Linguistic and content validation of the translated and culturally adapted PG-SGA, as perceived by Norwegian cancer patients and healthcare professionals

Abstract

Background & aims: The Scored Patient-Generated Subjective Global Assessment (PG-SGA©) is a validated nutritional screening, assessment, monitoring, and triage tool. When translated to other languages, the questions and answering items need to be conceptually, semantically, and operationally equivalent to the original tool. In this study, we aimed to assess linguistic and content validity of the PG-SGA translated and culturally adapted for the Norwegian setting, as perceived by Norwegian cancer patients and healthcare professionals (HCPs). Methods: We have translated and culturally adapted the original PG-SGA for the Norwegian setting, in concordance with the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Cancer patients and HCPs, including nurses, dietitians and physicians, were invited to participate. Comprehensibility and difficulty were assessed by patients for the patient component (PG-SGA Short Form), and by HCPs for the professional component. Content validity was assessed for the full PG-SGA by HCPs only. The data were collected by a questionnaire and evaluations were operationalized by a 4-point scale. Item and scale indices were calculated for comprehensibility (Item CI, Scale CI), difficulty (Item DI, Scale DI) and content validity (Item CVI, Scale CVI). Results: Fifty-one cancer patients and 92 HCPs participated in the study. The patients perceived comprehensibility and difficulty of the Norwegian PG-SGA Short Form as excellent (Scale CI ¼ 0.99 and DI ¼ 0.97). However, HCPs perceived comprehensibility and difficulty of the professional component as below acceptable (Scale CI ¼ 0.78 and DI ¼ 0.66), and the physical exam was being rated as the most difficult part (Item DI 0.26 to 0.65). Content validity for the full Norwegian PG-SGA was considered excellent (Scale CVI ¼ 0.99) by the HCPs. Conclusion: The patient component of PG-SGA was considered clear and easy to complete, and the full Norwegian PG-SGA was considered as relevant by HCPs. In the final Norwegian PG-SGA, changes have been made to improve comprehensibility of the professional component. To improve perceived difficulty of completing the professional component, training of professionals is indicated.

Translation and cultural adaptation of the scored Patient-Generated Subjective Global Assessment (PG-SGA©)

“…The study results are consistent with findings from similar ISPOR-based translations and cultural adaptations of the PG-SGA for Norwegian, Dutch, German, Greek, and Japanese languages [24,25,27,28,32]. Similar to the Danish results, the patient component consistently received high ratings, indicating high content validity (S-CVI ¼ 0.89e0.99), ease of comprehension (SeCI ¼ 0.90e0.99), and low level of difficulty (S-DI ¼ 0.90e0.97) [24,25,27,28]. In addition, content validity of the professional component was rated excellent in all translated and culturally adapted language versions [24,25,28,32].…”

“…In addition, content validity of the professional component was rated excellent in all translated and culturally adapted language versions [24,25,28,32]. In contrast, comprehensibility of the PG-SGA reached below acceptable in Norwegian (SeCI: 0.78) as in Danish, acceptable in German, Dutch and Japanese (SeCI: 0.81e0.88), and excellent in Greek [24,25,27,28]. As for perceived difficulty of the PG-SGA, the Danish, Dutch, Norwegian, German, and Japanese version was rated below acceptable (S-DI: 0.55e0.72), whereas the Greek reached excellent results [24,25,27,28,32].…”

A Japanese translation, cultural adaptation, and linguistic and content validity confirmation of the Scored Patient-Generated Subjective Global Assessment

“…Development of the Japanese version of the PG-SGA was performed according to the 10 steps of the ISPOR "Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-reported Outcome Measures" [14]. The specifics of the ISPOR process as applied to PG-SGA translations was described in a Dutch study [15], which served as the basis for the development of other language versions of the PG-SGA [15][16][17][18].…”

Malnutrition according to GLIM criteria in stable renal transplant recipients: Reduced muscle mass as predominant phenotypic criterion

“…The Dutch version of the Patient-Generated Subjective Global Assessment (PG-SGA version 3.7 NL, as available on http://www.pt-global.org/) was used to assess nutritional status [28,29]. The PG-SGA is a validated nutrition assessment tool and available in multiple language versions, based on translation and cultural adaptation processes using the International Society for Pharmacoeconomics and Outcomes Research's (ISPOR's) "Principles of Good Practice for the Translation and Cultural Adaptation Process for PRO Measures" [30,31]. The first part of the PG-SGA (PG-SGA Short Form, SF) was completed by the patient and included items on weight history (Box 1), food intake (Box 2), nutrition impact symptoms (Box 3), activities and function (Box 4).…”