Cross-cultural adaptation of the Spanish MINICHAL instrument into English for use in the United Kingdom

Abstract

Background Hypertension is a highly prevalent condition, with optimal treatment to BP targets conferring significant gains in terms of cardiovascular outcomes. Understanding why some patients do not achieve BP targets would be enhanced through greater understanding of their health-related quality of life (HRQoL). However, the only English language disease-specific instruments for measurement of HRQoL in hypertension have not been validated in accordance with accepted standards. It is proposed that the Spanish MINICHAL instrument for the assessment of HRQoL in hypertension could be translated, adapted and validated for use in the United Kingdom. The aim of the study was therefore to complete this process. Methods The MINICHAL authors were contacted and the original instrument obtained. This was then translated into English by two independent English-speakers, with these versions then reconciled, before back-translation and subsequent production of a 2nd reconciled version. Thereafter, a final version was produced after cognitive debriefing, for administration and psychometric analysis in the target population of patients living in the Exeter area (Southwest UK) aged 18–80 years with treatment-naïve grade II-III hypertension, before, during and after 18 weeks’ intensive treatment. Results The English-language instrument was administered to 30 individuals (median age: 58.5 years, 53% male). Psychometric analysis demonstrated a floor effect, though no ceiling effect. Internal consistency for both state of mind (StM) and somatic manifestations (SM) dimensions of the instrument were acceptable (Cronbach’s alpha = 0.81 and 0.75), as was test–retest reliability (ICC = 0.717 and 0.961) and construct validity, which was measured through co-administration with the EQ-5D-5L and Bulpitt-Fletcher instruments. No significant associations were found between scores and patient characteristics known to affect HRQoL. The EQ-5D-5L instrument found an improvement in HRQoL following treatment, with the StM and SM dimensions of the English language MINICHAL trending to support this (d = 0.32 and 0.02 respectively). Conclusions The present study details the successful English translation and validation of the MINICHAL instrument for use in individuals with hypertension. The data reported also supports an improvement in HRQoL with rapid treatment of grade II-III hypertension, a strategy which has been recommended by contemporaneous European guidelines. Trial registration ISRCTN registry number: 57475376 (assigned 25/06/2015).

Designing and validating a scale for evaluating the sources of unreliability of a high-stakes test

“…This happens if the items are not correlated with the test’s total score. Moreover, items that cannot distinguish between lower- and higher-level test-takers decrease the reliability of the test and, therefore, deteriorate the validity of the test too (Jordan et al, 2022 ). As a result, such items should be removed from a test to increase its reliability and validity, which is rarely considered.…”

“…Of course, a few researchers like Ahmadi et al ( 2015 ) focused on the subject but narrowly as they covered only some limited sources of unreliability such as the administration conditions. To overcome this gap and to probe into sources of unreliability of a test in detail, especially regarding high-stakes tests such as the University Entrance Exam in Iran which influences the lives of millions of test-takers annually, the primary purpose of the present study was to discover the probable sources of unreliability of a test since unreliable or invalid tests cause serious problems for test-takers (Jordan et al, 2022 ). Furthermore, this study attempted to develop and validate a scale for measuring such sources following Bachman and Palmer’s ( 2010 ) classification of principal sources of unreliability or inconsistency in test scores, which included the effect of test-takers , structure of the test itself , and administration conditions of the test .…”