Cross-cultural Validation Research Articles

Cross-cultural adaptation and validation of a self-administered Urdu version of the child oral impacts on daily performances index among 11-12-year-old children in Lahore, Pakistan.

The Child Oral Impacts on Daily Performances (Child-OIDP) index was developed to assess children's oral health-related quality of life. This study aimed to culturally adapt the self-administered Child-OIDP index into Urdu, evaluate its psychometric properties, and provide an initial estimate of oral impacts among 11-12-year-old children in Lahore, Pakistan. The translation of the Child-OIDP index from English to Urdu was performed, and the content and face validity of the initial Urdu version were evaluated by experts and 11-12-year-old children, respectively. The psychometric properties of the Urdu Child-OIDP were assessed by administering the index to 264 children aged 11-12 from five schools in the Lahore district. Psychometric properties were evaluated using criterion and construct validity, internal consistency, test-retest reliability, and global self-rated oral items, followed by an oral examination. The standardized Cronbach's alpha was 0.77, and the weighted Kappa was 0.94 (intraclass correlation coefficient = 0.98). The index exhibited significant associations with subjective outcome measures, dental problem history, and dental caries status (p = 0.001). Children reporting poor oral health, lower satisfaction with oral health, and experiencing oral impacts demonstrated higher Child-OIDP scores. Additionally, children with dental caries and perceived treatment needs exhibited higher Child-OIDP scores, indicating poorer Oral Health-Related Quality of Life (OHRQoL). The prevalence of oral impacts was 88.3% (mean score = 17.8, standard deviation (SD) =14.7). Eating performance was the most affected while speaking was the performance least affected, while toothache and sensitive teeth were identified as the two most common causes of oral impacts. Toothache was the primary cause of condition-specific impacts, responsible for the majority of oral impacts. This study demonstrates that the self-administered Urdu Child-OIDP index is a valid and reliable tool for assessing OHRQoL among 11-12-year-old children in Lahore, Pakistan.

Brazilian Version of the Vestibular Activities and Participation Measure: Cross-Cultural Adaptation, Validity, and Reliability.

Vestibular Activities and Participation Measure (VAP) subscales assess the effect of vestibular disorders on activity and participation. This study aimed to perform the cross-cultural adaptation and assess the validity, internal consistency, reliability, and measurement error of the Brazilian version of VAP subscales. The cross-cultural adaptation followed the translation, synthesis, back-translation, review by a committee of experts, and pretesting phases. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while Spearman's correlation between VAP subscales and the Dizziness Handicap Inventory (DHI) was used to assess construct validity. Cronbach's alpha measured internal consistency. Intraclass correlation coefficient (ICC) assessed intra- and inter-rater reliability, and measurement error was calculated by using the standard error of measurement (SEM) and minimal detectable change (MDC). Additional information was included in the Brazilian version of the Vestibular Activities and Participation measure (VAP-BR) after approval by one of the developers of the instrument to improve the understanding among individuals. One factor was found in the EFA for each subscale with 50% explained variance. Regarding CFA, the subscales 1 (S1) and 2 (S2) presented, respectively, adequate model fit indices (ie, comparative fit index of 0.99 and 0.97, and standardized root mean square residual of 0.04 for both subscales), but a very low factor load in item 6 of S1 (0.08). Chronbach's alpha was 0.80 (S1) and 0.82 (S2). For intra-rater assessment, the S1 and S2 presented an ICC of 0.87 and 0.90, SEM of 0.01 and 1.16, and MDC of 0.39 and 0.46, respectively. When assessed by 2 different raters, SEM values were 1.03 and 1.53, and MDC values were 2.85 and 4.23 for S1 and S2, respectively; both subscales showed an ICC of 0.92. Correlations between DHI and VAP subscales presented coefficients above 0.57. The Brazilian version of VAP subscales presents good measurement properties and may assist health professionals in identifying activity limitations and participation restrictions in individuals with vestibular disorders.

Hindi translation and modification of modified JOA score for cervical myelopathy and its validation for the Indian population

Abstract Objective: To do a cross-cultural adaptation and validation of the translated Hindi version with Indian modification of the Japanese Orthopedic Association (In-mJOA-H) score for cervical myelopathy. Background: Indian modification of the Japanese Orthopedic Association (In-mJOA-H) score has never been translated and studied in any vernacular language. This is one of the biggest limitations in assessing disease severity where most of the population is speaking Hindi or other regional languages. Materials and Methods: A cross-sectional study of 193 patients, from November 2020 to May 2021, with cervical myelopathy or neck pain with radiculopathy was done. The acceptability, validity, responsiveness, reproducibility, and cross-cultural adaptation were evaluated for the Hindi version (In-mJOA-H). Results: A strong correlation was found between In-mJOA-H with the English version and its individual component of the English version Indian modification of the JOA scale (In-mJOA-E). Conclusion: Good acceptability, validity, responsiveness, and reproducibility were established for the Hindi version (In-mJOA-H) with Indian modifications and its correlation to the English version Indian modification of the JOA scale (In-mJOA-E).

Connotation, Dimensions and Scale Development of work volition in the Chinese Context

The Psychology of Working Theory (PWT) was developed to complement existing vocational theories[1], in which work volition is a central construct. There is a lack of local measurement tools for Chinese university students’ work volition, which restricts the breadth and depth of research. Based on survey data from 960 college students nationwide, this study explored the cross-cultural validity of the WVS-SV. Through exploratory factor analysis and confirmatory factor analysis, a measurement scale of work volition was developed involving two dimensions of volition and constraints, with a total of fourteen items. This study opens up new perspectives for work volition research, enriches the literature on careers guidance research, and provides an effective measurement tool for subsequent research on college students’ work volition.

Cross-cultural adaptation of the Neonatal Medical Index (NMI) to Brazil.

To perform a cross-cultural adaptation and assess the content validity of the Neonatal Medical Index (NMI) for the Brazilian context. The cross-cultural adaptation was completed in six steps, including translation, synthesis of translations, back translation, submission to an expert committee, testing of the prefinal version, and appraisal by the original author. The expert committee assessed the equivalence between versions based on the percentage of agreement, and content validity was evaluated using the content validity index (CVI) for each item of the scale (I-CVI) and for the overall scale (S-CVI) in terms of representativeness and clarity. Participants of the prefinal version also evaluated the CVI for clarity. After two evaluation rounds of the expert committee it was attained 98% agreement, attesting to the equivalence between the instrument versions, maximum values for representativeness I-CVI and S-CVI/Ave (1.00), and high values for clarity I-CVI (all items ≥0.97) and S-CVI/Ave (0.98). The expert committee members defined that the Brazilian version of the instrument would be called Índice Clínico Neonatal (NMI-Br). The NMI-Br reached high values of CVI for clarity (all I-CVI ≥0.86 and S-CVI/Ave=0.99) among the participants of the prefinal version. The NMI-Br is the Brazilian version of the NMI, obtained in a rigorous cross-cultural validation process, counting with adequate values of content validity.

Cross-cultural validation of the Korean male version of athletes sleep behavior questionnaire

Cross-cultural validation of the Korean male version of athletes sleep behavior questionnaire

Transcultural Adaptation and Validation of the Spanish Version of the Visual Analogue Scale for the Foot and Ankle (VASFA).

The main aim of this study is to perform a cross-cultural adaptation and validation of the Visual Analogue Scale for the Foot and Ankle (VASFA) questionnaire, creating a Spanish-language version (VASFA-Sp), and to determine the measurement properties of this instrument. VASFA was cross-culturally translated into Spanish following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). The study sample was composed of 228 participants who were recruited from February to May 2022. All were at least 18 years old, gave signed informed consent to take part and properly completed the Foot and Ankle Ability Measures-Sp and VASFA-Sp questionnaires. Cronbach's alpha and test/re-test reliability values were calculated. Structural validity was assessed via exploratory factor analysis. The 228 patients included in the final analysis presented the following characteristics: 35.53% were male and 64.47% were female; the mean age was 35.95 (18-81) years; and the mean body mass index was 23.79. Internal consistency was excellent. The Cronbach's alpha for VASFA-Sp was 0.96 and the intraclass correlation coefficient was 0.932 (95% CI; 0.84 to 0.97). Exploratory factor analysis identified one main factor. VASFA-Sp is a reliable, valid and sensitive questionnaire that is suitable for measuring perceived foot and ankle function impairment in a Spanish-speaking population.

The social dimension of quality of life following spinal cord injury or disease: an international ICF-linking study.

International Classification of Functioning, Disability and Health (ICF) linking study. Analyze cognitive interview data using the ICF as an analytic framework, to examine aspects of social life relevant to quality of life (QoL) according to people with spinal cord injury or disease (SCI/D). This study builds upon results of an international study about the cross-cultural validity of the International SCI QoL Basic Data Set (QoL-BDS). Four specialized outpatient clinics in SCI/D rehabilitation, from the US, Brazil and Australia. Analysis of qualitative data from 39 cognitive interviews with SCI/D patients at least one year post onset. Participants were asked to define their concept of QoL, overall life satisfaction, physical health and psychological health, and other relevant matters. Four independent researchers coded text fragments related to the items, and fragments were linked to ICF chapters d6-d9, following established linking rules. The proportion of text referring to social life was 35.8% (definition QoL), 24.9% (QoL life as whole), 6.0% (physical health) and 34.9% (psychological health). The most frequent ICF categories were d760 Family relationships, d770 Intimate relationships and d920 Recreation and leisure. Most frequent responded social topics to the 'other issues' item were d770 Intimate relationships, d760 Formal relationships, and d870 Economic self-sufficiency. The importance of social life aspects to the QoL was highlighted based on responses of SCI/D patients, clearly demonstrated through the ICF linking process. Adding a satisfaction with social life item to the QoL-BDS has made this instrument a more comprehensive measure.

Developing An Achievement Test For Primary School English Course: Validity And Reliability Study

The objective of this research was to develop a multiple-choice achievement test for the 4th-grade English lesson unit called "My Day." The test's administration took place in the autumn term of the 2022-2023 academic year and involved 621 fifth-grade students from the central district of Niğde province. Out of these students, 209 participated in the pilot phase, while the remaining 412 students were involved in the actual application of the test. The test items were meticulously analyzed using the Test Analysis Program (TAP). Based on the results of the item discrimination analysis, two items were deemed less effective and, therefore, excluded from the final version of the test. Ultimately, the test consisted of 25 carefully selected items to evaluate the student's understanding of the "My Day" unit. To assess the internal reliability of the test, the researchers calculated the KR-20 value which turned out to be 0.888. This value demonstrated that the test exhibited a satisfactory level of consistency and reliability in measuring the intended learning outcomes. Overall, the rigorous development process and statistical analysis provide confidence in the validity and accuracy of the achievement test. Several recommendations are made in order to increase the test's usefulness and efficacy. The researcher could conduct a follow-up study to evaluate the long-term impact of the achievement test on students' language learning progress. Additionally, they may explore adapting the test for use in various regions and cultures to assess its cross-cultural validity, aiming to further improve its effectiveness and applicability.

Cross-Cultural Adaptation and Validation of the Russian-Language Version of the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AHS)

Background. Developed in 1994 by H. Kitaoka et al. the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot scale (AOFAS-AHS) allows to assess pain, function, deformity and alignment of the foot and ankle. There is no Russian-language AOFAS-AHS questionnaire adapted according to current standards in the scientific literature.
 The aim of this paper is to perform the cross-cultural adaptation and to assess the validity of the Russian-language version of the AOFAS-AHS scale, including the evaluation of its psychometric properties.
 Methods. The original English version of the AOFAS-AHS scale was translated from English into Russian by a native Russian speaker. Then the questionnaire was back-translated into English by another translator whose native language is English. The next stage was the comparison of the original and back-translated versions, followed by the presentation of a pre-final cross-culturally adapted version, which was tested on 10 patients to ensure that the questions were comprehensible. The next step was the approval of the final version and its completion by patients to be operated on the hindfoot or ankle. The printed copy of the final version of the questionnaire was completed by the patients with an interval of 3 days. Total of 44 consecutive patients were enrolled, including 18 women (41%) and 26 men (59%), with a mean age of 61.7 (32-78) years. The psychometric properties of the Russian-language version of the AOFAS-AHS questionnaire (internal consistency, retest reliability, measurement error, responsiveness, and construct validity) were assessed based on the COSMIN (COnsensus-based Standards for the selection of health status Measurement INstruments) principles.
 Results. The mean score according to the AOFAS-AHS scale was 49.6 (min 2; max 82) out of a possible 100. The average time to complete the questionnaire was 4.2 minutes. All hypotheses formulated showed correlations of varying moderate to strong degrees. The Cronbach’s alpha coefficient was 0.76, which indicates a high level of internal consistency of the elements of the validated questionnaire. A good intra-class consistency of 0.83 was obtained, which shows a high degree of reliability of the questionnaire’s reproducibility. The ceiling and floor effects for the primary results of the questionnaires did not exceed 15%. The mean value of the Russian-language version of the AOFAS-AHS increased to 86.6 after surgical treatment. The values of standardized effect size (ES) and standardized response mean (SRM) were 5.56 and 4.83, respectively.
 Conclusion. The adapted Russian-language version of the AOFAS-AHS scale showed good psychometric properties and can be recommended for assessment of the physical activity in patients with ankle and hindfoot-related pathology and can also be used for monitoring the changes during the treatment.

Cross-cultural adaptation and validation of the Brazilian Portuguese version of the Maladaptive Daydreaming Scale (BMDS-16)

Introduction and objective: Daydreaming is a common mental experience in which one gets immersed in stories, narratives, images, and fantasies, imagining them as they were real, although knowing they are unreal. Maladaptive daydreaming is characterised by an excessive and compulsive involvement on fantasy which in severe cases replaces human interaction and impairs academic, interpersonal, or vocational functioning. It can be measured using the 16-item Maladaptive Daydreaming Scale (MDS-16) which has been translated into 39 languages but validated only in eight. This study investigates the psychometric properties of the Brazilian version of this instrument (BMDS-16). Materials and methods: A total of 2,682 Brazilian adults (78% women; Mage = 26.6 years, standard deviation, SD = 7.0) participated in the study. Exploratory and confirmatory factor analyses provided support for a three-factor structure of BMDS-16 with satisfactory reliability indices. Results: Maladaptive daydreaming had positive but weak correlations with attention deficit hyperactivity disorder symptoms and dissociative experiences. As a result of the latent profile analysis, a cut-off score of 63 for maladaptive daydreaming was suggested. Based on this cut-off score, 18.6% of our sample could be considered maladaptive daydreamers. The general reliability of the scale was good (McDonald’s ω = 0.93; Cronbach’s α = 0.90). Conclusions: Overall, BMDS-16 demonstrated sound psychometric properties and applicability for general use to assess maladaptive daydreaming. The daydreaming tendency should be carefully examined in people with scores above 63, who may use fantasy in a maladaptive way, causing impairment in daily functioning and potentially conflicting with treatment.

Cross-Cultural Adaptation and Validation of the Malay-Translated Version of the Food Neophobia Scale for Malaysian Young Adults.

The Food Neophobia Scale (FNS) is a research instrument, originally developed in English, to assess an individual's level of food neophobia. However, it has not yet been translated and validated for Malaysians. Therefore, we aimed to translate and validate a Malay-translated version of the FNS. Respondents were 200 young adults (mostly females, 73%; and students, 82.0%; M age = 22.3years, SD = 2.3). We first translated the FNS into Malay using the forward-backward translation method, and a panel of nutrition and dietetics experts then reviewed it for item relevance, clarity, simplicity, and ambiguity. The translated FNS suggested good content validity with an item-level content validity index (I-CVI) > .8, a scale-level content validity index (S-CVI)/average = .8 and a S-CVI/universal agreement = .96. Principal component analysis revealed a two-factor model: (i) willingness and trust; and (ii) rejection and fear. Cronbach's alpha for the Malay-translated FNS was .808, demonstrating high internal consistency and reliability among young Malaysian adults. Future investigators can now use this Malay-translated FNS instrument to determine levels of food neophobia among Malaysians.

The Nonviolent Communication Behaviors Scale: Cross-Cultural Validity and Association with Trauma and Post-Traumatic Stress

Purpose: This study examined the cross-cultural validity of nonviolent communication (NVC) behaviors as measured using the Nonviolent Communication Behaviors Scale (NVCBS) and explored their potential relationship with post-traumatic stress (PTS). Methods: We analyzed data from two samples (N = 412 Chinese adults and N = 283 English-speaking adults). Results: The best-fitting model of NVCBS was the proposed three-factor model (“self-connection,” “authentic self-expression,” and “empathic listening”), with configural, metric, and scalar invariance established across samples with different languages and sociocultural backgrounds. The NVCBS had satisfactory internal consistency and convergent validity and was negatively associated with PTS. The findings were replicated across the two samples. Discussion: NVC behaviors can be reliably and validly measured using the NVCBS. Given its brevity and measurement invariance across cultures, the NVCBS is a promising tool to facilitate future studies on NVC. Moreover, a lack of NVC behaviors may be a social-behavioral feature associated with PTS.

Cross-cultural Diagnostic Validity of the Multilingual Naming Test (MINT) in a Sample of Older Adults.

We aimed to evaluate the psychometric properties and diagnostic accuracy of the 32-item version of the Multilingual Naming Test (MINT) in participants from 2 ethnic groups (European Americans [EA; n= 106] and Hispanic Americans [HA; n= 175]) with 3 diagnostic groups (cognitively normal [CN], n= 94, mild cognitive impairment [MCI], n= 148, and dementia, n= 39). An Item Response Theory model was used to evaluate items across ethnicity and language groups (Spanish and English), resulting in a 24-item version. We analyzed the MINT discriminant and predictive validity across diagnostic groups. A total of 8 items were differentially difficult between languages in the 32-item version of the MINT. EA scored significantly higher than HA, but the difference was not significant when removing those 8 items (controlling for Education). The Receiver Operating Characteristics showed that the MINT had poor accuracy when identifying CN participants and was acceptable in identifying dementia participants but unacceptable in classifying MCI participants. Finally, we tested the association between MINT scores and magnetic resonance imaging volumetric measures of language-related areas in the temporal and frontal lobes. The 32-item MINT in English and Spanish and the 24-item MINT in Spanish were significantly correlated with the bilateral middle temporal gyrus. The left fusiform gyrus correlated with MINT scores regardless of language and MINT version. We also found differential correlations depending on the language of administration. Our results highlight the importance of analyzing cross-cultural samples when implementing clinical neuropsychological tests such as the MINT.

Community and motivation among tennis officials: a cross-cultural multilevel analysis.

Sport officials are pivotal to the development of the game at every level. Yet, the exploration of these officials' job satisfaction and turnover intentions, especially within tennis, remains largely neglected. This study undertakes a cross-cultural adaptation and validation of the Referee Retention Scale (RRS) in a Chinese context (RRS-CN) and uses multilevel models (MLM) to explore the influence of perceived administrator consideration, mentoring, continuing education opportunities, remuneration, stress, and ecological factors on tennis officials' sense of community and officiating motivation. Data from 523 tennis officials across 26 provinces in China were gathered via an online survey. Through exploratory and confirmatory factor analyses, the RRS-CN was validated as a culturally adaptive 25-item scale. In the following, MLM results revealed that officiating levels, socioeconomic status, perceived administrator consideration, mentoring, and levels of continuing education significantly predict officials' sense of community. Additionally, we identified that continuing education, mentoring, and remuneration significantly influences officiating motivation. These findings underscore the importance of fair assignments, mentorship, and ongoing professional development in enhancing job satisfaction and retention. Future explorations are encouraged to extend the analysis to more ecological variables and further investigate their potential effects on systematic partial nesting, enhancing the generalizability and precision of measurement in job satisfaction and turnover studies across diverse cultural landscapes.

Cross-cultural adaptation and validation of the Autism Family Experience Questionnaire to an Indian context

Purpose The Autism Family Experience Questionnaire (AFEQ) is a 48-item questionnaire that assesses parental priorities for outcomes of early intervention of parents of children with autism spectrum disorder (ASD). The present study aims to adapt and validate the AFEQ to the Indian context as an attempt to provide a measure of family life and parent-reported outcomes before and after intervention. Methods Seventy-five parents of children with ASD were recruited for the study. The adapted version of AFEQ was given to five experienced professionals for content validation to assess cultural suitability in the Indian context. The test–retest reliability was assessed by re-administering the questionnaire to 40 parents within 15 to 30 days of initial administration. Results The Cronbach’s alpha value for the overall AFEQ score was 0.64, indicating acceptable internal consistency. Cohen’s kappa agreement was found to be 0.62, indicating good agreement between the five professionals. The adapted AFEQ scale showed good test–retest reliability (ICC = 0.72). Conclusion Results of our study indicated that AFEQ has good internal consistency, test–retest reliability, and content validity. The adapted AFEQ is a reliable and valid assessment tool that can be used to assess the parental experiences of families with ASD in the Indian context.

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.

Cross-cultural adaptation and validation for central sensitization inventory: based on Chinese patients undergoing total knee arthroplasty for knee osteoarthritis

BackgroundThis study was conducted to develop a simplified Chinese version of the central sensitization inventory (CSI-CV) and to evaluate its reliability and validity.MethodsThe CSI-CV was developed through a process involving the translation and back translation of the original CSI. Subsequently, experts reviewed and revised the content of the items to ensure their appropriateness. A total of 325 patients with knee osteoarthritis (KOA), who were scheduled to undergo total knee arthroplasty (TKA), completed the CSI-CV at a prominent orthopedic center in Xi'an, China. Afterward, a random selection of 100 participants was chosen for retesting after one week. The reliability and validity of the inventory were evaluated through exploratory factor analysis, correlation coefficient calculation and other methods.ResultsThe CSI-CV consists of 25 items in five dimensions (emotional distress, headache and jaw symptoms, physical symptoms, urological symptoms, and fatigue and sleep problems). The cumulative variance contribution rate was 75.3%, the Cronbach's α coefficient was 0.83, the Guttman split-half reliability coefficient was 0.88 and the intraclass correlation coefficient was 0.965. The CSI-CV scores correlated moderately with the total scores of the brief pain inventory (r = 0.506), Western Ontario and McMaster Universities Osteoarthritis Index (r = 0.466) and EuroQoL Group's five-dimension questionnaire (r = 0.576).ConclusionsThe findings demonstrate that the CSI was successfully trans-culturally adapted into a simplified Chinese version (CSI-CV) that was reliable and valid for Chinese-speaking patients who awaiting TKA for KOA.

Cross-cultural validation of the Spanish version of the mini cambridge-exeter repetitive thought scale (Mini-CERTS) in two Spanish-speaking populations.

The Mini Cambridge-Exeter Repetitive Thoughts Scale (Mini-CERTS) captures constructive and unconstructive aspects of repetitive thinking, but there is a need to revise and improve it given its novelty. For this reason, we present a validation and factor analysis of the Spanish version of the Mini-CERTS. Given that it is important to take cultural issues into account in instrument adaptation, we also assess its measurement invariance across Spanish (N = 430) and Peruvian (N = 394) populations. After deleting conflictive items, a 9-items version of the Mini-CERTS showed a two-factor model distinguishing constructive and unconstructive repetitive thinking, although this solution was not invariant across groups. Results also showed that the unconstructive factor was positively associated with anxiety, depression and stress measures. Despite its acceptable internal consistency, the absence of measurement invariance across groups does not recommend its use in cross-group comparisons in these populations. Cultural issues that could explain this result are discussed. Our findings highlight the importance of performing cross-cultural adaptations of assessment instruments even with the same language.

Cluster-Based Multinomial Logistic Regression Model for Health-Related Quality of Life Among People Living with HIV in Brazil.

Improvement in treatment options has increased the survival of people living with HIV (PLHIV). Thus, we evaluated the factors associated with better health-related quality of life (HRQoL) among PLHIV in Brazil. This was a cross-sectional study carried out among 349 PLHIV. Data were collected using an interview-based questionnaire, and HRQoL was assessed by the Brazilian version of the WHOQOL HIV BREF instrument. We used non-hierarchical cluster analysis (K-means) to compile the WHOQOL HIV BREF's overall and domain scores into a unique more multidimensional measure for HRQoL consisting of three clusters: poor, fair and good; associations with clusters of better HRQoL were assessed using multinomial logistic regression models. The mean and median overall HRQoL scores were 15.13 (SD = 3.39) and 16, respectively. The reliability and validity of the Brazilian version of the WHOQOL HIV BREF instrument was confirmed among PLHIV in a non-metropolitan, medium-sized municipality of Brazil, which reaffirmed the cross-cultural validity of this instrument. The factors male sex; heterosexual and asexual orientations; higher individual income; undetectable viral load; absence of any comorbidity and presence of an infectious or a chronic comorbidity, with mental illness as the reference; and never having consumed illegal substances were independently associated with good HRQoL. Thus, the compilation of the WHOQOL HIV BREF's overall and domain scores into a unique multidimensional measure for HRQoL, which this study proposed for the first time, may facilitate more robust interpretations and models of predictors. These differentials could simplify HRQoL as an indicator of health and wellbeing to be routinely used as a key outcome in the clinical management of patients and in the global monitoring of health system responses to HIV.