Transcultural Adaptation Research Articles

Translation and Transcultural Adaptation of the Universal Design for Learning Observation Measurement Tool (UDL-OMT)

Universal Design for Learning (UDL) is a widely accepted educational approach in the United States, and its adoption is increasingly observed in Europe and other international contexts. This growing implementation necessitates the development of standardized criteria for consistent evaluation of UDL in educational settings. This study describes the methodology for translating and cross-culturally adapting the UDL Observation and Measurement Tool (UDL-OMT), originally developed by Basham et al., into French and Italian. It also reports the results of a pretest conducted to evaluate the adapted instruments. Preliminary results indicate a high degree of adaptability of UDL-OMT for use in the French- and Italian-speaking regions of Switzerland. These results are discussed in the context of the potential for wider dissemination and validation of the instrument in French- and Italian-speaking classrooms.

Assessment of Gluten-Free Products' Availability and Satisfaction in a Polish Population of Coeliac Disease Patients and Their Caregivers.

Among the most important challenges associated with the gluten-free diet are the high costs and limited availability of gluten-free products, accompanied by the lower nutritional value of gluten-free products. The aim of the presented study was to assess gluten-free products' availability and satisfaction in a Polish population of coeliac-disease patients and their caregivers. The study was conducted in a population of Polish female coeliac-disease patients and female family members/relatives of patients diagnosed with coeliac disease, being members of the Polish Coeliac Society and purchasing gluten-free products. A population of n = 819 was included in the studied group based on the inclusion and exclusion criteria (n = 547 of patients and n = 272 of family members/relatives of patients). The study was conducted as a part of an international project to assess the opinions of coeliac-disease patients about gluten-free products, as well as the availability and prices of gluten-free products in various countries, while an identical questionnaire was applied in all participating countries, with transcultural adaptation applied. Opinions concerning the availability of and satisfaction with gluten-free products were assessed based on a questionnaire of agreement with fixed statements about the accessibility, range and quality of gluten-free products in Poland, with a five-point Likert scale to declare the agreement. This was stratified by the following variables: age, place of residence, being diagnosed with coeliac disease, place of purchasing major grocery shopping, gluten-free products at least occasionally bought online, declared problem(s) with the availability and quality of gluten-free products. While comparing the studied sub-groups, it may be stated that some of them were more satisfied than the other sub-groups with the gluten-free products, including their availability and quality; namely, older respondents were more satisfied than younger ones (p < 0.05), respondents living in small towns/villages were more satisfied than those living in big cities (p < 0.05), respondents undertaking major grocery shopping in hypermarkets were more satisfied than those not doing this (p < 0.05), and respondents not buying gluten-free products online were more satisfied than those undertaking this at least occasionally (p < 0.05). At the same time, respondents diagnosed with coeliac disease were more satisfied with the availability and less satisfied with the quality of gluten-free products, while respondents with diagnosed family members/relatives were less satisfied with the availability and more satisfied with the quality (p < 0.05). The group of female coeliac-disease patients and female family members/relatives of patients diagnosed with coeliac disease was highly diverse in terms of their satisfaction with gluten-free products' availability and quality, whilst older respondents, respondents living in small towns/villages, respondents doing major grocery shopping in hypermarkets, and respondents not buying gluten-free products online were more satisfied. Respondents with family members/relatives diagnosed with coeliac disease declared serious efforts and sacrifice to purchase gluten-free products, which was associated with their higher satisfaction with quality and lower satisfaction with availability, while respondents diagnosed with coeliac disease chose easier options, resulting in their higher satisfaction with availability and lower satisfaction with quality.

Validity and reliability of the Polish version of the Pregnancy Mobility Index (PMI-PL).

Mobility, defined as active, controlled, multi-joint flexibility used in movement, is limited in pregnant women due to problems with low back pain (LBP) and pelvic girdle pain (PGP). The Pregnancy Mobility Index (PMI) is a tool for assessing mobility in relation to LBP/PGP. The lack of a Polish version of the PMI test prompted a transcultural adaptation to the Polish conditions. The aim of the study was to evaluate the measurement properties of the Polish adaptation of the Pregnancy Mobility Index. The study involved 121 pregnant women aged 18-44. The translation process was in accordance with the transcultural adaptation design. Reliability was assessed by intraclass correlation coefficient (ICC). Construct validity between the Polish version of the PMI (PMI-PL) and the Physical Activity Pregnancy Questionnaire (PPAQ-PL) was assessed by Spearman's rank correlation coefficient. The transcultural adaptation of the PMI test into Polish was satisfactory, with high internal consistency (Cronbach's alpha = 0.97-0.98, ICC = 0.989). Statistically significant inverse proportional correlations were found for total PA, total PA (light and above), light PA, moderate PA, and vigorous PA in the construct validity analysis between PMI-PL and PPAQ-PL. The Polish version of the PMI is a reliable instrument. The introduction of a questionnaire with a classification system will make it easier for health professionals to monitor the health status of pregnant women and encourage them to engage in physical activity appropriate for their current level of mobility.

Transcultural Adaptation of the “Caregiver Guilt Questionnaire” (CGQ)

ABSTRACT Objectives To implement a transcultural adaptation of the Caregiver Guilt Questionnaire (CGQ) for the Brazilian population. Methods Five stages were involved in the adaptation: two independent translations by Brazilian nationals fluent in Spanish; summary of translations produced; back-translation; evaluation by expert panel of judges (n = 5); and lastly, assessment by family caregivers (n = 30). Results semantic changes were made to render the items more relevant to Brazilian culture and replicate the five factors of guilt proposed by the original questionnaire. Conclusions A Brazilian version of the questionnaire was produced and transculturally adapted for use in Brazil, allowing future validation and application. Clinical implications The CGQ allows healthcare professionals to quantify feelings of guilt. Clinicians and clinical researcher can use the scale to obtain more precise interventions.

French translation and transcultural adaptation of the Shoulder Pain and Disability Index (SPADI)

French translation and transcultural adaptation of the Shoulder Pain and Disability Index (SPADI)

Transcultural adaptation and validation of Persian Version of Patient Assessment of Chronic Illness Care (PACIC-5As) Questionnaire in Iranian older patients with type 2 diabetes

BackgroundThe Patient Assessment of Chronic Illness Care (PACIC-5As) questionnaire has been designed to evaluate the healthcare experiences of individuals with chronic diseases such as diabetes. Older adults are at higher risk for diabetes and its associated complications. The aim of this study was transcultural adaptation and evaluation of the validity and reliability of the PACIC-5As questionnaire in older patients with diabetes residing in Qazvin City, Iran.MethodIn this validation study, we recruited 306 older patients with diabetes from Comprehensive Health Centers in Qazvin, Iran. The multi-stage cluster sampling technique was used to choose a representative sample. The PACIC-5As questionnaire was translated into Persian using the World Health Organization (WHO) standardized method. The validity (face, content, and construct) and reliability (Cronbach’s alpha) of the PACIC-5As were assessed. Data analysis was conducted using R software and the Lavaan package.ResultsThe mean age of the older patients was 69.99 ± 6.94 years old. Most older participants were female (n = 180, 58.82%) and married (n = 216, 70.59%). Regarding face validity, all items of PACIC-5As had impact scores greater than 1.5. In terms of content validity, all items had a content validity ratio > 0.49 and a content validity index > 0.79. The results of confirmatory factor analysis demonstrated that the model exhibited satisfactory fit across the expected five factors, including assess, advise, agree, assist, and arrange, for the 25 items of the PACIC-5As questionnaire. The Cronbach’s alpha coefficient for the PACIC-5As questionnaire was 0.805.ConclusionThis study indicates that the Persian version of the PACIC-5As questionnaire is valid and reliable for assessing healthcare experiences in older patients with diabetes. This means that the questionnaire can be effectively used in this population.

Transcultural adaptation and theoretical models validation of the Spanish version of the Self-Care of Diabetes Inventory.

For patients with diabetes mellitus, self-care is crucial because it prevents complications and helps preserve quality of life. Clinicians and researchers require effective tools for assessing self-care behaviors across various dimensions to identify individual needs and maximize resource allocation. The aim of this study was to evaluate the validity and reliability of the Spanish version of the Self-Care of Diabetes Inventory (SCODI). Two hundred eighteen participants with DMT1 and DMT2 who were recruited through convenience sampling from a university hospital participated in our cross-sectional study. After translation and cultural adaptation, the enrolled patients answered the questions. We performed an exploratory factor analysis (EFA) on each of the SCODI scales and Confirmatory factor analysis (CFA) was performed using our models which appropriate fit indices. The original structure of the four-dimensions tool was confirmed. The overall consistency across the four scales was assessed by Cronbach's alpha: self-care maintenance (0.766), self-care monitoring (0.790), self-care management (0.771), and self-care confidence (0.936). The model fit yielded a chi-square index of 1.028 with 773 degrees of freedom. Confirmatory factor analysis showed a good fit, thereby affirming the reliability of the model. The internal consistency and reliability of the SCODI Spanish version are deemed adequate. This tool is appropriate when it is desired to evaluate the self-care practices of Spanish persons suffering from diabetes due to its good psychometric qualities.

The Translation, Cross-Cultural Adaptation and Validation of the Italian Version of the Hip and Groin Outcome Score Questionnaire for a Young and Active Population.

The HAGOS (Hip and Groin Outcome Score) questionnaire is a valid and reliable measure of the self-assessment of symptoms, activity limitation, participation restriction, and quality of life (Qol) of subjects with hip and/or groin pain. The aims of this study are to translate and transculturally adapt the HAGOS into Italian (HAGOS-I) and to assess its internal consistency, validity, and reliability in physically active, young, and middle-aged subjects. The translation and transcultural adaptation of (HAGOS-I) was carried out according to international guidelines. Eight-one subjects (mean age 28.19) were included in this study. All the participants completed the HAGOS-I, the Lower Extremity Functional Scale (LEFS-I), the Oxford Hip Score (OHS-I), and the Short Form 36 Health Surveys (SF-36-I). The Cronbach's α for the six HAGOS subscales ranged from 0.63 to 0.87. Statistically significant correlations were obtained between the six HAGOS-I subscales and the LEFS-I (rs = 0.44-0.68; p < 0.01). Only one HAGOS-I subscale (Participation in Physical Activities) did not reach statistical significance with the OHS-I, while the remaining five had a moderate correlation (rs = 0.40-0.60; p < 0.01). The test-retest reliability (Intraclass Correlation Coefficient) ranged from 0.57 to 0.86 for the six HAGOS-I subscales. The HAGOS-I is a valid and reliable instrument that can be used in clinical settings with young and middle-aged subjects with hip and/or groin pathologies.

Transcultural adaptation and validation of the 4-Domain Sports PROM into Italian

ObjectivesThis work aims to evaluate and validate the process of cross-cultural adaptation and validation of the 4-Domain Sports PROM (4-DSP) into Italian, assessing its understandability and reproducibility in all questionnaire domains for Italian-speaking patients. MethodsCross-sectional study, level of evidence II. The questionnaire was self-administered by 100 patients (80 males and 20 females) who had undergone anterior cruciate ligament (ACL) reconstruction and had a one-year minimum follow-up. The mean age and standard deviation (SD) was 31.20 ​± ​12.65 years. According to their level of sports participation, 51% were recreational, 31% were regional, 12% were national, and 6% were international athletes. All patients filled in the 4-DSP questionnaire without direct supervision of their trainer/coach or researcher. All data were collected and processed anonymously. The translation and cultural adaptation of the 4-DSP involved six phases: (1) translation, (2) synthesis, (3) back-translation, (4) pre-test, (5) expert committee review and (6) final version approval by the author of the original version for publication. ResultsThe cross-cultural validation of the questionnaire 4-DSP into Italian presented a global Cronbach's alpha of 0.65, Conceptual equivalence to translation and relevance were 99.09% and 99.81%, respectively, and the percentage of agreement was 99.09%. ConclusionThe cross-culturally validated version of the 4-DSP into Italian proved to be adequately understandable and reproducible in all questionnaire domains and can be safely and reliably used in Italian-speaking patients. Level of evidenceStudy level II.

Thriving of Older People Assessment Scale (TOPAS): Transcultural adaptation, psychometric evaluation, and refinement in a Spanish sample

The objective of this study was to culturally adapt the Thriving of Older People Assessment Scale (TOPAS) instrument and evaluate its psychometric properties. The study was carried out in two phases: cross-cultural adaptation and psychometric validation and refinement through a cross-sectional study conducted between 2018 and 2020 with 314 participants. The refinement resulted in an abbreviated version of TOPAS, maintaining the original 5 factors with 16 items. Cronbach alpha was 0.91. Composite reliability (0.72–0.89) and average variance extracted (0.57–0.81), supporting discriminant validity. Maximum shared variance for the factors (0.22–0.50) and average shared variance (0.16–0.31), demonstrating discriminant validity. The abbreviated version of TOPAS showed evidence of being a valid and reliable instrument for measuring the adaptability of elderly residents in institutions. Implementing this instrument in Spanish nursing homes allows for a continuous evaluation of residents' well-being in relation to their environment, a construct not previously assessed with available scales.

Portuguese version of the Short-Form Condom Attitude Scale and psychometric properties among undergraduate students.

The condom use can be influenced by psychological and sociocultural aspects, which can be modulated by individual's attitudes. The aim was to propose a Brazilian Portuguese version of the Short-Form Condom Attitude Scale (Short-Form CAS), describing all procedures of translation, transcultural adaptation, and psychometric properties evaluation when applied to undergraduate students. A cross sectional study was conducted among students enrolled at University of São Paulo (USP), Campus Ribeirão Preto (n = 491; 61.2% female; average age: 22 years; standard deviation: four years). Confirmatory factor analysis was performed. A one-factor model with seven items exhibited good factorial validity and reliability, suggesting to be a better factorial solution of the Short-Form CAS in the sample. Few studies have been carried out on the behavioral factors associated with condom use in key populations, which can be exacerbated by a lack of appropriate scales. Therefore, the main contribution of the present study was to propose a simplified and transculturally adapted version of the Short-form CAS with some psychometric properties verified. Since the use of condoms is a component of the study of sexual risk behavior, this scale might be an option to be applied in various Brazilian population segments for this purpose.

French-language questionnaires in ENT: Inventory and review

ObjectivePatient-Reported Outcome Measures (PROMs) are now an integral part of clinical and academic practice in ENT, and it is essential to have tools with a validated French version. However, there are no guidelines on ENT questionnaires available in French or those that could have transcultural adaptation. MethodsThe present study, under the auspices of the ENT National Professional Council and the French Society of ENT, inventoried PROMs, for each super-specialty and pathology, meeting one of the following inclusion criteria: validated French version, not translated but used internationally (i.e., translated into other languages and widely cited since 2017), or subjectively deemed useful by experts in the super-specialty in question. ResultsIn total, 103 questionnaires were identified. To encourage and accompany their intercultural adaptation and statistical validation, this article presents the rationale and methodology of such an undertaking. ConclusionPROMs either already validated in French or which it would be useful to translate were inventoried. The methodology of translation and validation to guarantee reliability and relevance is presented.

Translation, transcultural adaptation, and convergent validity of the Arabic version of the Mukbang addiction scale

IntroductionThe present study evaluated the psychometric properties of the Arabic translation of the Mukbang Addiction Scale (MAS) among Arabic-speaking adults from the general population. Specifically, it aimed to assess the factorial structure through a confirmatory factor analysis, determine the composite reliability through Cronbach alpha and McDonald’s omega scores, assess gender invariance, and evaluate the convergent validity by examining its correlation to eating addiction and psychological distress.MethodsA total of 370 individuals with a mean age of 21.94 ± 2.29 years participated in this study, which was conducted using an online platform. The participants were surveyed on demographic information, mukbang addiction, food addiction, and psychological distress. Translation was conducted using the forward and backward technique.ResultsThe findings demonstrated excellent internal consistency of the Arabic MAS (McDonald’s omega coefficient = 0.93). Confirmatory factor analyses validated the one-factor structure of the scale, while establishing measurement invariance across sex at the configural, metric, and scalar levels. No sex differences were observed in the Mukbang addiction levels. Lastly, the MAS scores were significantly and positively correlated with food addiction and psychological distress, supporting their convergent validity.ConclusionThe current research provides evidence supporting the reliability and validity of the Arabic version of the MAS as a self-report method for assessing addictive Mukbang watching. While further validations are needed to corroborate the present findings, this measure can be effectively utilized across different fields, including schools, mental health centers, and researchers aiming to understand this global phenomenon.Plain English SummaryMukbang refers to individuals or hosts consuming large quantities of food while interacting with their audiences through recorded video or a live stream. The Mukbang phenomenon has gained substantial popularity among young individuals over the past years, rising concerns about its potential impact on their eating habits and health, especially when overconsumed. Overconsumption of mukbang content, or Mukbang addiction, aligns with the core features of addiction, including compulsive engagement, tolerance, and withdrawal symptoms, making it comparable to other addictive behaviors. Mukbang addiction can lead to detrimental effects on mental and physical health, including neglect of balanced nutrition, disordered eating habits, obesity, feelings of guilt, shame, poor self-esteem, distorted self-images, body dissatisfaction, heightened anxiety or depression, and social isolation. Given these significant impacts, valid and reliable tools are crucial to enable an accurate assessment of Mukbang addiction. This study proposes to translate, adapt and examine the psychometric properties of the Mukbang Addiction Scale (MAS) in a sample of Arabic-speaking individuals from the general population. Findings showed that the six MAS items loaded on a single factor with strong internal consistency and good convergent validity, preliminarily indicating its potential validity and reliability for assessing addictive mukbang-watching among Arabic-speaking individuals.

Contextual similarities in psychological flexibility: the Brazil-Portugal transcultural adaptation of Psy-Flex

Psychological Flexibility is an essential concept in Contextual Behavioural Sciences. The development of instruments is vital for its study, and it is an opportunity to reflect on this concept. Among the measures of this construct, Psy-Flex shows promise due to comprehensiveness in assessing the six facets of psychological flexibility and its pragmatic value. In the present study, we sought to translate Psy-Flex to Portuguese and adapt it transculturally for use in Portugal and Brazil. The translation was done independently by Brazilian and Portuguese researchers, and a consensus procedure was done to identify a synthesis. A total of 873 adults from Portugal and Brazil were involved in this study. The participants completed several questionnaires with ACT-related measures (e.g., cognitive fusion, mindful attention) and instruments measuring conceptually related variables (e.g., positive mental health). The results show good psychometric properties of PsyFlex. The one-factor structure of the original instrument was confirmed in both the Portuguese and Brazilian samples. Confirmatory factor analysis revealed a good fit of the model to the data (CFI = 0.985, RMSEA = 0.055) of both countries. Furthermore, the Psy-Flex showed convergent validity with related measures in a conceptually expected way. As a transcultural instrument, we argue that both the similarities and differences across samples suggest the broad human nature of psychological flexibility while retaining its context sensitivity.

Translation and validation of the Neurological Assessment in Neuro-Oncology scale to Brazilian Portuguese.

The Neurological Assessment for Neuro-Oncology (NANO) scale was elaborated to assess neurologic function in integration with radiological criteria to evaluate neuro-oncological patients in clinical setting and enable the standardization of neurological assessment in clinical trials. The objective of this study is the translation to Brazilian Portuguese and transcultural adaptation of NANO scale in patients with the diagnosis of glioblastoma, brain metastasis and low-grade glioma. Patients with diagnosis of glioblastoma, brain metastasis, and low-grade glioma were prospectively evaluated between July 2019 and July 2021. The process of translating and cross-culturally adapting the NANO scale included: translation from English to Portuguese, synthesis and initial revision by an expert committee, back-translation from Portuguese to English, a second revision by the expert committee, and the application of the NANO scale. Regarding the reliability of the NANO scale, Cronbach's alpha was employed to measure the internal consistency of all scale items and assess the impact of item deletion. Additionally, Spearman's correlation test was used to evaluate the convergent validity between the NANO scale and Karnofsky Performance Scale (KPS). One hundred and seventy-four patients were evaluated. A statistically significant inverse relation (p < 0.001) between KPS and NANO scale was founded. The Cronbach's alpha values founded for NANO scale were 0.803 for glioblastoma, 0.643 for brain metastasis, and 0.482 for low grade glioma. The NANO scale Brazilian Portuguese version proves to be reproducible and valid to evaluate neuro-oncological patients with glioblastoma and brain metastasis, presenting a strong correlation with KPS scale. Further studies are warranted to assess the validity and reliability of the scale in patients diagnosed with low-grade glioma.

Transcultural adaptation and validation of the DASH questionnaire in Mexican healthy volunteers and patients with neurogenic disorders of the upper extremity

The Disability of the Arm, Shoulder and Hand (DASH) questionnaire assesses the impact of upper extremity disorders on quality of life. However, its use in the Mexican population has not been formally validated. To conduct a cultural adaptation and validation of the DASH questionnaire to evaluate the perspective of patients with neurogenic disorders of the upper extremity regarding the impact on their quality of life. We performed an adaptation of the Spanish version of the DASH questionnaire to the Mexican vocabulary and applied it to 478 volunteers. Ceiling effect, floor effect, item-total correlation, descriptive statistics of items and total score, internal consistency, precision, cross-sectional and longitudinal validity were estimated by comparing healthy controls and affected individuals with different disability levels. Our DASH questionnaire version was equivalent to those previously approved and showed homogeneity of the items with respect to the total value of the questionnaire (Cronbach's alpha > 0.96). In addition, it showed an accuracy of 7.25 points and the crosssectional and longitudinal validity was documented with significant differences between groups and subgroups with distinct disability levels. The DASH questionnaire can be used with a high level of confidence in the Mexican population.

Transcultural adaptation and validation of IMPACT-III and IMPACT-III-P in Spanish families: a multicenter study from SEGHNP.

The SEGHNP versions of IMPACT-III and IMPACT-III-P are valid and reliable instruments for Spanish p-IBD families. • IMPACT-III and parent-proxy IMPACT-III (IMPACT-III-P) are useful questionnaires for assessing health-related quality of life (HRQoL) in pediatric inflammatory bowel disease (p-IBD) patients and their parents/caregivers and have been translated and validated in several countries. • To date, no transcultural adaptation and validation of these questionnaires have been published for Spanish patients with p-IBD and their families. • This is the first transcultural adaptation and validation of IMPACT-III and IMPACT-III-P for Spanish p-IBD families. • These are valid and reliable instruments for assessing HRQoL in Spanish families of patients with p-IBD.

Transcultural Adaptation of the Collaborative Model for Promoting Competence and Success for Students with Autism Spectrum Disorder (COMPASS)

ABSTRACT This study describes the transcultural adaptation of the Collaborative Model for Promoting Competence and Success for Students with Autism Spectrum Disorder (COMPASS) to Brazilian Portuguese (BP). A blind translation of the original version in English (OV) to the version in BP, blind back-translation of the BP version into English (BT), comparison of BT with OV to statistically verify the convergence (CO), minimum divergence (MD) and divergence of meaning (DM) between BT and OV, review of the BP version by a committee of experts, maintaining conceptual, idiomatic, semantic and cultural equivalence, and sending of the files to the author of the model, was carried out. 1372 items were translated from English to BP. After comparing BT/OV, 0.6% DM (9 items), 47.9% MD (657 items), and 51.5% CO (706 items) were found. 97 equivalences were made, 43 semantic and 54 conceptual. The author of the model received all files from steps 1 to 4. Having carried out this process, it is possible to state that COMPASS was transcultural adapted to BP. With the future availability of COMPASS in Brazil, we hope that it can contribute to the development of the quality of education for students with Autism Spectrum Disorder in the country.

Transcultural adaptation to Spain of the CDPQOL questionnaire specific for coeliac children.

This study aimed to translate, cross-culturally adapt, and validate the CDPQOL questionnaire, a coeliac disease (CD)-specific paediatric health-related quality of life (HRQoL) instrument (CDPQOL), in Spanish children with CD. The CDPQOL questionnaire has two versions for children aged 8-12 and 13-18. Translation and linguistic validation were performed following an international consensus process. Internal consistency was calculated using Cronbach's alpha and McDonald's omega coefficients, and convergent validity was assessed with average variance extracted (AVE). Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA), when necessary, were carried out to assess the construct validity. A total of 235 children were included. In the 8-12 age group, a change in the distribution of items to a new structure of three dimensions (negative emotions, food feelings and social interaction) was required. In this new model, CFA supported the fit of the model (χ2/gl = 1.79, RMSEA = 0.077 (IC 95% 0.05-0.100), CFI = 0.969, TLI 0.960, SRMR = 0.081) and Cronbach's alpha and McDonald's omega coefficients were > 0.7 in all three dimensions. In the 13-18 age group, CFA showed that all fit indexes were acceptable (χ2/gl = 1.702, RMSEA = 0.102 (IC 95% 0.077-0.127), p < 0.001, CFI = 0.956, TLI = 0.947, SRMR = 0.103) and Cronbach's alpha and McDonald's omega coefficients were > 0.7 in all three dimensions, except for uncertainty dimension. Conclusions: The Spanish version of the CDPQOL questionnaire is a useful instrument to assess quality of life in coeliac children whose native language was Spanish spoken in Spain, with changes in item distribution in the younger age group questionnaire. What is Known: • The first specific questionnaire for coeliac children, Dutch Coeliac Disease Questionnaire (CDDUX), which focuses on diet, was translated into Spanish and validated allowing to evaluate the HRQoL of Spanish coeliac children. • Spanish Children and parents feel the disease had no substantial negative impacts on patient HRQoL using this questionnaire, similar to that observed with other countries. What is New: • The age specific for CD children (CDPQOL) was elaborated in the USA and focuses on other aspects not evaluated by CDDUX such as emotional and social issues related to living with CD. • The CDPQOL was translated into Spanish and validated allowing it to be used to assess Spanish coeliac children's QoL.

Transcultural Adaptation of the Breast Cancer Awareness Measure in a Rural Border Area of Greece.

Breast cancer awareness is a concept suggesting that awareness of signs and symptoms and early seeking of medical advice may decrease mortality, especially in limited resource settings. A modified questionnaire based on the breastcancerawarenessmeasure (BCAM) by Cancer Research UK was translated into Greek and used for the first time. Participants were women residing in a rural border area in Greece. For statistical analysisthe χ2 goodness-of-fit and Cramer's V test for categorical comparisons were used and Cronbach's alpha for reliability analysis. In total, 110 women filled out and returned the questionnaire. Respondents appeared to be inappropriately informed regarding the less common warning signs of breast cancer, the most common age of breast cancer occurrence, the national screening program, and the less important risk factors of breast cancer. On the other hand, most women appeared to be confident in recognizing breast changes and seeking medical advice if needed. The translated modified BCAM tool can be used to evaluate breast cancer awareness in Greek women. Future campaigns developed by policymakers should focus on improving breast cancer awareness, especially in socioeconomically deprived areas.