Date Presented 3/30/2017
Racial and ethnic health care disparities indicate gaps in cultural competence. Cultural adaptations of assessments afford the opportunity to reduce disparities and enact culturally competent assessment. Study results contribute new knowledge about cultural adaptations with and without translation.
Primary Author and Speaker: Kristen Arestad
Contributing Authors: Erin Albrecht, Lauren Nale, Pat Sample, David MacPhee, Chun Yi Lim, Mary Khetani
PURPOSE: Culture informs the occupations in which children engage as well as how occupations are enacted. Significant racial and ethnic health care disparities, such as those experienced by Hispanic children with special health care needs (CSHCN), indicate gaps in enacting cultural competence. One way to minimize these disparities and facilitate culturally competent care is to ensure pediatric occupational therapists are equipped with culturally relevant assessments.
Current approaches to cultural adaptation of assessments present with three major limitations: use of inconsistent translation processes; current processes that assess for some, but not all, elements of cultural equivalence; and limited evidence to guide decision making about whether to undertake cultural adaptation with and without language translation. This study addressed these limitations in the context of culturally adapting the Young Children’s Participation and Environment Measure (YC–PEM) in English and Spanish for use by caregivers of Hispanic CSHCN. The aims of this study are (1) to examine the similarities and differences in the revisions required to achieve semantic, idiomatic, item, and conceptual equivalencies across pilot versions and (2) to examine the feasibility of cultural adaptation processes.
DESIGN: This study used a cross-sectional design with qualitative and quantitative methods and a cognitive testing approach. Recruitment was done through convenience sampling primarily in the context of early intervention agencies. Participants were seven caregivers (four Spanish speaking, three English speaking) of CSHCN who met the following inclusion criteria: (1) resided in the United States, (2) self-identified as a parent or legal guardian age 18 yr or older, (3) self-identified as a caregiver of a child of Mexican descent age 0–5 yr, and (4) was able to read and write in English or Spanish.
METHOD: Data collection occurred in two phases. Phase 1 involved the Spanish translation of the YC–PEM. Phase 2 involved cognitive testing of the Spanish and English versions of the YC–PEM. For Phase 2, caregivers completed a demographic questionnaire, Acculturation Rating Scale for Mexican Americans–II, and YC–PEM inclusive of cognitive testing items. To inform decisions regarding content revisions to both YC–PEM pilot versions, responses to cognitive testing items were content coded to established cultural equivalencies (i.e., semantic/idiomatic, item, conceptual) by up to four research staff. Coded data were summed to compare frequency of revisions needed to achieve cultural equivalence between the two versions. Enrollment and process data were used to examine the feasibility of language translation and cognitive testing.
RESULTS: Results show that more revisions were required to achieve cultural equivalence for the translated (Spanish) version; however, conceptual equivalence concerns were identified in both versions. Feasibility results revealed that language translation processes required high resource investment but increased translation quality, as evidenced by decreased discrepancy rates, and that use of questionnaire (i.e., electronic, paper) versus interview methods may have limited data saturation for cognitive testing results. Results lend preliminary support to the need for and feasibility of cultural adaptation with and without language translation and have informed protocol revisions for a study under way to confirm findings.
CONCLUSION: To our knowledge, this is the first study to systematically develop and compare multiple versions of a culturally adapted questionnaire. Knowledge generated from this study serves to inform decisions surrounding cultural adaptations with and without translation and, thus, to potentially enhance cultural competence within occupational therapy practice.
References
Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25, 3186–3191. https://doi.org/10.1097/00007632-200012150-00014
Khetani, M. A., Graham, J. E., Davies, P. L., Law, M. C., & Simeonsson, R. J. (2015). Psychometric properties of the Young Children’s Participation Measure. Archives of Physical Medicine and Rehabilitation, 96, 307–316. https://doi.org/10.1016/j.apmr.2014.09.031
Sousa, V. D., & Rojjanasrirat, W. (2011). Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. Journal of Evaluation in Clinical Practice, 17, 268–274. https://doi.org/10.1111/j.1365-2753.2010.01434.x
Stevelink, S. A. M., & van Brakel, W. H. (2013). The cross-cultural equivalence of participation instruments: A systematic review. Disability and Rehabilitation, 35, 1256–1268. https://doi.org/10.3109/09638288.2012.731132
