Cross-cultural Validation Study Research Articles

Translation and Cross-Cultural Adaptation, Reliability and Validation Study of the Persian Version of Kansas City Cardiomyopathy Questionnaire

The Kansas City Cardiomyopathy Questionnaire (KCCQ) has been developed to measure the health status of Congestive heart failure (CHF) patients. This study aimed to translate KCCQ into a Persian version and assess its validity and reliability. We used a forward-backward procedure to translate the questionnaire. In a cross-sectional study, 150 CHF patients and 50 healthy subjects over 30 years old were selected to assess the reliability and construct validity of the instrument. The face and content validity were used for the questionnaire's validity. The validity was examined on a population of patients with CHF using the Persian version of the Minnesota Living Heart Failure Questionnaire (MLHF) health survey. Calculation of the Intraclass correlation coefficient (ICC) and Cronbach's alpha was done to evaluate the questionnaire's reliability. Test-retest reliability was examined by re-administering the KCCQ after 2 weeks. Test-retest results demonstrated that the Persian version has excellent reliability (ICC for all domains was higher than 0.93, P≤0.000). Internal consistency was found by Cronbach's alpha to be 0.86 for the clinical summary and 0.87 for the overall summary, respectively. Also, the correlation between the components of KCCQ and MLHQ showed satisfactory construct validity. Good Pearson's Correlation Coefficient was seen between KCCQ and MLHF (r= -0.44, P≤0.000 for the clinical summary; r= -0.45, P≤0.000 for the overall summary). Analysing the data from 50 healthy persons and 150 patients were shown that the Persian version of KCCQ has acceptable discriminate validity for all domains except self-efficacy. The Persian version of the KCCQ had satisfactory reliability and validity for assessing health-related quality of life status for Iranian CHF patients.

Cross-cultural evaluation of the Michigan Hand Outcomes Questionnaire: a systematic review

This systematic review aims to provide a comprehensive synthesis and in-depth analysis of the quality of the different cross-cultural versions of the MHQ. This study was conducted using Pubmed, Web of Science, CINAHL and SCOPUS databases to identify cross-cultural validation studies of the MHQ. Methodological quality, quality of evidence and criteria for good measurement properties of these studies were applied for each psychometric property. Quality assessment and data extraction were performed independently by two reviewers according to the COnsensus-based Standards for selection of health Measurement INstruments (COSMIN) guidelines. A total of 493 articles were identified, of which 22 were included and 20 were analysed.Of the six properties analysed, responsiveness and hypothesis testing for construct validity had the highest methodological quality and quality of evidence, and met the criteria for good measurement properties. The lowest quality properties were measurement error and internal consistency. The different cross-cultural versions of the MHQ were found to be reliable, valid and able to detect clinical change. The lack of development of measurement error, formulation of an a priori hypothesis or structural validity affects the detection of small clinical changes and their discriminative capacity.

Development and validation of the Emotional Climate Change Stories (ECCS) stimuli set

Climate change is widely recognised as an urgent issue, and the number of people concerned about it is increasing. While emotions are among the strongest predictors of behaviour change in the face of climate change, researchers have only recently begun to investigate this topic experimentally. This may be due to the lack of standardised, validated stimuli that would make studying such a topic in experimental settings possible. Here, we introduce a novel Emotional Climate Change Stories (ECCS) stimuli set. ECCS consists of 180 realistic short stories about climate change, designed to evoke five distinct emotions—anger, anxiety, compassion, guilt and hope—in addition to neutral stories. The stories were created based on qualitative data collected in two independent studies: one conducted among individuals highly concerned about climate change, and another one conducted in the general population. The stories were rated on the scales of valence, arousal, anger, anxiety, compassion, guilt and hope in the course of three independent studies. First, we explored the underlying structure of ratings (Study 1; n = 601). Then we investigated the replicability (Study 2; n = 307) and cross-cultural validity (Study 3; n = 346) of ECCS. The collected ratings were highly consistent across the studies. Furthermore, we found that the level of climate change concern explained the intensity of elicited emotions. The ECCS dataset is available in Polish, Norwegian and English and can be employed for experimental research on climate communication, environmental attitudes, climate action-taking, or mental health and wellbeing.

Cultural adaptation and validation of the caring behaviors assessment tool into Spanish

BackgroundThe aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context.MethodsThree-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses.ResultsThe overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions.ConclusionsThe new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain.

The domain-specific grammar grit questionnaire: a cross-cultural validation study

ABSTRACT This cross-cultural validation study aimed to develop and validate the Domain-Specific Grammar Grit Questionnaire (DSGGQ) among Iranian and Polish university students majoring in English. The DSGGQ was developed based on the L2 grit scale proposed by Teimouri, Plonsky and Tabandeh (2022. “L2 grit: Passion and perseverance for second-language learning.” Language Teaching Research 26 (5): 893–918. https://doi.org/10.1177/1362168820921895) and administered to a total of 807 participants, 440 from Poland and 367 from Iran. The data underwent confirmatory factor analysis (CFA) to assess the scale’s psychometric characteristics. The differences in the levels of grit between the Polish and Iranian students were also explored. The results demonstrated that the DSGGQ has satisfactory psychometric properties, and its structure proved to be invariant across nationality, gender, and age group. In addition, there were significant differences in grit levels between the two groups. Findings of this study suggest that the DSGGQ can be a useful tool for measuring grit in the domain of English grammar learning and can be applied in different cultural contexts.

IAPS in India: A Cross-cultural Validation Study of Highly Arousing Emotional Pictures

This article aims to obtain a set of erotic and gory pictures from the International Affective Picture System (IAPS) for use in studies across India. Additionally, it compares the ratings of a representative Indian sample with North American norms. Using the Self-assessment Manikin, adult Indian participants rated 72 arousal-matched IAPS pictures on emotional dimensions of arousal, valence and dominance. The ratings of the Indian and North American samples for valence were similar, but arousal and dominance ratings differed significantly. According to the valence–arousal relationship, the Indian sample’s emotional reactions to the unpleasant pictures compared to the pleasant ones were stronger. The Indian sample’s affective space of valence and arousal had a more curved and deeper boomerang pattern than the North American sample. The divergences in arousal and dominance ratings are attributed to cultural differences in interpreting affective information specific to erotic and gory pictures. Although there are marked similarities between the Indian and North American ratings, careful consideration of country-specific normative ratings is recommended for erotic and gory IAPS pictures.

Perspectives of older people on environmental sustainability: A cross-cultural validation study between five countries

The global agenda to move societies towards a more sustainable course of development also affects the lives of older people in our ageing populations. Therefore, it is important to understand the drivers, intentions and behaviours concerning sustainability among older adults. The aim of this study is to translate and cross-culturally validate an existing instrument (SustainABLE-16 Questionnaire), developed in the Netherlands, which measures how older people view the theme of environmental sustainability in their daily lives, for use in Romania, Poland, North Macedonia and Israel. The SustainABLE-16 covers three domains: 1) Pro-environmental behaviours; 2) Financial position; and 3) Beliefs. The scale was translated in Romanian, Polish, Macedonian, Albanian and Hebrew. Its 16 items were appraised for relevance by older people and experts in the field. A total of 2299 older people, including the original Dutch respondents, were included for the assessment of the level of measurement invariance across six languages, spoken in five countries. As the initial validation of the SustainABLE-16 did not meet internationally-recognised fit requirements, the shorter SustainABLE-8 was validated instead. This instrument proved valid for use in all participating countries (configural validity). Subsequently, increasingly constrained structural equation models were applied to test their fit with the data, ensuring that the fit did not deteriorate. The test results of measurement invariance across the countries indicated that items were stable, achieving partial scalar invariance, with five items demonstrating full scalar invariance. The shorter SustainABLE-8 functions uniformly across all language groups and can, therefore, be used to evaluate sustainable practices among older people. A better understanding of the drivers and practices among older citizens across Europe could, in turn, feed into more fitting public policies on sustainability in the built environment.

Cross-cultural adaptation, reliability, and validity study of the Turkish version of the “Spinal Cord Injury-Falls Concern Scale”

Purpose This study aims to conduct a Turkish validity and reliability study of the Spinal Cord Injury-Falls Concern Scale (SCI-FCS). Methods The study involved 134 volunteer patients with spinal cord injury. Various validity analyses, including content validity analysis, Confirmatory Factor Analysis (CFA), Pearson product-moment correlation coefficient, and Cronbach’s alpha value based on a single application for reliability, were employed. The Falls Efficacy Scale-International (FES-I) was used for criterion validity. Results All the standardized regression coefficients for the single factor measurement model established with 16 items in the scale are above 0.84. The CFA model, also with a single factor and 16 items, yields the following fit indices: Root-Mean-Square Error of Approximation value of 0.15, Standardized Root Mean Residual Squares value of 0.06, Chi-square value of 2.20, and Comparative Fit Index and Non-Normed Fit Index values of 0.98. The scores they received from the SCI-FCS and the scores they received from the FES-I scale have a statistically significant positive correlation (p < 0.01). The test-retest reliability coefficient value is 0.81, and the Cronbach Alpha value is 0.97. Conclusion The Turkish version of the SCI-FCS is a valid and reliable tool for determining fall concerns for patients with spinal cord injury.

Persian Translation of the Sport Concussion Assessment Tool 6 (SCAT6); a Cross-Cultural Adaptation and Validation Study.

Sport Concussion Assessment Tool (SCAT) aids the physicians in early management of concussion among suspected athletes and its 6th version was published in 2023 in English. This study aimed to describe the translation and validation process of SCAT6 from English to Persian. The Persian translation of SCAT6 and its evaluation has been done in seven stages: initial translation, appraisal of the initial translation, back translation, appraisal of the back-translation, validation (face and content validities), final reconciliation and testing by simulation. Initial translation, was done by two bilingual translators followed by an initial appraisal, which was made by both translators and one general physician. Back translation was done by two naïve translators who were unfamiliar with SCAT6, followed by its appraisal by initial translators. Face and content validity of the translation were surveyed by medical professionals and athletes and the results of the validation process were provided to the reconciliation committee and this committee made the modifications needed. Finally, the use of Persian SCAT6 was simulated and the mean time needed to complete the Persian SCAT6 was roughly a little more than 10 minutes. The present study provides the readers with the translation and cross-cultural adaptation process of SCAT6 from English to Persian. This translated version will be distributed among the Iranian sports community for assessing concussions among athletes.

The risk assessment of imminent inpatient aggression: A cross-cultural validation study of the dynamic appraisal of situational aggression in Estonia.

The reason for this study was void of a data-driven imminent risk assessment instrument for aggression in psychiatry clinics in Estonia. The predictive accuracy of the observer-rated Dynamic Assessment of Situational Aggression (DASA) has been repeatedly demonstrated. However, the research gap remains regarding a deeper conceptual understanding of the underlying latent structure of the DASA. Comprehensively evaluate the psychometric properties of the Estonian DASA version for cross-cultural clinical use. We used a prospective repeated measure design and collected 6097 risk evaluations from 381 adult inpatients, 151 of whom committed 1013 aggressive incidents during the study. The Estonian DASA version has acceptable inter-rater reliability (Kendall's τ = 0.74) and is a useful instrument with excellent predictive validity (AUC = 0.86) for identifying potentially aggressive inpatients. In our sample, the DASA has a bi-factorial structure which explains 83% of the total variance. The adapted DASA has acceptable validity and reliability indices for measuring imminent aggression risk in adult inpatient units. Evidence-based risk assessment of aggression in psychiatric clinics enhances recognition of the signs of potentially aggressive behaviour in order to apply preventive actions and reduce aggression, thereby improving the quality of the care provided.

Translation and Validation of Tampa Scale for Kinesiophobia in Urdu Language for Patients with Chronic Low Back Pain

Background: Chronic Low Back Pain (CLBP) significantly impacts patients' quality of life and is often associated with kinesiophobia, the fear of movement due to pain. The Tampa Scale for Kinesiophobia (TSK) is a recognized tool for assessing this condition, but there is a need for a version tailored to Urdu-speaking populations. Objective: This study aimed to translate and validate the TSK into Urdu for patients with CLBP, ensuring its reliability and cultural relevance in the Pakistani context. Methods: This descriptive cross-cultural linguistic validation study followed Bombardier, Beaton, and Guillemin’s guidelines. The TSK underwent forward and backward translation by two independent translators, a professor of Urdu literature and a medical professional. A final version was created and reviewed by bilingual experts, then validated by a panel of 20 physical therapists. This validated version was tested on 150 patients to determine the reliability of the Urdu version of the instrument. Results: The Urdu version of the TSK achieved a Cronbach’s alpha of 0.986 post-translation and 0.817 after testing with the target population. The inter-item correlation varied between 0.443 to 0.987. The intra-class correlation coefficient, indicating test-retest reliability, ranged from 0.1 to 0.8, demonstrating high reliability. Conclusion: The Urdu version of the TSK is a valid and reliable tool for assessing kinesiophobia in patients with CLBP. It exhibits good construct validity, high internal consistency, as well as good test-retest reliability and low to moderate responsiveness.

Cross-cultural validation of the COVID-19 peritraumatic distress index (CPDI) among Spanish and Peruvian populations

The COVID-19 pandemic has had a significant psychological impact worldwide. The COVID-19 Peritraumatic Distress Index (CPDI) is widely used to assess psychological stress during the COVID-19 pandemic. Although CPDI has been validated in Peru and Spain, no cross-cultural validation studies have been conducted. As an exploratory aim, differences in CPDI factorial scores between the most prevalent medical conditions in the two samples (arterial hypertension, respiratory diseases and anxious-depressive disorders) from a general population of Peru and Spain were investigated. We conducted secondary data analysis with data from Peru and Spain to validate the CPDI in a cross-cultural context. Exploratory factor analysis (EFA) and multigroup confirmatory factor analysis (MGCFA) were performed to evaluate the factor structure and measurement invariance of the CPDI across cultural contexts. Concerning the exploratory analysis, we performed a U-Mann–Whitney test to evaluate differences in the factorial scores in the two samples. This study revealed a two-factor solution (stress and rumination/information) for the CPDI that included 21 of the 24 original items, and consistent with previous studies. The MGCFA demonstrated measurement invariance across cultural contexts (scalar invariance), indicating that the CPDI construct has the same meaning across both groups, regardless of cultural context and language variations of Spanish. Patients with anxious-depressive disorders showed higher CPDI factorial scores for both factors, whereas patients with respiratory diseases were only associated with the stress factor. This study provides evidence for the cross-cultural validity of the CPDI, highlighting its utility as a reliable instrument for assessing psychological stress in the context of COVID-19 across different cultures. These findings have important implications for developing and validating measures to assess psychological distress in different cultural contexts.

Transcultural Adaptation and Validation of the Turkish Version of the Breast Cancer Awareness Measure (BCAM) Questionnaire

Purpose: To analyze the validity and reliability of the Turkish version of the Breast Cancer Awareness Measure (BCAM-Tr).&#x0D; Material and Methods: This was cross-cultural adaptation and validation study. The study sample consisted of a total of 552 women who volunteered to participate in the study between December 2020 and November 2021. Data were collected using a descriptive characteristics form and the BCAM-Tr. The validity of the BCAM-Tr was tested with language validity, content validity, construct validity (first-level Confirmatory Factor Analysis and comparison of known groups) analyses. Reliability was evaluated by conducting test-retest analysis and internal consistency &#x0D; Results: The BCAM-Tr showed good test-retest reliability (Intraclass Correlation Coefficient=0.89) and internal consistency (Cronbach’s alpha=0.89). Cohen’s kappa coefficients indicated moderate to excellent agreement (0.55-0.96). Confirmatory factor analysis confirmed a two‐factor structure. Health professionals had higher correct response rates than women in the general population (p=0.0001), indicating good construct validity.&#x0D; Conclusion : The BCAM-Tr was shown to be valid and reliable for assessing breast cancer awareness in Turkish women.

Translation and Validation of Childhood Healthcare Assessment Questionnaire in Urdu Language for Juvenile Idiopathic Arthritis

Aim: To translate and validate Childhood Healthcare Assessment Questionnaire (CHAQ) in Urdu language and assess its psychometric properties for cross cultural adaptation. Methods: The Childhood Healthcare Assessment Questionnaire (CHAQ) was translated into the target language of Urdu by two independent translators, one of whom was familiar with the questionnaire's concept while the other was not, and the two translations were then compared as part of a cross-cultural linguistic validation study. These two initial translations of the questionnaire were blindly reversed, and the results were compared1. The pre-final version of the translated version underwent thorough psychometric testing in a sample of 38 members of the target population (parents of children with juvenile idiopathic arthritis at Ghurki Trust and Teaching Hospital, Lahore) who satisfied the inclusion requirements. The final version was reviewed by an expert panel. Parents' prior approval was obtained before testing. Results: The Cronbach’s alpha for the Urdu version of CHAQ was calculated as 0.993 after testing on the population showing excellent internal consistency. For test-retest reliability, Pearson correlation ranged from (0.378–0.956).The inter-item correlation of the Urdu version of CHAQ after applying to the targeted population has a mean value of 1.177, a minimum value of 0.056, a maximum value of 4.00, a variance value of 0.723, and a range of 3.944. The scale statistics have a mean value of 103.55, a variance of 1462.37, a standard deviation of 38.241, and a total number of items of 88.The intraclass correlation coefficient ranges from 0.606-0.993. Conclusion: The Childhood Healthcare Assessment Questionnaire in Urdu is a screening tool for parents of children with juvenile idiopathic arthritis since it has adequate inter-item correlation values and great internal consistency. Keywords: Childhood Healthcare Assessment Questionnaire (CHAQ), Juvenile Idiopathic Arthritis (JIA), Reliability, Validity, Cross-cultural adaptation

Cross-Cultural Adaptation, Validity, and Reliability Study of Turkish Version of the International Hip Outcome Tool-33 (iHOT-33): A Pilot Study

Anketler hastalığın hikayesinde, fizik muayenede ve görüntüleme araçlarına bağlı olarak kalça patolojilerinin teşhisinde önemli rol oynamaktadırlar. Kalça patolojileri için farklı anketler vardır. Bu çalışmanın amacı, International Hip Outcome Tool (iHOT-33)’un Türkçe versiyonuna uyarlama, geçerlik ve güvenirliğini araştırmaktır. iHOT-33’ün Türkçe’ye çevirisi ve kültürel uygunluğu mevcut yönergeler izlenerek yapılmıştır. Bu çalışmaya düşük yaş ortalamasına ve yüksek fiziksel kapasiteye sahip 50 hasta katıldı. Ölçeğin güvenirliğini değerlendirmek için test-tekrar test ve iç tutarlık analizleri uygulandı. Test tekrar test analizi, sınıf içi korelasyon katsayısı (ICC) yöntemi ile analiz edildi. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 (SF-36) anketlerinin toplam puanları, iHOT-33’ün geçerliğini belirlemek için Pearson korelasyonu ile değerlendirildi. iHOT-33’ün yüksek düzeyde iç tutarlılığa sahip olduğu bulundu (Cronbach alfa 0.908). Test-tekrar test sonuçları yüksek korelasyon gösterdi (0.702-0.938 aralığında). Faktör analizi, ölçeğin dört faktörlü bir yapıya sahip olduğunu gösterdi. iHOT-33, WOMAC ve SF-36 ile iyi düzeyde korelasyona sahiptir (Pearson korelasyon katsayısı WOMAC ile -0.710, SF-36 ile -0.594). iHOT-33’ün Türkçe versiyonu geçerli ve güvenilirdir.

Patient Safety Culture Analysis in Dental Hospital Using Dental Office Survey on Patient Safety Culture Questionnaire: A Cross-cultural Adaptation and Validation Study.

The culture of safety and patient safety management in dental practice lags compared with medical practice. Hospitals strive to pursue quality and safety of healthcare services, with evidence of patient safety incidents in medical practice demonstrating the importance of promoting a safety culture. Measuring patient safety culture is a necessary first step to improving safety culture in clinical settings. As a hospital, dental hospital should improve the quality and culture of patient safety. Thus, our objective was to conduct a cross-cultural adaptation of a US measure of dental office patient safety culture for use in Indonesian dental hospitals. A cross-sectional study was conducted on 200 respondents at a dental hospital in Java, Indonesia. The first stage includes cultural adaptation and translation, followed by developing a questionnaire that was tested through expert agreement and analysis of validity and reliability using Spearman, Cronbach correlation coefficients, and correlation coefficients between classes. The Dental Office Survey on Patient Safety Culture consists of 58 items and 10 dimensions (overall perceptions of patient safety and quality, organizational learning, teamwork, staff training, work pressure and pace, management support for patient safety, office processes and standardization, communication about errors, communication openness, and patient care tracking/follow-up). A total of 200 respondents with a response rate of 61.5% and 77 invalid responses due to incomplete filling, so 123 respondents were analyzed. The validity test results on 38 question items from 10 dimensions, with a sign of 0.05%, 35 items are declared valid. The Indonesian version of the Dental Office Survey on Patient Safety Culture shows good validity and good reliability and has the potential to be used to evaluate patient safety culture in dental hospitals in Indonesia.

Sustainability attitudes in nursing survey: A cross-cultural adaptation and validation study

Research aim: The aim of this study was to cross-culturally adapt the Sustainability Attitudes in Nursing Survey into Turkish and evaluate its validity and reliability among Turkish speaking nursing students. Methods: This methodological study was conducted with 400 nursing students, selected using a simple random sampling method from students studying at a state university in Turkey. Sociodemographic Characteristics Questionnaire and Sustainability Attitudes in Nursing Survey were used for data collection. The linguistic content validity analysis and Confirmatory Factor Analysis were performed to determine the validity of the survey. Test-retest reliability and Cronbach Alpha coefficient were determined for reliability of the survey. Findings: The Content Validity Index of the Turkish version of the Sustainability Attitudes in Nursing Survey was found to be 0.91. In the Confirmatory Factor Analysis, the survey was confirmed as a single-factor model. The Cronbach Alpha coefficient of the survey was determined to be 0.76 and the intra-class correlation was 0.81 as a result of the test-retest. Conclusions: The Turkish version of the survey has sufficient validity and reliability to evaluate sustainability attitudes of nursing students in the Turkish culture. It is recommended to conduct international comparative studies to identify nursing students’ sustainablity attitudes.

Quality of life patient/cancer survivor version in Chinese cancer survivors: A validation study

ObjectiveTo validate the Chinese version of the Quality of Life (QoL) Patient/Cancer Survivor Version (QOLCSV-C) for measuring QoL in Chinese cancer survivors. MethodsThe study followed a seven-step research practice guideline for cross-cultural research instrument validation study including translation, adaptation, and psychometric assessment. A forward- and backward-translation procedure was approached, followed by cultural adaptation and acceptability assessment. For its psychometric properties, its concurrent validity with the Functional Assessment of Cancer Therapy-General (FACT-G) was examined with correlation analysis. The internal consistency (Cronbach's alpha) and item-total and item–subtotal correlations of the QOLCSV-C were obtained. Factor analyses were conducted. Floor and ceiling effects and the discriminant performance of the selected variables on QOLCSV-C score were also examined. ResultsThe QOLCSV-C was translated from the 41-item QOLCSV with four domains: psychological, physical, spiritual and social well-being. The content validity was excellent (content validity index [CVI] ​= ​1.00). Time spent to complete the QOLCSV-C was about 10 ​min. The QOLCSV-C was found easy to use, appropriate in length, and reflective of their QoL. The strong correlation between QOLCSV-C and FACT-G indicates a satisfactory concurrent validity (Spearman's rho ​= ​0.765, P ​< ​0.001, n ​= ​205). The overall internal consistency of the QOLCSV-C (Cronbach's alpha ​= ​0.888) and the split-half reliability (Spearman-Brown coefficient ​= ​0.918) were excellent. Most of the items show moderate to strong item-total correlation. The exploratory factor analysis revealed a four-factor solution, and confirmatory factor analysis has a satisfactory model fit with indicative items. None of the total scores of QOLCSV-C reveal the floor or ceiling effect. For discriminant performance, variables demonstrating significant between-group differences include sleep quality, pain, fatigue, nausea, physical health, and financial burden. ConclusionsThe QOLCSV-C is a reliable and valid instrument for measuring the QoL in Chinese cancer survivors. Future studies can explore the factor structure, gender universal or specific items, and significant predictors of QoL of cancer survivors in different cultures.

Systematic Review of Translation and Cultural Adaptations of Autism Spectrum Disorder’s Screening Tool: The Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R)

In recent years, the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R), a screening tool for autism spectrum disorder (ASD), has been translated into various languages and made accessible for the assessment of children globally. This study aims to systematically review and identify the available translations of the M-CHAT-R that have been adapted for use in different cultures, to evaluate the translation and cultural adaptation process, to report on the methodologies and psychometric properties of the adaptations of the M-CHAT-R and to critically discuss the implications for clinical practice and future research. An electronic search was performed through four main databases, EBSCOhost, Google Scholar, PubMed and Elsevier, to identify eligible articles. The PRISMA guidelines were employed as the primary search strategy and reporting system, while the COSMIN checklist was used to evaluate the selected studies' psychometric properties and cultural validity. Thirteen studies were included in this systematic review. The evaluation of screening accuracy properties for all studies showed that the M-CHAT-R translations achieved reasonable to good screening accuracy and further highlighted that sensitivity and specificity values, which are not dependent on the prevalence rate, are more appropriate measures than other psychometric properties to reflect the validity of the M-CHAT-R. The review of methodologies and results showed that the M-CHAT-R might be equally effective as the original tool in screening children aged up to 48 months, but future research is required to obtain more normative data. The large discrepancies among sample sizes and differences in population settings with ambiguous translations and adaptations highlighted the need for a more in-depth adaptation process for future cross-cultural validation studies.

E038 A common measure of the impact of glucocorticoids in patients with inflammatory and autoimmune conditions - the Steroid PRO: A cross-cultural validation study with Rasch models

Abstract Background/Aims Systemic glucocorticoids are key in the management of life- and organ-threatening rheumatic diseases, but have wide-ranging adverse effects of concern to patients and clinicians. We aimed to validate a Patient Reported Outcome (PRO) measure (the Steroid PRO) for assessing the impact of glucocorticoids on health-related quality of life (HRQoL) in patients receiving glucocorticoids for rheumatic disease. Methods This was a cross-sectional study of adults from the UK, USA, Australia and New Zealand, taking glucocorticoids for a rheumatic disease. An online survey was conducted at two time points: Time 1: (i) demographics - age, gender, country, ethnicity, educational level; (ii) clinical information - diagnosis, glucocorticoid dose; (iii) 40 candidate items for the Steroid-PRO, developed in a previous qualitative study; (iv) EQ5D-5L. Time 2 (optional, completed 3-5 days later): (i) the Steroid PRO candidate items; (ii) a condition change question. The survey was distributed via social media and patient organisations. After descriptive analysis, iterative testing with Rasch measurement model and exploratory factor analysis (EFA) informed item reduction and established structural validity, reliability and unidimensionality of the final Steroid-PRO. Item reduction was based on clinical importance, lack of fit to the Rasch model, and redundancy. Evidence of discriminative validity of the Steroid-PRO was established by comparing its scores for participants receiving lower dose glucocorticoid (up to 10 mg) versus higher dose (&amp;gt;10 mg). Intraclass correlation (ICC) between Time 1 and Time 2 was calculated for patients who reported ‘no change’ compared with 3-5 days ago. Results A total of 946 patients returned complete responses at Time 1 (Time 2: 447 responses). They were from UK, n = 743 (78.5%); USA, n = 139 (14.7%); Australia, n = 59 (6.2%). Their mean age was 57.6 (SD = 13.6); 833 (88%) were women. They were treated for inflammatory arthritis (n = 194), connective tissue disease and/or vasculitis (n = 398), and giant cell arteritis and/or polymyalgia rheumatica (n = 341). A total of 25 items were removed due to floor effects and lack of fit to the Rasch model. The remaining 15 items showed a satisfactory fit to the model. EFA suggested a scale structure with four domains: Participation (4 items), Appearance (3 items), Psychological (5 items), and Treatment concerns (3 items). This 4-domain structure was supported by the Rasch model, confirming construct validity; χ2=47.82 (DF = 36), p = 0.899; and reliability (Person Separation Index, PSI=0.757). Patients on a lower glucocorticoid dose had lower Steroid-PRO domain scores than those receiving higher dose (discriminant validity). ICC between Time 1 and Time 2 ranged from 0.892 to 0.942 (95%CI 0.868 to 0.953) suggesting excellent (test-retest) reliability. Conclusion The final Steroid-PRO is a 15-item, valid and reliable 4-domain scale measuring the impact of glucocorticoid therapy on HRQoL of people with rheumatic diseases. Disclosure S. Bridgewater: Grants/research support; S.B. has received funding for research from Vifor Pharma. M. Ndosi: Grants/research support; M.N. has received funding for research from Vifor Pharma. J. Dawson: None. P. Richards: None. C. Silverthorne: None. E. Dures: Grants/research support; E.D. has received funding for research from Vifor Pharma. S. Goodman: Consultancies; S.G. reports consultancy for UCB. Grants/research support; S.G. has received research support from Novartis. Other; S.G. has given talks for NYU, Case Western, ACR Rheumatology Courses. C. Hill: None. S.L. Mackie: Consultancies; S.L.M. has provided consultancy on behalf of her institution for Roche/Chugai, Sanofi, AbbVie, AstraZeneca. Grants/research support; S.L.M. has been an investigator on clinical trials for Sanofi and GSK, as a research grant co-applicant, S.L.M. has received research funding (partial salary support) from Vifor, paid to her institution. Other; S.L.M. has given talks on behalf of her institution for Pfizer, Vifor and UCB. In all cases fees were paid to her institution and no personal fees were received, S.L.M. was supported by Roche to attend EULAR2019 and by Pfizer to attend ACR2021 virtually. J.C. Robson: Consultancies; J.C.R. reports: Consultancy for Vifor Pharma. Grants/research support; Funding for research from Vifor Pharma. Other; Speaking fees from Vifor Pharma.