Cultural adaptation and validation of the Attribution Questionnaire for stigma towards disability pension applicants for use among psychiatrists and general practitioners in Sweden

Abstract

Background This study aimed to culturally translate the Attribution Questionnaire (AQ) to the Swedish language and examine the reliability and validity of the new Swedish version to measure stigma towards disability pension applicants in the Swedish context among psychiatrists and general practitioners. Methods The AQ was translated from the original English version into Swedish using the recommended guidelines for cultural translation of questionnaires. Steps included forward/back-translation, use of expert committee and pretesting. Cronbach’s alpha was used to determine internal consistency and structural equation modelling (SEM) was used to test the responsibility model of stigma compared to the original English version. Results 1,414 physicians completed the questionnaire (23.6%). Cultural translation resulted in many modifications to the original questionnaire to increase the external validity. Internal reliability of the AQ Swedish version (AQ-S) was 0.733 and is considered acceptable. Pity and Segregation-coercion sub-scales showed limited consistency. SEM findings show that the responsibility model of stigma is an acceptable fit for the Swedish setting. Conclusion Findings show that the AQ-S is comparable to the other versions of the AQ and is a reliable measure to assess and monitor stigma among physicians in the Swedish setting. Our study shows that cultural translation does not significantly impact the validity of the questionnaire.

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“…The adaptation procedure brings together areas of expertise in different areas, including psychometric and statistical (e.g., structural equation modeling, item response models) (Clark & Watson, 2019;Y. Liu et al, 2019;McAllister et al, 2021;Mels et al, 2010). The cross-cultural adaptation process is essential when a scale is used in a different language, environment, and time to reduce the risk of bias in a study (Herdman et al, 1998;Swami & Barron, 2019).…”