Conceptual Equivalence Research Articles

Inventario de Ideación Suicida Positiva y Negativa (PANSI): Propiedades Psicométricas en Universitarios Peruanos

It is necessary to rely on tools that evaluate suicidal ideation, given that it is one of the first factors that lead to suicide. This research performed an adaptation process of the Positive and Negative Suicidal Ideation (PANSI) so that it can be used in Peruvian university students. Two samples were studied, one before and one during the COVID-19 pandemic. At the methodological level, a rational procedure was followed with expert judges and individuals from the population to achieve cultural and conceptual equivalence of the tool;while, at the statistical level, three theoretical models were tested: unidimensional, orthogonal and oblique. The two-factor correlated model revealed better fit indexes for both samples, with optimal levels of reliability. We completed a new version of the PANSI and discussed its theoretical basis for improving inferences from this tool.

Translation and cultural adaptation of Shoulder Pain and Disability Index in Urdu (SPADI-U)

Introduction: Shoulder joint is the third most-frequently involved structure in musculoskeletal conditions globally. More than 30 shoulder specific questionnaires have been generated in English in order to measure shoulder related quality of life and incidence of pain. Among all these questionnaires, Shoulder Pain and Disability Index (SPADI) is one of the most useful tools, therefore it has been translated, culturally adapted and validated to many languages. This study was carried out to translate and culturally adapt SPADI into Urdu language. Material & Methods: Study was conducted over a timeframe of three months, that’s March 2019 to May 2019 in Helping Hand Institute of Rehabilitation Sciences, Mansehra. Translation and cultural adaptation of Shoulder Pain and Disability Index (SPADI) was carried out according to internationally published six-step guidelines. In accordance with the provided directions a number of changes were made to the six-step guidelines. Through consensus of the expert panel, its final version was field in and tested on forty individuals with and without shoulder pathologies in an equal proportion. Results: Changes were required during each step of Beaton’s guidelines for cross-cultural adaptation. Translators during ‘forward and backward translations’ had faced a number of obstacles. Minor differences were found during reconciliation process and expert panel review. The pilot testing highlighted, misinterpretation among target population regarding item 3, 5, 7 and 8 of disability scale due to cultural differences. These items were adjusted according to cultural relevance and conceptual equivalence to the original version. Final version was found relevant and easily understood by the patients having shoulder pathology. Conclusion: SPADI-U has good face and content validity and it can be used to measure shoulder related quality of life in Urdu speaking population.

Validation of the Korean Version of the Patient-Reported Outcomes Information System® Emotional Distress Measures

Purpose: This methodological study aimed to translate the Korean version of the Patient-Reported Outcomes Measurement Information System® item bank-emotional distress (i.e., depression, anxiety, and anger) for adults and evaluate its psychometric properties. Methods: Translation involved forward translation, back translation, expert review, harmonization and quality assurance, and cognitive testing. Psychometric properties were evaluated with a community sample of 201 adults. To assess the unidimensionality of the measures, we used factor analysis to examine construct validity. Results: All items of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress measures were translated through a rigorous translation process, and semantic, conceptual, and normative equivalences between the original and Korean version were ensured. Exploratory factor analysis revealed that all items loaded on one dominant factor. The Korean Patient-Reported Outcomes Measurement Information System measures demonstrated acceptable psychometric properties and unidimensionality. Conclusion: The Korean version of the Patient-Reported Outcomes Measurement Information System item bank-emotional distress (i.e., depression, anxiety, and anger) for adults is reliable and valid. Hence, it may be utilized extensively in clinical and research settings and contribute to patient-centered care.

A Portuguese Adaptation of the Teruel Orthorexia Scale and a Test of Its Utility with Brazilian Young Adults.

The aims for this study were to perform a Portuguese language cross-cultural adaptation of the Teruel Orthorexia Scale (TOS) and to evaluate the scale's psychometric properties, including verifying the frequency of behaviors characteristic of orthorexia nervosa and healthy orthorexia, among a group of Brazilian gym users. First, we adapted the Spanish version of the TOS to the Brazilian Portuguese language following international protocols to guarantee idiomatic, semantic, conceptual, and cultural equivalence. Then participants completed both the new Portuguese version of the TOS and a socioeconomic questionnaire. Among our sample of 226 young Brazilian adults (63.7% men; M age = 28.8, SD = 5.1 years), we assessed the bi-factorial model of the TOS through factorial, convergent, and discriminant validity, reliability, and factorial invariance. We calculated the mean scores of the TOS factors and the frequency of behaviors of both orthorexia nervosa and healthy orthorexia. The new Portuguese version was well understood by participants, and the TOS bi-factorial model presented adequate psychometric properties and showed invariance in independent subsamples and in men and women. The mean scores were different between sexes only for orthorexia nervosa, with women obtaining higher values. The frequency of orthorexia nervosa behaviors was 5.3% and of healthy orthorexia was 41.2%. Based on these findings, the Brazilian Portuguese version of the TOS can be a useful tool for investigating orthorexia-like behaviors in future research.

Improving diversity in research and trial participation: the challenges of language

Improving diversity in research and trial participation: the challenges of language

Psychometric Evaluation of the Korean Version of Control Attitudes Scale-Revised.

Heart failure (HF) is a chronic heart condition that requires patients to adapt to the disease and maintain a high degree of self-management. Patients with HF commonly feel loss of control, which has a negative effect on their compliance to self-care, health-related quality of life, and health outcomes. To promote self-care behavior and to develop healthy coping mechanisms, it is important to understand individual HF patients' perceived control, a self-generated belief that one has the ability to bring forth desired outcomes. Currently, there is no valid and reliable Korean instrument available in measuring perceived control among patients with HF. The objective of this study was to cross-culturally translate, adapt, and evaluate psychometric properties of the Korean version of Control Attitudes Scale-Revised (KCAS-R) in Korean patients with HF. The KCAS-R was developed using a translation/back-translation process and an examination of semantic and conceptual equivalence. Reliability was assessed using Cronbach α to determine internal consistency, and item-total and interitem correlations were assessed to test item homogeneity. The construct validity was examined using exploratory factor analysis, confirmatory factor analysis, and testing hypotheses for known associations with self-efficacy, self-care confidence, and self-care. A convenience sample of 138 patients with HF were included for the psychometric testing of an 8-item KCAS-R. The Cronbach α for internal consistency was 0.835, and the item-total correlation was acceptable. The construct validity revealed a 2-factor structure accounting for 63.23% of the total variance. The KCAS-R was associated with higher levels of self-efficacy, self-care confidence, and self-care. In addition, patients with higher perceived control had less depression and anxiety compared with those with lower levels of perceived control. This study provided support for the satisfactory reliability and validity of the 8-item KCAS-R in measuring perceived control in Korean patients with HF.

PNS2 Does the Type of Device Affect Usability or Conceptual Understanding of Patient-Reported Outcomes? Qualitative Evidence and Implications for Bring-Your-Own-Device (BYOD)

Today, around 50% of clinical trials capture clinical outcomes assessments electronically. For the initial paper to electronic migration, cognitive debriefing and usability testing (CD/UT) is typically conducted to ensure the meaning of assessments are not altered. However, what happens when we move between different electronic executions is less clear. While there is some variation across license holders, a significant portion request CD/UT for each electronic device. Whether this is needed, and how it would work using Bring-Your-Own-Device (BYOD) where there is significant variation in devices used, is unknown. To better understand the level of variation between different electronic devices, we synthesized results from 7 conceptual equivalence and usability studies conducted internally by ERT between 2017-2019. To assess equivalency of generic diaries using a range of response scales across different devices (handhelds, tablets, and PCs), 4 studies included in-person qualitative interviews with adult participants and 3 used expert screen review. All qualitative interview studies found that devices were easily and similarly usable by participants. Participants reported no differences in their understanding of or user experience with the diary content. All expert screen review studies similarly concluded no differences that would change the meaning of diary items, and that cognitive understanding and diary responses were maintained between devices. This data supports conceptual equivalence and usability of common diaries across various devices, demonstrating that device type would not influence how participants think about or answer items. Together with mounting evidence in the literature, this suggests that conducting routine CD/UT for each device may not be necessary when using proper eCOA migration and best practices. Obtaining an industry consensus on CD/UT requirements for electronic-to-electronic migrations is critically urgent given the increase in home assessments due to the COVID-19 pandemic and resulting uptake in BYOD studies where there is little control over device type.

How was the cooking skills and healthy eating evaluation questionnaire culturally adapted to Brazil?

Abstract The study described the cross-cultural adaptation process of the American Cooking Skills and Healthy Eating questionnaire to Brazil. Six stages were followed: Translation; Synthesis of translations; Back-translations; Expert Committee; Synthesis of final version; and the Pretest (self-administered online questionnaire in a Brazilian University). Participants responded to the translated questionnaire twice for test-retest. Conceptual, item, semantic, operational and measurement equivalences were evaluated between original and translated questionnaires, as well as the internal consistency and test-retest reliability. Item, conceptual, semantic equivalences between original and Brazilian questionnaires were reached before the Expert Committee stage. Specific cooking techniques and terms were adapted. Forty-eight students answered the questionnaire in the pre-test stage, achieving the operational and measurement equivalences with kappa’s agreement from moderate to substantial, and satisfactory to excellent correlations between measures. Only two measures showed low internal consistency. The combination of stages and equivalences approaches used in this cross cultural adaptation study provided lessons for further Nutrition’s researches, disclosing the complexity of cooking skills concepts.

Cross-cultural adaptation and reliability evaluation of the Lithuanian version of the keys questionnaire

The aim of this study is the KEYS questionnaire cross-cultural adaptation into the Lithuanian language. This study was designed to translate and perform cultural adaptation as well as test the reliability of the Lithuanian version of the KEYS questionnaire. Guidelines for the questionnaire translation and adaptation procedure according to international recommendations based on scientific literature were followed in order to establish the cultural equivalence to the original English version of the KEYS questionnaire. In the cross-cultural adaptation stage, due to the Lithuanian cultural context, several discrepancies between the semantic and conceptual equivalence of the items were modified. In total, 155 respondents participated in the pilot study of the Lithuanian KEYS version. As to reliability of the Lithuanian KEYS version, psychometric properties were tested, Cronbach’s alpha coefficient was used to assess the internal consistency. Mostly all scales and items demonstrated good internal consistency. The Lithuanian KEYS version was a well-accepted, reliable tool for evaluating and assessing individual work environment perceptions that influence the creativity of organizations among the Lithuanian speaking population. We conclude that the Lithuanian version of the KEYS questionnaire was successfully translated and adapted for application to Lithuanian-speaking respondents and it is ready for the validation study. Such a research is the first in the Baltic region.

Cross-cultural translation and adaptation of the Danish version of the Fugl-Meyer assessment for post stroke sensorimotor function

Purpose The Fugl-Meyer assessment (FMA) is the most widely used and recommended clinical assessment scale for evaluating sensorimotor impairments in stroke patients, but an official Danish version has not been available. This study aimed to perform a standardized translation and cross-cultural adaptation (TCCA) of the FMA into Danish. Methods First, a comprehensive eight-step TCCA procedure including forward and backward translation and step-wise reviewing by proof-reader and bilingual physiotherapists, to ensure conceptual and semantic equivalence was applied to develop a Danish version of the FMA. Second, inter-rater reliability of the Danish FMA was assessed in 10 subacute stroke patients. Svensson’s statistical method designed for rank-based paired ordinal data to identify items showing non-systematic or systematic disagreements in relative position or concentration was used to make further improvements on translation. Results A Danish FMA version was successfully made by the step-wise TCCA procedure. The clinical validation revealed satisfactory to excellent inter-tester reliability across all items (70–100%). Significant systematic disagreement either in position or concentration or both were observed in about 20% of the items. Conclusions The Danish version of the FMA was translated and adapted allowing for a wider standardized use of the FMA in stroke rehabilitation in Denmark. Implications for rehabilitation The Fugl–Meyer assessment (FMA) is the most used and recommended clinical assessment scale for evaluating sensorimotor impairments in stroke patients. The translated and adapted Danish version of the FMA is now available for use in research and clinical practice in Denmark. This allows for a standardized and unified description of stroke motor recovery and severity in neurorehabilitation nationwide as well as the possibility to compare and conduct trials using FMA internationally.

Impact of Self-Perceived Dental Esthetic on Psycho-Social Well-Being and Dental Self Confidence: A Cross-Sectional Study Among Female Students in Riyadh City.

PurposeTo assess the self-perceived psychological impact of dental aesthetics among female university students and its relationship to various sociodemographic factors.Patients and MethodsA cross-sectional study was conducted on a sample of 2400 female students from various departments of selected private and public universities in Riyadh City. Participants completed an Arabic translated version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) and a short demographic sheet. Descriptive statistics was used to describe the sample’s sociodemographic characteristics as well as the mean PIDAQ scores. Bivariate analysis (ANOVA) and linear regression were used to investigate the impact of the sociodemographic factors on the mean PIDAQ scores.ResultsThe pilot test revealed the instruments’ conceptual equivalence, semantic equivalence and ease of comprehension. Cronbach’s alpha was 0.81, indicating good internal consistency. The total sample was 1845 with a mean age of 20.74 years. The total mean score for the (PIDAQ) was 58.10 (SD=11.41). Significant differences were detected between different university affiliation in the dental self-consciousness (<0.0001), social (<0.0001) and psychological impacts (0.0256) and the total PIDAQ scores (0.0024). Significant differences were also detected between different disciplines in the dental aesthetics (0.0110) and social (0.0195) domains as well as the total PIDAQ scores (0.0144). College level was also a significant factor where middle students were significantly impacted socially (0.0026) compared to junior level students. As for the impact of income, those with the highest income displayed greater social impact (0.0039), psychological impact (0.0046) and impact on aesthetic attitude (0.0037) when compared to students with lower income levels.ConclusionDental aesthetics was found to affect the psychological well-being of the subjects. University affiliation, faculty affiliation, college level, and level of income were all factors that significantly affected self-perceived aesthetics and psychosocial well-being.

The Psychometric Properties of the Meaning of Home and Housing-Related Control Beliefs Scales among 67-70 Year-Olds in Sweden.

Background: The housing environment is important for health and well-being among older people, and it is important to consider both physical and perceived aspects of housing. Psychometrically sound scales are necessary to assess perceived housing. This study evaluated the psychometric properties of two instruments that measure perceived aspects of housing among a younger cohort of older adults in Sweden. Methods: A random sample of 371 participants aged 67 to 70 years (mean 67.9 (SD = 0.98)) was used. Participants lived in ordinary housing in the south of Sweden. Data on perceived aspects of housing were collected with the Meaning of Home Questionnaire (MOH) and the Housing-Related Control Beliefs Questionnaire (HCQ). Internal consistency, corrected item–total correlations, floor and ceiling effects, and construct validity were analyzed. Results: Cronbach’s alphas for all four subscales of MOH and two of three subscales of HCQ had acceptable levels (α > 0.50). Some items from both scales had low item–total correlations. All subscales, except for one from HCQ, had good construct validity. Conclusion: While both instruments had some limitations, all subscales with one exception had adequate psychometric properties. When used in different national contexts, further development may be necessary to achieve conceptual equivalence.

Symptom Status Questionnaire – Heart Failure – Brazilian Version: cross-cultural adaptation and content validation

BackgroundIn Brazil, there are no instruments available to measure the presence, frequency, severity and distress related to heart failure (HF) symptoms. AimsTo adapt the Symptom Status Questionnaire - HF (SSQ-HF) into Brazilian Portuguese and to examine the content validity of the adapted version. MethodsThe instrument was translated, back-translated and evaluated by an expert committee for semantic, idiomatic, cultural, and conceptual equivalences. An agreement ≥80% was considered adequate. The adapted version was evaluated by both an expert committee (n = 9) for clarity, theoretical relevance and practical relevance (acceptable content validity coefficient (CVC): ≥0.70), and by a patient committee regarding understanding (n = 40). ResultsThe adapted version obtained 100% agreement regarding the equivalences. The total instrument CVC was 0.99. All patients understood the items. ConclusionThe SSQ-HF-Brazilian version has satisfactory evidence of equivalence and content validity. Additional psychometric tests are deemed to confirm that the instrument can be used in Brazil.

Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients

Head and neck cancers (HNC) and their treatments cause dysfunction and distress. Ongoing psychological assessment using disease-specific patient-reported measures may optimize clinical decision-making, facilitate interventions to reduce psychosocial burden. As most such measures are developed in English, non-English speaking patients are disadvantaged. This study translated HNC-specific measures (Body Image Scale, Patient Concerns Inventory, Zung's Self-Rating Anxiety and Depression Scales and Patient Health Questionnaire-9) into three Indian languages (Hindi, Tamil and Telugu) and linguistically validated them. Translation followed established guidelines on translation and linguistic validation of measures. Process involved two independent forward translations, reconciliation, two independent backward translations by bilingual experts, and cognitive debriefing interviews with nine healthcare professionals (HCPs) and 29 HNC patients. Translated versions were compared with the original versions for semantic, cultural and conceptual equivalence. Overall, 17 Hindi items, 19 Tamil items and 13 Telugu items were identified to have semantic, cultural and/or conceptual issues. These were resolved to achieve equivalence with the original measures. Interviews with HCPs indicated that equivalent terms for words such as anxiety, panicky, sexuality, and self-conscious might be difficult to understand. Interviews with patients indicated all items were understandable, easy, sensitive, unambiguous and relevant. Hence, no further revisions were made. The translated Hindi, Tamil and Telugu versions of the Body image scale, Patient concerns inventory, Zung's self-rating anxiety and depression scales and Patient health questionnaire-9 measures are conceptually and linguistically validated and equivalent with the original English versions. Psychometric validation of these measures with relevant patient populations is needed.

Cross-cultural adaptation of a quality of life questionnaire for individuals with oral potentially malignant disorders in the Brazilian context.

The aim of this article is to describe the cross-cultural adaptation of a quality of life (QoL) questionnaire for individuals with potentially malignant oral diseases (OPMD) in the Brazilian context. This methodological study consisted of the following stages of content validation process: (1) Conceptual and item equivalence: stage during which a comprehensive literature review on the construct was performed; (2) Semantic equivalence. The extensive literature review showed that the questionnaire enables evaluation of QoL, and that domains and items are also considered and relevant to the Brazilian context. Semantic equivalence was evaluated as satisfactory by a committee of judges. The scope of the domains was analyzed according to the agreement rate and presented results equal to or greater than 84%. The general Content Validity Calculation (CVC) was 0.84 for clarity and 0.92 for representativeness. Of the 20 items, 18 presented CVC values above 0.8. The indicators for content validation, pre-test and operational equivalence indicate that the Brazilian version of the OPMD QoL questionnaire is a promising instrument and a tool that seems valid to evaluate the quality of life of people with oral potentially malignant disorders. As a next step, it is important to measure equivalences to evaluate the psychometric properties of this instrument.

Validation of the German version of the Family Reported Outcome Measure (FROM-16) to assess the impact of disease on the partner or family member

BackgroundThe Family Reported Outcome Measure (FROM-16) assesses the impact of a patient’s chronic illness on the quality of life (QoL) of the patient’s partner or family members. The aim of the study was to translate, explore the structure of and validate the FROM-16.MethodsThe questionnaire was translated from English into German (forward, backward, four independent translators). Six interviews with family members were conducted to confirm the questionnaire for linguistic, conceptual, semantic and experiential equivalence and its practicability. The final German translation was tested for internal consistency, reproducibility and test validity. Criterion validity was tested by correlating the scores of the FROM-16 and the Global Health Scale (GHS). Principal component analysis, factor analysis, and confirmatory factor analysis was used to assess the questionnaire’s structure and its domains. Reliability and reproducibility were tested computing the intraclass correlation coefficient (ICC) using one sample t-test for testing the hypothesis that the difference between the scores was not different from zero.ResultsOverall, 83 family members (61% female, median age: 61 years) completed the questionnaire at two different times (mean interval: 22 days). Internal consistency was good for the FROM-16 scores (Cronbach’s α for total score = 0.86). In those with stable GHS, the ICC for the total score was 0.87 and the difference was not different from zero (p = 0.262) indicating reproducible results. A bi-factor model with a general factor including all items, and two sub-factors comprising the items from the original 2-factor construct had the best fit.ConclusionsThe German FROM-16 has good reliability, test validity and practicability. It can be considered as an appropriate and generic tool to measure QoL of a patient’s partner or family member. Due to the presence of several cross-loadings we do not recommend the reporting of the scores of the two domains proposed for the original version of FROM-16 when using the German version. Thus, in reporting the results emphasis should be put on the total score.Trial registration: Retrospectively registered: DRKS00021070.

A Systematic Literature Review of Preference-Based Health-Related Quality-of-Life Measures Applied and Validated for Use in Childhood and Adolescent Populations in Sub-Saharan Africa

ObjectivesConsideration of health status in children and adolescents now includes broader concepts such as health-related quality-of-life (HRQoL). Globally, there is a need for relevant preference-based HRQoL measures (PBMs) for use in children and adolescents, yet measurement of HRQoL in these groups presents particular challenges. This article systematically reviews the available generic childhood PBMs and their application and cross-cultural validation in sub-Saharan African (sSA). MethodsA systematic review of published literature from January 1, 1990, to February 8, 2017, was conducted using MEDLINE (through OvidSP), EMBASE (OvidSP), EconLit (EBSCOhost), PsycINFO, Web of Science, and PubMed. ResultsA total of 220 full-text articles were included in a qualitative synthesis. Ten generic childhood PBMs were identified, of which 9 were adapted from adult versions and only 1 was developed specifically for children. None of the measures were originally developed in sSA or other resource-constrained settings. The Health Utilities Index Mark 3 (HUI3) and the EQ-5D-Y were the only measures that had been applied in sSA settings. Further, the HUI3 and the EQ-5D-Y were the only generic childhood PBM that attempted to establish cross-cultural validation in sSA. Five of the 6 of these validation studies were conducted using the EQ-5D-Y in a single country, South Africa. ConclusionsThe findings show that application of generic childhood PBMs in sSA settings has hitherto been limited to the HUI3 and EQ-5D-Y. Most adaptations of existing measures take an absolutist approach, which assumes that measures can be used across cultures. Nevertheless, there is also need to ensure linguistic and conceptual equivalence and undertake validation across a range of sSA cultural contexts.

Cross-cultural adaptation, validity and reliability of the Chinese Version of Miller Behavioral Style Scale

BackgroundHealth education basing on patients’ information-seeking styles can improve the effectiveness of health education and patients’ health outcomes. The Miller Behavioral Style Scale (MBSS) is widely used to identify individual’s information-seeking styles, but the Chinese version is lacking. The study aim was to translate and culturally adapt the MBSS into Chinese version and test the content validity, construct validity and internal consistency reliability of the Chinese version of MBSS (C-MBSS).MethodsThe forward-back-translation procedure was adopted in the translation of the MBSS. Content validity was assessed in a panel of experts. In a sample of 1343 individuals including patients, patients’ caregivers, university students, and medical staff, reliability and construct validity were assessed using Cronbach’s alpha coefficient and factor analysis. The measurement invariance across samples was tested using multigroup confirmatory factor analysis (MGCFA). Floor and ceiling effects were checked.ResultsThe C-MBSS achieved conceptual and semantic equivalence with the original scale. The item-level content validity index (I-CVI) of each item ranged from 0.78 to 1, and the averaging scale-level content validity index (S-CVI/ Ave) was 0.95. The exploratory factor analysis resulted in 2-factor assumption for each hypothetical threat-evoking scenario. Confirmatory factor analysis demonstrated a good fit between theoretical model and data, which provided confirmatory evidence for the second-order factor structure of 2-factor solution (Monitoring and Blunting). The Cronbach's alpha coefficients for the Monitoring and Blunting sub-scales of the C-MBSS were 0.75 and 0.62 respectively. MGCFA results supported the measurement invariance for the Monitoring sub-scale of the C-MBSS across samples. No floor or ceiling effects occurred.ConclusionsThis study indicates that the C-MBSS has good content and construct validity. The Monitoring sub-scale of the C-MBSS had acceptable internal consistency reliability while the Blunting sub-scale had unsatisfactory one, which suggest that the Monitoring sub-scale of the C-MBSS can be used to identify individuals’ information-seeking styles in Chinese contexts across different populations.

Agreement on Symptoms Between Children With Ulcerative Colitis and Their Caregivers: Towards Developing the TUMMY-UC.

As part of the development of the TUMMY-UC, a patient-reported outcome (PRO) measure for pediatric ulcerative colitis (UC), we aimed to explore agreement on UC symptoms between children and their caregivers. We conducted 44 interviews with children ages 8-12 years, who completed the PRO version of the TUMMY-UC, and their caregivers, who completed the observer-reported outcome (obsRO) version. There was excellent agreement between the total TUMMY-UC PRO and obsRO scores (intra-class correlation coefficient = 0.92 [95% confidence interval 0.74-0.98]). The obsRO scores were always within the same disease-activity category as the corresponding PRO score (ie, remission, mild and moderate-severe disease). There was a strong correlation of the TUMMY-UC PRO and obsRO scores with physician global assessment of disease activity (r = 0.94 and r = 0.90, respectively, P < 0.001) and the pediatric UC activity index (r = 0.95 and r = 0.96; P < 0.001). These data support conceptual equivalence between the PRO and obsRO TUMMY-UC versions, and provide support for their incorporation into one score.

Prenatal attachment: using measurement invariance to test the validity of comparisons across eight culturally diverse countries

Studies in high-income countries (HICs) have shown that variability in maternal-fetal attachment (MFA) predict important maternal health and child outcomes. However, the validity of MFA ratings in low- and middle-income countries (LMICs) remains unknown. Addressing this gap, we assessed measurement invariance to test the conceptual equivalence of the Prenatal Attachment Inventory (PAI: Muller, 1993) across eight LMICs. Our aim was to determine whether the PAI yields similar information from pregnant women across different cultural contexts. We administered the 18-item PAI to 1181 mothers in the third trimester (Mean age = 28.27 years old, SD = 5.81 years, range = 18–48 years) expecting their first infant (n = 359) or a later-born infant (n = 820) as part of a prospective birth cohort study involving eight middle-income countries: Ghana, Jamaica, Pakistan, Philippines, Romania, South Africa, Sri Lanka and Vietnam. We used Multiple Group Confirmatory Factor Analyses to assess across-site measurement invariance. A single latent factor with partial measurement invariance was found across all sites except Pakistan. Group comparisons showed that mean levels of MFA were lowest for expectant mothers in Vietnam and highest for expectant mothers in Sri Lanka. MFA was higher in first-time mothers than in mothers expecting a later-born child. The PAI yields similar information about MFA across culturally distinct middle-income countries. These findings strengthen confidence in the use of the tool across different settings; future studies should explore the use of the PAI as a screen for maternal behaviour that place children at risk.