of comprehensive support systems for refugee populations in host countries, such as active lifestyles, social support, volunteer work, and successful integration.

Enhancing the understanding of safety and the quality of patient care among medical and health sciences students in interprofessional climate: an interventional study

BackgroundInterprofessional education (IPE) plays an essential role in improving healthcare outcomes through achieving shared understanding. Unfortunately, most healthcare professionals have not received training for patient safety (PS) in an interprofessional setting, which can meet the societal medical needs. This study aimed to foster the understanding of senior medical, dental, pharmacy and health sciences students about PS and quality of care at the University of Sharjah (UoS) in UAE.MethodsUsing a convenience sampling technique, we recruited students from the College of Medicine (CoM), College of Pharmacy (CoP), College of Dental Medicine (CDM), and College of Health Sciences (CHS) of UoS. The study was conducted in spring 2023, and an ethical approval was obtained from the UoS Research Ethics Committee (REC-21–12-12). After a thorough literature search, a bespoke English language questionnaire was developed covering three domains—medical professionalism, leadership in healthcare, and precision medicine. To ensure its validity across different settings, cultural adaptation was ensured with reiterative revision among the panel of experts. The online synchronous real-time workshop included interactive resource sessions, breakout room discussions using real clinical cases, and pre-post surveys using the questionnaire.ResultsA total of 248 students and 20 facilitators participated in the workshop. CoM had the highest representation (47.5%), followed by CoP (36.5%), CHS (13.3%), and CDM (2.7%). There was a statistically improved understanding of the participants, as reflected by significantly high scores of post-test survey in all domains of PS across all colleges (p < 0.001). Notably, students in years four and five from CoM and CoP showed significant improvement in their perceptions than other colleges (p < 0.001). The participants encountered challenges of weak internet connections, software issues, technical failures, and power outages during the workshop.ConclusionThis study highlights the positive impact of an IPE-based interventional workshop on students' attitudes, perceptions, and insights about PS and quality of care. Students' understanding and insights of PS and quality of care underscore the paramount role of IPE in improving perceptions and approaches towards PS in the context of healthcare education.

Language proficiency and cultural intelligence: A meta‐analysis based on conservation of resources theory and the overt‐covert model of culture

AbstractResearch on language proficiency and cultural intelligence (CQ) has developed somewhat independently, resulting in a partial understanding of the personal resources required to facilitate job performance and adaptation in a foreign culture. Our meta‐analysis synthesizes the two constructs by drawing on the overt‐covert model of culture and the conservation of resources (COR) theory. Specifically, we propose that language proficiency and CQ complement each other by overcoming resource losses arising from overt (i.e., explicit language differences) and covert (i.e., implicit rules) cultural differences, respectively. We further propose that the host‐country communication context (i.e., higher vs. lower context dependence) moderates the effects of language proficiency and CQ. Meta‐analytic results based on 355 field samples (N = 128,358) support our hypotheses and show that (1) both language proficiency and CQ are positively related to job performance and cultural adaptation, (2) the effects of language proficiency are accentuated in cultures with lower communication‐context dependence, while (3) the effects of CQ are accentuated in cultures with higher communication‐context dependence. We discuss the implications of these findings for future research and practice.

An empirical study on intercultural contact and intercultural communication competence of Chinese international students in the UK

This study explores the relationship between intercultural contact (IC) and intercultural communication competence (ICC) among Chinese international students at Lancaster University, UK. Using a mixed-methods approach, the research analyzes the frequency and nature of IC and self-assessed ICC levels.Findings reveal a predominance of indirect IC, such as media consumption and cultural events, over direct interactions with native English speakers. Self-assessment of ICC indicates strong attitudes towards cultural diversity but identifies areas for improvement in domestic cultural knowledge and cognitive skills.Statistical analysis demonstrates a significant positive correlation between IC and ICC, with direct IC positively impacting communication skills and indirect IC contributing to cultural knowledge and positive attitudes.These findings emphasize the importance of both direct and indirect IC in developing ICC. Educational institutions should focus on facilitating diverse IC opportunities to enhance students’ language proficiency, cultural adaptation, and overall well-being.

Evaluating Smart Home Usability and Accessibility in Early Detection and Intervention of Mental Health Challenges Among Older Adults: A Narrative Review and Framework

Background: Smart home technologies (SHTs) hold promise for supporting older adults by enabling early detection and intervention in mental health challenges such as depression, anxiety, and cognitive decline. However, adoption remains limited due to usability, accessibility, and privacy concerns. Methods: This narrative review examined the literature from 2010 to early 2024 related to SHTs and their impact on older adults’ mental health. In total, 34 relevant studies met the inclusion criteria, and also, a standardized quality assessment tool was used to evaluate the methodological soundness of the included studies. Results: Findings reveal that interface complexity, cognitive overload, high costs, and privacy concerns are significant barriers to adoption. Accessibility challenges, including physical and sensory impairments, further reduce engagement and inclusivity. Key facilitators for user acceptance include user-centric design, personalization, participatory co-development, and cultural adaptations. SHTs incorporating AI-driven features, such as behavioral monitoring, medication reminders, and social engagement tools, demonstrate significant potential for early mental health interventions. Based on these findings, we propose a holistic framework integrating technical innovation with human-centered design to address these challenges and optimize SHTs for mental healthcare. Conclusions: Tailored systems that prioritize usability, accessibility, ethical data management, and user feedback can empower older adults to maintain autonomy, support aging in place, and enhance their quality of life with dignity.

A Validated Cultural Adaptation and Translation of the CLEFT-Q Patient Reported Outcome Measure (PROM) from English into Italian

Cleft lip and/or palate (CL/P) is a prevalent congenital malformation, affecting approximately 1 to 7 children per 1000 live births, with consequences impacting both appearance and functional abilities such as speech, hearing, and orodental health. These factors contribute to significant psychological challenges and reduced quality of life (QoL) in affected individuals. Treatment typically involves a multidisciplinary approach that begins during pregnancy and continues into young adulthood, ideally managed by specialized centers with dedicated cleft teams. In Italy, the Cleft Center of Milan, part of the European Reference Network (ERN CRANIO), is a leading facility providing care for CL/P. International collaboration and standardized outcome measures, like Patient-Reported Outcome Measures (PROMs), are essential in ensuring high-quality patient-centered care. The CLEFT-Q is a widely used, CL/P-specific PROM developed to assess aspects of facial appearance, psychosocial well-being, and functional abilities. Though originally developed in English, the Cleft Center of Milan, along with ERN CRANIO, undertook the translation and validation of the CLEFT-Q into Italian to enable its implementation in Italy. The translation process adhered to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines and included expert review, patient interviews, and adjustments based on participant feedback. The study confirmed the effectiveness of the CLEFT-Q in capturing relevant patient-reported outcomes in Italian-speaking populations. It also highlighted the importance of standardized PROMs in improving CL/P treatment outcomes and facilitating international research collaboration. The paper concludes with recommendations for the integration of PROMs in CL/P care and explores alternative PROMs, such as the Pediatric Quality of Life Inventory (PedsQL) and the Cleft Hearing, Appearance, and Speech Questionnaire (CHASQ), which could complement the CLEFT-Q for more comprehensive patient assessments.