The cross-cultural equivalence of participation instruments: a systematic review
Authors:
Stevelink, S. A. and van Brakel, W. H.
Abstract:
PURPOSE: Concepts such as health-related quality of life, disability and participation may differ across cultures. Consequently, when assessing such a concept using a measure developed elsewhere, it is important to test its cultural equivalence. Previous research suggested a lack of cultural equivalence testing in several areas of measurement. This paper reviews the process of cross-cultural equivalence testing of instruments to measure participation in society.
METHODS: An existing cultural equivalence framework was adapted and used to assess participation instruments on five categories of equivalence: conceptual, item, semantic, measurement and operational equivalence. For each category, several aspects were rated, resulting in an overall category rating of 'minimal/none', 'partial' or 'extensive'. The best possible overall study rating was five 'extensive' ratings. Articles were included if the instruments focussed explicitly on measuring 'participation' and were theoretically grounded in the ICIDH(-2) or ICF. Cross-validation articles were only included if it concerned an adaptation of an instrument developed in a high or middle-income country to a low-income country or vice versa.
RESULTS: Eight cross-cultural validation studies were included in which five participation instruments were tested (Impact on Participation and Autonomy, London Handicap Scale, Perceived Impact and Problem Profile, Craig Handicap Assessment Reporting Technique, Participation Scale). Of these eight studies, only three received at least two 'extensive' ratings for the different categories of equivalence. The majority of the cultural equivalence ratings given were 'partial' and 'minimal/none'. The majority of the 'none/minimal' ratings were given for item and measurement equivalence.
CONCLUSION: The cross-cultural equivalence testing of the participation instruments included leaves much to be desired. A detailed checklist is proposed for designing a cross-validation study. Once a study has been conducted, the checklist can be used to ensure comprehensive reporting of the validation (equivalence) testing process and its results.
IMPLICATIONS FOR REHABILITATION: * Participation instruments are often used in a different cultural setting than initial developed for. * The conceptualization of participation may vary across cultures. Therefore, cultural equivalence - the extent to which an instrument is equally suitable for use in two or more cultures - is an important concept to address. * This review showed that the process of cultural equivalence testing of the included participation instruments was often addressed insufficiently. * Clinicians should be aware that application of participations instruments in a different culture than initially developed for needs prior testing of cultural validity in the next context.
Cognitive/mental functioning Physical functioning Role functioning Social functioning
Age:
Adults (18-65) Seniors (65+)
Disease:
Certain conditions originating in the perinatal period and related symptoms Certain infections and parasitic diseases and related symptoms Codes for special purposes Congenital malformations, deformations and chromosomal abnormalities and related symptoms Diseases of and symptoms related to the blood and blood-forming organs and certain disorders involving the immune mechanism Diseases of and symptoms related to the circulatory system Diseases of and symptoms related to the digestive system Diseases of and symptoms related to the ear and mastoid process Diseases of and symptoms related to the eye and adnexa Diseases of and symptoms related to the genitourinary system Diseases of and symptoms related to the musculoskeletal system and connective tissue Diseases of and symptoms related to the nervous system Diseases of and symptoms related to the respiratory system Diseases of and symptoms related to the skin and subcutaneous tissue Endocrine, nutritional and metabolic diseases and related symptoms External causes of morbidity and mortality Injury, poisoning and certain other consequences of external causes Mental and behavioural disorders and related symptoms Neoplasms and related symptoms Pregnancy, childbirth and puerperium and related symptom Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified
