Development and Validation of the Krio Version of the WHOQOL-BREF for Use in Sierra Leone

Abstract

Formal measures of subjective well-being are needed to assure that health and psychosocial support services in Sierra Leone are objectively evaluated and evidence-based. The purpose of this study was to evaluate a Krio version of the brief form of the World Health Organization's Quality of Life (WHOQOL-BREF) questionnaire. A convenience sample of 425 adult Sierra Leoneans was verbally interviewed in the northern province of Bombali, using a previously piloted version of the scale, as well as a short demographic survey. Descriptive, correlational, and inferential statistics were used to assess evidence of reliability and validity in a manner similar to the WHOQOL-BREF international field trial. Cronbach's alpha for the four domains ranged from 0.55 to 0.72 and improved when the three negatively phrased items requiring reversed scoring were removed, as well as when all items were treated as a unidimensional scale (alpha = 0.83). Patients scored significantly lower scores on all four subscales and the question assessing overall quality of health question. Persons with no formal education had lower scores on Physical, Psychological, and Environmental domains, as well as the two overall quality of life and health questions. Age was negatively correlated with Physical, Psychological, and Social domains, as well as the questions for overall quality of life and quality of health. Multiple regression analyses found Physical, Psychological, and Environmental domains to be significantly associated with questions assessing overall quality of life and quality of health. Twenty-three out of 24 items correlated highest to their expected domain, but 10 also correlated above 0.40 on another domain. Confirmatory factor analysis allowing for two pairs of error variances to covary showed good fit with the original scale's four domain model (χ 2 /df = 3.02; CFI = .833; RMSEA = .069, 90% CI = 0.063-0.076). The results indicate that the new scale shares many of the same psychometric properties as the original WHOQOL-BREF and is appropriate for health-related research. Future studies with the WHOQOL and other quality of life instruments should use caution when developing negatively phrased items in scale development, particularly when planned for use across multiple settings, as they may yield unwanted method effects and adversely impact test reliability and internal structure.

The feasibility, repeatability, validity and responsiveness of the EQ-5D-3L in Krio for patients with stroke in Sierra Leone

“…The EQ-5D-3L Interviewer Administered v2.1 was translated into Krio for Sierra Leone using an expanded methodology based on the EuroQol Foundation guidelines [ 18 ] including focus groups, a process of iterative forward and backward translation, two independent forward translations and two independent back translations, followed by review and reconciliation. EQ-5D-3L was selected instead of the EQ-5D-5L due to difficulties of translating the five levels into Krio and difficulties in discriminating between the five levels with similar issues experienced by other researchers [ 19 ]. The translated tool can be accessed here [ 20 ].…”

The development of a contextually appropriate measure of psychological distress in Sierra Leone

“…A four-point scale was used in an attempt to balance sensitivity with simplicity. Price, Conteh and Esliker [ 30 ], in their translation of the WHOQOL-BREF into Krio, found that some of the extreme anchor points in a five-point scale required the creation of terms that are not commonly used in Krio, raising questions of whether individuals are able to distinguish between the different options.…”

“…It is also in line with Betancourt's [44] observation that more concrete items tend to be more easily understood in a scale. Price, Conteh & Esliker [30] also noted that in Krio, psychological constructs are not easily separated from physical ones. A related challenge (also noted by Kaiser et al [21]) is that, particularly when trying to describe relatively abstract concepts, items sometimes became relatively long and difficult to follow.…”