Cross-cultural Validation Study Research Articles

Cross-cultural validation of the Spanish version of the Kidney AlloTransplant Immunosuppressive Therapy Adherence Questionnaire (KATITA-25)

The KATITA-25 (Kidney AlloTransplant Immunosuppressive Therapy Adherence) Questionnaire is a multidimensional self-administered scale developed in Brazilian Portuguese that measures the predisposition for non-adherence to immunosuppressive medication in candidate patients for kidney transplantation, in the pre-transplant setting. The aim of this study was the cross-cultural validation of the Spanish version of the KATITA-25 scale. The translation/back-translation method was used, followed by cognitive interviews and a pre-test. The Spanish version of KATITA-25 was administered to 163 candidate patients for kidney transplantation from 2 kidney transplant centres and 2 dialysis centres in Catalonia, Spain. The scale was re-administered to the first 79 patients included into the study, after a 2 to 4 weeks interval. Internal consistency was assessed using Cronbach’s alpha, test–retest reliability with the intraclass correlation coefficient (ICC); construct validity with goodness of fit indices after confirmatory factor analysis using structural equation modelling. The Cronbach’s alpha of the Spanish version was 0.83, the ICC was 0.86. Confirmatory factor analysis showed adequate fit of the structural model. Overall, the analytical results closely resembled those obtained in the validation of the original scale. In conclusion, this cross-cultural validation study showed adequate reliability and construct validity of the Spanish version of the KATITA-25 questionnaire.

Psychometric Testing of an Arabic Version of the Attitude Toward Skin-to-Skin Contact Instrument among Women in Saudi Arabia: A Cross-Cultural Validation Study.

The World Health Organization recommends skin-to-skin contact immediately after birth, yet the practice rate remains low in Saudi Arabia, impacting the health and well-being of mother-baby dyads. No previous studies have explored Saudi women's attitudes toward skin-to-skin contact, a critical factor in developing strategies to increase its adoption. This study aimed to develop and evaluate an instrument to assess attitudes toward skin-to-skin contact among women in Saudi Arabia. An instrument was developed by modifying the validated "Mother-Newborn Skin-to-Skin Contact Questionnaire". Psychometric testing was conducted to validate the instrument through a cross-cultural survey involving 383 participants recruited from two hospitals in Saudi Arabia using a convenience sampling method. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.885, indicating that the sample size was suitable for performing exploratory factor analysis. The overall Cronbach's alpha value was 0.85, reflecting adequate internal consistency of the questionnaire. The criteria of the two-factor confirmatory factor analysis were also met. The majority of women (85.6%) demonstrated a positive attitude towards skin-to-skin contact. A positive correlation was observed between higher educational levels and the total attitude score (r = 0.161, p = 0.002). The developed questionnaire is a reliable tool for measuring attitudes towards skin-to-skin contact among women in Saudi Arabia. The findings highlight the importance of educational interventions to improve the uptake of this practice.

Validating performance status and activities of daily living assessment tools for Chinese palliative care in a cancer setting: A cross-cultural psychometric study

ObjectivesNational approaches to the routine assessment of palliative care patients improve patient outcomes. However, validated tools and a national methodology for this are lacking in Mainland China. The Australian Palliative Care Outcome Collaboration (PCOC) model is a well-established national program aimed at improving the quality of palliative care based on point-of-care outcomes assessment. This study aimed to culturally adapt and validate two measures used in PCOC (Australia-modified Karnofsky Performance Status (AKPS), Resource Utilization Groups - Activities of Daily Living (RUG-ADL)) in the Chinese context. MethodsA cross-cultural adaptation and validation study involving forward and backward translation methods, cognitive interviewing, and psychometric testing. ResultsTwo minor adjustments were made to the scoring instructions for the RUG-ADL, and the AKPS remained unchanged. Twenty-two clinicians participated in psychometric testing, completing 363 paired assessments on 135 inpatients. The correlations between AKPS and the Barthel index (BI) for activities of daily living (r ​= ​0.77, P ​< ​0.001), AKPS and RUG-ADL (r ​= ​−0.82, P ​< ​0.001), RUG-ADL and BI (r ​= ​−0.67 to −0.76) demonstrated good concurrent validity for both the AKPS and the RUG-ADL. The inter-rater reliability for AKPS (k ​= ​0.63) and RUG-ADL were substantial and moderate (k ​= ​0.51–0.56), respectively. The RUG-ADL also showed good internal consistency (Cronbach's alpha ​= ​0.92). Both tools were able to detect patients' urgent needs. ConclusionsThe Chinese version of AKPS and RUG-ADL can be systematically used to assess performance status and dependency among palliative care patients. However, observational assessments and enhanced communication between clinicians and patients/caregivers is also recommended for optimal clinical utility.

European Portuguese version of the Mini-BESTest: a cross-cultural adaptation and psychometric measurements in individuals with sensorimotor impairments

Purpose This study aimed to translate and cross-culturally adapt the Mini-BESTest into European Portuguese and to evaluate its psychometric properties in individuals with sensorimotor impairments. Material and Methods A cross-sectional cross-cultural adaptation and validation study was conducted according to the COSMIN guidelines and the STROBE statement. The study included 100 participants with sensorimotor impairments who were able to walk 6 m. Cronbach’s alpha and item-total correlations were used to assess internal consistency. Interpretability was assessed by examining floor and ceiling effects and skewness. To investigate construct validity, Spearman correlation coefficients and Bland-Altman analysis were performed to compare the Berg Balance Scale and the Mini-BESTest Inter- and intra-rater reliability were assessed by calculating the ICC, SEM and MDC based on video recordings of the participants during the Mini-BESTest assessments. Results The European Portuguese Mini-BESTest showed good internal consistency (Cronbach’s α = 0.892) and no significant floor or ceiling effects. Excellent inter- and intra-rater reliability (ICC = 0.97) were also demonstrated, with MDC of 2.58 and 2.57, respectively. Furthermore, this instrument showed a significant correlation with the BBS (r = 0.902). Bland-Altman analysis showed small absolute differences. Conclusion The European Portuguese Mini-BESTest is comparable to the original English version in terms of validity and reliability and is therefore highly recommended for use by Portuguese-speaking professionals to assess postural control.

Urdu translation and cross-cultural validation of neurological fatigue index on post stroke

BackgroundThe Neurological Fatigue Index (NFI) is the instrument used to evaluate stroke patients’ fatigue. There was no Urdu version of NFI available officially.ObjectiveThis study aimed to translate the Neurological Fatigue Index into Urdu and to determine the validity and reliability of Urdu NFI among stroke patients.MethodologyIt is a cross-cultural validation study. According to international guidelines in phase I, a process of translation was carried out. In phase II, using the sample of 120 participants, validity and reliability of the Urdu version of the Neurological Fatigue Index scale was conducted. The Urdu version’s content validity, convergent/concurrent validity, test-retest reliability, and internal consistency were determined. The latest version of SPSS was used for the data analysis.ResultsThe Urdu version of NFI was drafted after the expert’s review. The content validity index was used to analyze the content validity. The reliability and validity of the Urdu version NFI were evaluated by calculating Cronbach’s alpha (α = 0.86), and intra-class correlation coefficient (ICC = 0.823). Correlations with other scales were the fatigue Severity Scale (FSS) (r = 0.76), Mental Fatigue Scale (MFS) (r = 0.68), Beck Depression Inventory (BDI) (r = 0.53) and Epworth Sleepiness Scale (ESS) (r = 0.47).ConclusionThe Urdu Version was linguistically acceptable for the fatigue assessment in post-stroke patients. It showed good content validity, convergent/concurrent validity, internal consistency, and test-retest reliability.

An Integrative Review on Cross-Cultural Psychometric Studies of the Fear of COVID-19 Scale.

Background and Purpose: The rapid spread of coronavirus disease 2019 (COVID-19) worldwide prompted global fear and panic among all populations. The Fear of COVID-19 Scale was developed to assess the degree of fear. This review summarizes and synthesizes the revised cross-cultural validation studies of the Revised Fear of COVID-19 Scale to explore the properties of the scale and fear characteristics among different populations. Methods: A systematic literature search was conducted on the electronic databases of PubMed and Scopus. The review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework. Results: The review demonstrated that the Revised Fear of COVID-19 Scale has robust psychometric properties and fear impacts mental health across all study populations. The characteristics of the fear of COVID-19 are associated with specific variables. Conclusion: The Revised Fear of COVID-19 Scale can be used as a screening tool to assess levels of COVID-19 fear among different populations globally.

The Myanmar Version of the Oswestry Disability Questionnaire: A Cross-Cultural Adaptation, Reliability and Validity Study in the Low Back Pain Population

Objective: To translate and cross-culturally adapt the Myanmar version of the Oswestry Disability Questionnaire (M-ODQ), and examine its reliability and validity in the low back pain (LBP) population. Material and Methods: The M-ODQ was cross-culturally adapted in accordance with the ISPOR guidelines for translation. Prefinal testing was done on 20 individuals with LBP, with minor changes. The test-retest reliability, internal consistency, concurrent and construct validity, plus ceiling and floor effects of the M-ODQ were conducted on 101 individuals with LBP, via calculating the intraclass correlation coefficient ICC(2,1), Cronbach’s alpha, and Spearman’s rank correlation coefficient by correlating with the Myanmar version of the Roland-Morris Disability Questionnaire (M-RMDQ), visual analogue scale (VAS), back performance scale (BPS), and the Stark quality of life (QoL) questionnaire. The level of significance was set at p-value&lt;0.05 for all statistical analyses.Results: The test-retest reliability and internal consistency of the M-ODQ showed an ICC(2,1) of 0.91 and a Cronbach’s alpha of 0.703, thus indicating that the M-ODQ had an acceptable level of reliability. A moderate correlation between the M-ODQ and M-RMDQ (rho=0.56); and fair correlation with the VAS (rho=0.253), BPS (rho=0.336), and the physical component of the Stark QoL questionnaire (rho= -0.274) were found. Weak or no correlation was demonstrated with the mental component of the Stark QoL questionnaire (rho= -0.204). No ceiling or floor effects of the M-ODQ occurred in this study. Conclusion: The M-ODQ is a reliable and valid outcome measure for assessing disability among LBP patients in the Myanmar population.

Urdu translation and cross-cultural validation of the stroke self-efficacy questionnaire

BackgroundThe Stroke Self-Efficacy Questionnaire (SSEQ) measures the self-confidence of the individual in functional activities after a stroke. The SSEQ is a self-report scale with 13 items that assess self-efficacy after a stroke in several functional domains.ObjectiveThe purpose was to translate the Stroke Self-Efficacy Questionnaire into Urdu Language and to find out the validity and reliability of Urdu SSEQ among stroke patients.MethodsThe cross-cultural validation study design was used. Following COSMIN guidelines, forward and backward translation protocols were adopted. After pilot testing on 10 stroke patients, the final Urdu version was drafted. A sample of 110 stroke patients was used to evaluate the validity and reliability of the SSEQ-U. Content and Concurrent validity were determined. The intraclass correlation coefficient and Cronbach’s alpha were used to measure internal consistency and test-retest reliability. Data analysis was performed using SPSS 25.ResultsThe final version was drafted after application on 10 stroke patients. Content validity was analyzed by a content validity index ranging from 0.87 to 1. The internal consistency was calculated by Cronbach’s alpha (α > 0.80). Test-retest reliability was determined by the Intra-class correlation coefficient (ICC2,1=0.956). Concurrent validity was determined by correlations with other scales by using the Spearman correlation coefficient; moderate to strong correlations (positive and negative) were found with the Functional Independence Measure (r = 0.76), Beck Depression Inventory (r=-0.54), Short Form of 12-item Scale (r = 0.68) and Fall Efficacy Scale (r = 0.82) with p < 0.05.ConclusionThe Urdu version was linguistically acceptable and accurate for stroke survivors for determining self-efficacy. It showed good content and concurrent validity, internal consistency and test-retest reliability.

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.