Faculty of Allied Health Sciences, Department of Physiotherapy, College of Health Sciences, Bayero University Kano, Kano, Kano State, Nigeria.
Department of Physiotherapy, Muhammad Abdullahi Wase Teaching Hospital, Hospitals Management Board, Kano, Kano State, Nigeria.
PLoS One. 2021 Apr 13;16(4):e0249370. doi: 10.1371/journal.pone.0249370. eCollection 2021.
Negative attitudes and beliefs about low back pain (LBP) can lead to reduced function and activity and consequently disability. One self-report measure that can be used to assess these negative attitudes and beliefs and to determine their predictive nature is the Back Beliefs Questionnaire (BBQ). This study aimed to translate and cross-culturally adapt the BBQ into Hausa and assess its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP.
The BBQ was translated and cross-culturally adapted into Hausa (Hausa-BBQ) according to established guidelines. To assess psychometric properties, a consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the questionnaire along with measures of fear-avoidance beliefs, pain catastrophizing, functional disability, physical and mental health, and pain. One hundred of the 200 patients completed the questionnaire twice at an interval of 7-14 days to assess test-retest reliability. Internal construct validity was assessed using exploratory factor analysis, and external construct validity was assessed by examining convergent, divergent, and known-groups validity. Reliability was assessed by calculating internal consistency (Cronbach's α), intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95), and limits of agreement using Bland-Altman plots. Reliability (ICC, SEM and MDC95) was also assessed separately for rural and urban subgroups.
The factor analysis revealed a four-factor solution explaining 58.9% of the total variance with the first factor explaining 27.1%. The nine scoring items loaded on the first factor hence supporting a unidimensional scale. The convergent and divergent validity were supported as 85% (6:7) of the predefined hypotheses were confirmed. Known-groups comparison showed that the questionnaire discriminated well for those who differed in education (p < 0.05), but not in age (p > 0.05). The internal consistency and ICC (α = 0.79; ICC = 0.91) were adequate, with minimal SEM and MDC95 (1.9 and 5.2, respectively). The limits of agreements were -5.11 to 5.71. The ICC, SEM and MDC95 for the urban and rural subgroups were comparable to those obtained for the overall population.
The Hausa-BBQ was successfully adapted and psychometrically sound in terms of internal and external construct validity, internal consistency, and test-retest reliability in mixed urban and rural Hausa-speaking populations with chronic LBP. The questionnaire can be used to detect and categorize specific attitudes and beliefs about back pain in Hausa culture to prevent or reduce potential disability due to LBP.
对腰痛（LBP）的负面态度和信念可能导致功能和活动减少，进而导致残疾。一种可用于评估这些负面态度和信念并确定其预测性质的自我报告衡量标准是背部信念问卷（BBQ）。本研究旨在将 BBQ 翻译成豪萨语并进行跨文化适应性研究，并评估其在混合城市和农村尼日利亚慢性 LBP 人群中的心理测量特性。
根据既定指南，将 BBQ 翻译成豪萨语（豪萨语-BBQ）并进行跨文化适应性研究。为了评估心理测量特性，连续招募了 200 名来自尼日利亚城乡诊所的慢性 LBP 患者完成了问卷，同时还评估了恐惧回避信念、疼痛灾难化、功能障碍、身体和心理健康以及疼痛。其中 100 名患者在 7-14 天的间隔内两次完成了问卷，以评估测试-重测信度。使用探索性因素分析评估内部结构效度，通过检验收敛、发散和已知组有效性评估外部结构效度。使用 Cronbach's α 计算内部一致性、组内相关系数（ICC）、测量标准误差（SEM）、95%置信区间的最小可检测变化（MDC95）和 Bland-Altman 图的一致性界限来评估可靠性。还分别为农村和城市亚组评估了可靠性（ICC、SEM 和 MDC95）。
因素分析显示，四因素解决方案解释了总方差的 58.9%，第一因素解释了 27.1%。九个评分项目加载到第一个因子上，因此支持单一维度量表。收敛和发散有效性得到支持，因为 85%（6:7）的预设假设得到证实。已知组别的比较表明，问卷对教育程度不同的人（p<0.05）有很好的区分能力，但对年龄（p>0.05）没有。内部一致性和 ICC（α=0.79；ICC=0.91）是足够的，最小 SEM 和 MDC95（分别为 1.9 和 5.2）。一致性界限为-5.11 至 5.71。城市和农村亚组的 ICC、SEM 和 MDC95 与总体人群的结果相当。
豪萨语-BBQ 在混合城乡豪萨语人群中具有良好的内部和外部结构有效性、内部一致性和重测信度，适用于慢性 LBP。该问卷可用于检测和分类豪萨文化中背部疼痛的特定态度和信念，以预防或减少因 LBP 导致的潜在残疾。
