Cross-Cultural Validation of the 5-Item Compliance Questionnaire for Rheumatology to the Arabic Language in Patients with Rheumatoid Arthritis

Abstract

Purpose A simple measure to assess drug adherence in Saudi patients with rheumatoid arthritis (RA) is required. The aim of this study was to translate and validate the 5-Item Compliance Questionnaire for Rheumatology (CQR5) into Arabic. Patients and Methods The questionnaire was translated and culturally adapted to Arab patients in six steps: initial translation, synthesis of the translation, back translation, expert committee review, test of the pre-final version, and development of the Arabic CQR5 (ACQR-5). The resulting version was tested for validity in patients with RA. Results A total of 103 adult patients with RA were recruited from rheumatology clinics at a university hospital in Riyadh, Saudi Arabia. After extensive translation, the final tool (CQR) was piloted in 15 patients. The final validation was performed with 88 patients. Of these, 80 (90.9%) were female and 43.2% were seropositive. The mean (±SD) age and disease duration were 50 (±13) and 11.4 (±8.2) years, respectively. Cronbach’s alpha reliability was 0.886, and the Kaiser-Meyer-Olkin measure of sampling adequacy for factor analysis was 0.870 (p<0.001). The mean ACQR-5 was 17.78 (2.70), with 14 (15.9%) classified as low adherents and the remaining 74 (84.1%) as high adherents. Binary logistic regression revealed that increasing age (odds ratio [OR] 1.082, 95% confidence interval [CI]: 1.025–1.142, p=0.005) and a trend toward the presence of other comorbidities (OR 3.111, 95% CI: 0.961–10.070, p=0.058) were associated with low adherence. Conclusion ACQR-5 is a simple and feasible tool for identifying adherence levels in patients with RA in Saudi Arabia. A high level of adherence was observed in this study. Additional studies are required to assess ACQR-5 validity and adherence levels in a larger, more diverse population.

Exploring factors influencing patient activation in Saudi rheumatoid arthritis patients: A Nationwide Cross‐Sectional Survey—Results from the COPARA study

“…The CQR is a short‐form survey that was developed to assess compliance among patients with rheumatic conditions 13 . It was translated and validated in the Arabic language in 2021 14 . In the survey, participants are expected to rate the extent to which they agree or disagree with five statements on a 4‐point Likert scale.…”

“…The primary outcome variable was patient activation, which was assessed using the Arabic version of the 13‐item patient activation measure (PAM‐13) 3 . Other outcome variables included disease activity, which was assessed using the translated RA Impact of Disease (RAID) tool, 12 and compliance, which was assessed using the Arabic version of the Compliance Questionnaire for Rheumatology (A‐CQR) 13,14 …”

“…13 It was translated and validated in the Arabic language in 2021. 14 In the survey, participants are expected to rate the extent to which they agree or disagree with five statements on a 4-point Likert scale. The RAID tool was originally developed in English and then translated into multiple languages.…”

Exploring Factors Influencing Medication Compliance in Saudi Rheumatoid Arthritis Patients: A Nationwide Cross-Sectional Survey – Results from the COPARA Study

“… 14 The CQR5 was translated in a previous study. 10 The last part was the Arabic version of the Rheumatoid Arthritis Impact of Disease (RAID), developed initially in English. 15 The tool aimed to measure the impact of RA by answering seven questions on a scale of (0 to 10) where (0) “Did not cause me pain” and 10 “Caused me severe pain.” Patients who accessed the questionnaire but did not complete all the items were excluded from the analysis.…”

“…The 19 and 5 item Compliance Questionnaire for Rheumatology (CQR) versions were only recently validated in the Arabic language. 10 , 11 The current study aimed to establish compliance on large sample size and study the impact of patient-related factors, disease characteristics, medication frequency, and route administration.…”