Cognitive Interviewing during Pretesting of the Prefinal Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand Questionnaire following Translation and Cross-Cultural Adaptation

Abstract

When patient-reported measures are translated and cross-culturally adapted into any language, the process should conclude with cognitive interviewing during pretesting. This article reports on translation and cross-cultural adaptation of the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire into Afrikaans (for the Western Cape). This qualitative component of a clinical measurement, longitudinal study was aimed at the pretesting and cognitive interviewing of the prefinal Afrikaans (for the Western Cape) DASH questionnaire highlighting the iterative nature thereof. Twenty-two females and eight males with upper limb conditions were recruited to participate at public health care facilities in the Western Cape of South Africa. Cognitive interviews were conducted as a reparative approach with an iterative process through retrospective verbal probing during a debriefing session with 30 participants once they answered all 30 items of the translated DASH questionnaire. The sample included Afrikaans-speaking persons from low socioeconomic backgrounds, with low levels of education and employment (24 of 30 were unemployed). Pragmatic factors and measurement issues were addressed during the interviews. This study provides confirmation that both pragmatic factors and measurement issues need consideration in an iterative process as part of a reparative methodology towards improving patient-reported measures and ensuring strong content validity.

Structural and cross-cultural validity of the Afrikaans for the Western Cape Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire

“…No explanation can be provided for item 2 as in both language versions item 2 is one word (Afrikaans for the Western Cape: skryf and South African English: write ), skryf being a direct translation, with no synonyms. In considering the other items it could be that during the process of translation and cross-cultural adaptation [ 10 , 11 ], despite our best efforts, the meaning across language versions changed. However, when considering that the items still load on the same factors (with factor loadings of 0.597 and above), appropriately fitting M1: configural invariance, just not sufficient to support metric invariance, it may not be necessary to investigate further.…”

“…This study is the first on structural and cross-cultural validity of the DASH questionnaire following translation and cross-cultural adaptation into a South African language [13]. In addition, novel approaches were followed during translation and cross-cultural adaptation of the Afrikaans for the Western Cape DASH questionnaire, to ensure relevance for the intended population [9][10][11]. Evidence of structural and cross-cultural validity is invaluable to allow clinical utility of the measure within the South African context and towards 'validating' novel approaches.…”

“…The total score is calculated as follows: (sum of responses/number of responses) − 1 × 25 with scores closer to 100 indicating greater disability. The Afrikaans for the Western Cape DASH (for which the translation and cross-cultural adaptation and content validity is described elsewhere [ 10 , 11 ]) and the South African English DASH (available from the IWH website: https://dash.iwh.on.ca/available-translations ; with evidence of construct validity available in Additional file 1 ) were used during data collection. Patients were requested to complete both language versions.…”

“…The total score is calculated as follows: (sum of responses/number of responses) − 1 × 25 with scores closer to 100 indicating greater disability. The Afrikaans for the Western Cape DASH (for which the translation and cross-cultural adaptation and content validity is described elsewhere [10,11]) and the South African English DASH (available from the IWH website: https:// dash. iwh.…”

“…English (20.3%), Afrikaans (49.7%) and isiXhosa (24.7%) are the three most predominantly spoken languages in the Western Cape of South Africa. The variation that exists within the Afrikaans language (previously described [ 9 ]) served as motivation to translate and cross-culturally adapt the DASH questionnaire into Afrikaans for the Western Cape, within the public health context of the Western Cape of South Africa and is reported on elsewhere [ 10 , 11 ]. Validity of this new language version and equivalence between language versions within this context would allow for accurate self-report and for comparisons between patient scores (from different languages and cultural backgrounds) within the same clinical setting, addressing the call to demonstrate outcomes of intervention [ 12 ].…”