Cross-cultural adaptation and psychometric validation of the Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P)

Abstract

ObjectivesThis study aimed to translate, cross-culturally adapt and psychometrically validate a Persian version of the Cardiac Rehabilitation Barriers Scale (CRBS-P) and to identify the main barriers in an Iranian setting.SettingAfshar cardiac rehabilitation (CR) centre, affiliated with the Yazd University of Medical Sciences, in the centre of Iran.DesignThis was a multimethod study, culminating in a cross-sectional survey.ParticipantsInpatient CR graduates who did not attend their initial outpatient CR appointment.MethodThe 21-item CRBS was translated and cross-culturally adapted in accordance with best practices; an expert panel considered the items and previous non-attending patients were interviewed via phone to refine the scale. Next, structural validity was assessed; participants were invited to complete the CRBS on the phone between March 2017 and February 2018. Using exploratory factor analysis (EFA) with principal component analysis extraction and oblique rotation. Second, confirmatory factor analysis (CFA) was used to verify the results; several goodness-of-fit indices were considered. The internal consistency and 3-week test–retest reliability of the scale (5% subsample) were evaluated using Cronbach’s α and intraclass correlation (ICC), respectively.ResultsFace, content and cross-cultural validity were established by the experts and patients (n=50). One thousand and one hundred (40.7%) of the 2700 patients completed the CRBS-P. Structural validity was established by EFA (Bartlett’s test p<0.001; =0.759) and confirmed by the CFA; a four-factor solution with 18 items accounting for 61.256% of variance had the best fit (χ2/df=3.206, root mean square error of approximation=0.061 and Comparative Fit Index=0.959). The internal consistency and test–retest reliability (n=42) of the scale were acceptable (ICC=0.743 95% CI (0.502 to 0.868); overall α=0.797). The top barriers were not knowing about CR, cost and lack of encouragement from physicians.ConclusionThe four-factor, 18-item CRBS-P had good psychometric properties, and hence can be reliably and validly used to measure CR barriers in Iran and other Persian-speaking populations.

Reliability of the Scale of Barriers for Cardiac Rehabilitation in the Colombian Population

“…The second one, designed by Cooper et al, shows an acceptable internal consistency (Cronbach's Alpha between 0.70 and 0.79) [16]. Finally, the CRBS [18] has shown a Cronbach's Alpha between 0.70 and 0.88 and ICCs between 0.64 and 0.78 in different studies [12,18,23]. These results are in line with the ones obtained in this study (Cronbach's Alpha of 0.84 and an ICC of 0.69).…”

“…However, the Brazilian CRBS is the only version that has assessed its psychometric properties in patients with cardiovascular risk factors, coronary heart disease, heart failure, arrhythmias, peripheral arterial disease and chronic obstructive pulmonary disease [20]. Additionally, the CRBS, when compared to the other two scales, is the only one that evaluates the factors influencing participation or adherence to CRPs [18][19][20][21][22][23][24][25][26][27][28].…”

“…The CRBS psychometric properties have been evaluated in subjects with average ages between 54 and 67 years, not considering other age groups that can demand cardiac rehabilitation services [19][20][21][22][23][24][25][26][27][28]. On the other hand, the Colombian version showed less reliability when it was self-reported, although in an interviewer's presence.…”

“…Thus, a high score indicates more barriers to participation in CRPs. The scale consists of four subscales: comorbidities/functional status, perceived needs, personal/family problems and conflict with work schedule/time [18][19][20][21][22][23][24][25][26][27][28].…”

“…The Cardiac Rehabilitation Barriers Scale (CRBS) was developed in Canada to assess the patient's perceived barriers at the patient, provider, and health system levels, affecting their participation and adherence to CRPs [18]. The CRBS discriminates between those who attend a CRP and those who did not and has been validated in 15 languages (e.g., Portuguese, French, Punjabi, Korean, Indonesian, Persian, and Chinese languages) [19][20][21][22][23][24][25][26][27][28]. The English version was psychometrically validated by Shanmugasegaram et al [18].…”