PhD, RN, Senior Lecturer, Faculty of Medicine, Department of Nursing Science, University of Malaya, Kuala Lumpur, Malaysia.
DClinP, RN, Professor, Department of Nursing, School of Healthcare and Medical Sciences, Sunway University, Kuala Lumpur, Malaysia.
J Nurs Res. 2020 Dec 7;29(1):e136. doi: 10.1097/jnr.0000000000000414.
The cross-cultural adaptation of questionnaires has tenuous theoretical underpinnings that limit the rigor of data collection and the meaningful analysis of cognitive interview data. An adaptation of existing models of equivalence and cognition provides structure to the comprehensive investigation of various equivalence types in enhancing the validity of translated questionnaires.
In this study, a framework comprising equivalence and cognition models was used to assess and finalize the Heart Quality-of-Life (HeartQoL)-Bahasa Malaysia (BM) questionnaire, which was derived from both forward-backward (FB) and dual-panel (DP) translation methods.
Investigation and finalization of two initial versions of the questionnaire were conducted based on findings from an expert assessment (n = 3 sociolinguists blinded to translation methods) and cognitive interviews with purposively sampled patients (FB: n = 11; DP: n = 11). The equivalence model of Herdman et al. and the question-and-answer model of Collins were adapted to form a "cognition-and-equivalence" model to guide data collection and analysis through modified cognitive interviews. The final HeartQoL-BM was completed by 373 patients with ischemic heart disease from two medical centers, and the data were analyzed using confirmatory factor analysis to assess the evidence of equivalence.
Findings from the expert assessment and cognitive interview showed the existence of semantic and item equivalence on almost all of the FB and DP items, identified some subtle potential equivalence gaps, and guided the process of item finalization. Confirmatory factor analysis, including tests of factorial invariance on the final two-factor model of HeartQoL-BM, confirmed conceptual, item, measurement, and operational equivalence, which supports functional equivalence.
The potential use of the cognition-and-equivalence model for modified cognitive interviewing and the application of the six equivalence types of Herdman et al. were supported by the HeartQoL-BM showing functional equivalence with its source. HeartQoL-BM is a potentially valid measure of health-related quality of life for patients with ischemic heart disease independent of conditions such as angina, myocardial infarction, and heart failure.
问卷的跨文化适应具有不牢固的理论基础，这限制了数据收集的严谨性和认知访谈数据的有意义分析。现有的等效和认知模型的改编为各种等效类型的综合调查提供了结构，从而增强了翻译问卷的有效性。
本研究使用包含等效和认知模型的框架来评估和最终确定源自正向-反向（FB）和双面板（DP）翻译方法的马来西亚版心脏生活质量（HeartQoL）问卷（HeartQoL-BM）。
根据专家评估（n = 3 名对翻译方法一无所知的社会语言学家）和有针对性抽样患者（FB：n = 11；DP：n = 11）的认知访谈的结果，对两个初始问卷版本进行了调查和最终确定。赫德曼等人的等效模型和柯林斯的问答模型被改编为“认知与等效”模型，通过修改后的认知访谈来指导数据收集和分析。最终的 HeartQoL-BM 由来自两家医疗中心的 373 名缺血性心脏病患者完成，并使用验证性因子分析来评估等效性的证据。
专家评估和认知访谈的结果表明，在几乎所有的 FB 和 DP 项目中都存在语义和项目等效性，发现了一些潜在的细微等效性差距，并指导了项目最终确定的过程。验证性因子分析，包括对 HeartQoL-BM 的最终两因素模型进行因子不变性检验，证实了概念、项目、测量和操作等效性，这支持了功能等效性。
通过认知与等效模型进行的修改后的认知访谈的潜在用途以及赫德曼等人的六种等效类型的应用，都得到了 HeartQoL-BM 的支持，该问卷与原始 HeartQoL 具有功能等效性。HeartQoL-BM 是一种用于评估缺血性心脏病患者健康相关生活质量的潜在有效工具，独立于心绞痛、心肌梗死和心力衰竭等疾病。
