Measuring impairments of functioning and health in patients with axial spondyloarthritis by using the ASAS Health Index and the Environmental Item Set: translation and cross-cultural adaptation into 15 languages

Abstract

IntroductionThe Assessments of SpondyloArthritis international society Health Index (ASAS HI) measures functioning and health in patients with spondyloarthritis (SpA) across 17 aspects of health and 9 environmental factors (EF). The objective was to translate and adapt the original English version of the ASAS HI, including the EF Item Set, cross-culturally into 15 languages.MethodsTranslation and cross-cultural adaptation has been carried out following the forward–backward procedure. In the cognitive debriefing, 10 patients/country across a broad spectrum of sociodemographic background, were included.ResultsThe ASAS HI and the EF Item Set were translated into Arabic, Chinese, Croatian, Dutch, French, German, Greek, Hungarian, Italian, Korean, Portuguese, Russian, Spanish, Thai and Turkish. Some difficulties were experienced with translation of the contextual factors indicating that these concepts may be more culturally-dependent. A total of 215 patients with axial SpA across 23 countries (62.3% men, mean (SD) age 42.4 (13.9) years) participated in the field test. Cognitive debriefing showed that items of the ASAS HI and EF Item Set are clear, relevant and comprehensive. All versions were accepted with minor modifications with respect to item wording and response option. The wording of three items had to be adapted to improve clarity. As a result of cognitive debriefing, a new response option ‘not applicable’ was added to two items of the ASAS HI to improve appropriateness.DiscussionThis study showed that the items of the ASAS HI including the EFs were readily adaptable throughout all countries, indicating that the concepts covered were comprehensive, clear and meaningful in different cultures.

Validity and reliability of the Assessment of Spondyloarthritis International Society Health Index in English‐speaking patients with axial spondyloarthritis in Singapore

“…Since the ASAS HI contains only 17 items with a dichotomous response option, administration of the questionnaire is feasible as seen from the relatively short time taken to complete the ASAS HI (mean of 1.2 minutes) in the field test for face validity. This relatively short completion time of the ASAS HI is consistent with that of existing literature . Face validity was supported as the 17 items of the ASAS HI were determined to be relevant, comprehensive, and unambiguous.…”

“…We conducted cognitive debriefing interviews (CDIs) with English‐speaking patients with axSpA to assess the cultural relevance, acceptability and comprehensiveness of questionnaire items and instructions in English . Patients with axSpA were chosen by the attending clinician to represent a range of gender, age, disease activity, and education level.…”

“…We conducted cognitive debriefing interviews (CDIs) with Englishspeaking patients with axSpA to assess the cultural relevance, acceptability and comprehensiveness of questionnaire items and instructions in English. 2,18 Patients with axSpA were chosen by the attending clinician to represent a range of gender, age, disease activity, and education level. The patients completed the English version of ASAS HI in the presence of a trained interviewer, who observed and made note of any difficulties or hesitation in answering the items.…”

Measurement properties of the ASAS Health Index: results of a global study in patients with axial and peripheral spondyloarthritis

“…Since the ASAS HI contains only 17 items with a dichotomous response option addressing all important aspects of patient complaints, administration of the questionnaire is feasible as it has been shown in a previous field test 10. The calculation to obtain a single sum score is simple and quick to undertake.…”

“…Strengths include the involvement of 23 countries with 18 country-specific translations with different cultures and socioeconomic backgrounds within the validation process 10. Thus, the domains of functioning and health assessed in the questionnaire are likely to be relevant across countries and cultures.…”