Cross-Cultural Adaptation, Validity, and Reliability Testing of the Tilburg Frailty Indicator (TFI) Amharic Version for Screening Frailty in Community-Dwelling Ethiopian Older People

Abstract

Background: Frailty is a global health problem, including in African countries. Despite this, no reliable or valid frailty instruments incorporate any African language, and no research exists to cross-culturally adapt and test the validity and reliability of instruments commonly used in other countries for use within African countries. The Tilburg Frailty Indicator (TFI) is a reliable and validated instrument with the potential to be relevant for older populations living in Africa. This study aimed to develop the TFI Amharic (TFI-AM) version for use within Ethiopia. Methods: This study employed psychometric testing and the evaluation of a translated and adapted instrument. The original English language version of the TFI was translated and culturally adapted into Amharic using the World Health Organization process of translation and adaptation of an instrument. A convenience sample of ninety-six community-dwelling older people 60 years and over was recruited. Cronbach's alpha was used for the analysis of the internal consistency of the TFI Amharic (TFI-AM) version using IBM SPSS 26.0 (IBM Corp., Armonk, NY, USA). Face and content validities of the TFI-AM were determined. Results:The TFI-AM total mean score was 5.76 (±2.89). The internal consistency of the TFI-AM was very good with an overall Cronbach alpha value of 0.82. The physical domain showed the highest reliability with a 0.75 Cronbach's alpha value while the social domain was the lowest with a 0.68 Cronbach's alpha value. The Cronbach's alpha reliability coefficients of the instrument ranged from 0.68 to 0.75. The item content validity index value ranged from 0.83 to 1.0 and the total content validity index average for the instrument was 0.91. Conclusion:The TFI-AM is reliable, valid, and reproducible for the assessment of frailty among community-dwelling older populations in Ethiopia. TFI-AM proved an easy-to-administer, applicable and fast instrument for assessing frailty in communitydwelling older populations.

Measuring the effects of nurse-led frailty intervention on community-dwelling older people in Ethiopia: a quasi-experimental study

“…The effect of our nurse-led intervention was assessed using one of the multidimensional frailty assessment instruments, the TFI-AM, following cross-cultural adaptation, validity, and reliability testing [ 69 ]. In low-income countries, multidimensional frailty assessments will play an important role in providing a comprehensive assessment of health status, facilitating individualised care, and informing public health planning.…”

Measuring the effects of a nurse-led intervention on frailty status of older people living in the community in Ethiopia: A protocol for a quasi-experimental study

“…The primary outcome is change in frailty status of community-dwelling older persons measured at three points in time: baseline (T0), immediately post-intervention (T1) and at 12 weeks post intervention (T2) using the Tilburg Frailty Indicator-Amharic Version (TFI-AM) [39]. We hypothesise that frail older people who received the nurse-led intervention will have a reduced frailty score, including the physical, psychological, and social domains of frailty.…”

“…In Ethiopia, the cutoff point for old age is 60 years [69,70]. Therefore, older people 60 years or above, whose frailty score � 5 as measured by the Tilburg Frailty Indicator Amharic Version (TFI-AM) [39] and residing in Bahir Dar, Ethiopia, will be included in the study. Participants will be excluded if they are unable to communicate, have major cognitive impairment, are bed-redden, do not live at home, have been hospitalised with a known psychiatric problem within the past six months, or will not reside in the selected area during the study period.…”