Department of Nursing, College of Health Sciences, Debre Berhan University, Debre Berhan, Ethiopia.
Department of Psychiatry, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Schizophr Bull. 2024 Jul 27;50(4):931-943. doi: 10.1093/schbul/sbad178.
Cognitive difficulties significantly burdened people with schizophrenia (PWS). However, cognitive assessment is often unavailable in low- and middle-income counties (LMICs) due to a lack of validated and culturally adapted cognitive assessment tools. In this study, we developed and evaluated a culturally sensitive cognitive battery for PWS in Ethiopia.
This study was conducted in three phases. First, we selected appropriate tests through an instrument selection procedure and created a new battery. Then, we rigorously adapted the tests using culturally competent procedures, including cognitive interviewing and expert meetings. Finally, we tested the new battery in 208 PWS and 208 controls. We evaluated its psychometric properties using advanced statistical techniques, including Item Response Theory (IRT).
The Ethiopian Cognitive Assessment battery for Schizophrenia (ECAS) was developed from three different batteries. Participants reported tests were easy to complete, and the raters found them easy to administer. All tests had good inter-rater reliability, and the composite score had very high test-retest reliability (ICC = 0.91). One-factor structure better represented the data with excellent internal consistency (α = .81). ECAS significantly differentiated PWS from controls with 77% sensitivity and 62% specificity at a Z-score ≤0.12 cut-off value. IRT analysis suggested that the battery functions best among moderately impaired participants (difficulty between -0.06 and 0.66).
ECAS is a practical, tolerable, reliable, and valid assessment of cognition. ECAS can supplement current assessment tools in LAMICs for PWS and can be used to measure cognitive intervention outcomes.
认知障碍给精神分裂症患者（PWS）带来了沉重负担。然而，由于缺乏经过验证和文化适应性的认知评估工具，在中低收入国家（LMICs），认知评估往往无法进行。在这项研究中，我们开发并评估了一种针对埃塞俄比亚 PWS 患者的具有文化敏感性的认知电池。
这项研究分为三个阶段进行。首先，我们通过仪器选择程序选择了合适的测试，并创建了一个新的电池。然后，我们使用文化能力程序（包括认知访谈和专家会议）对测试进行了严格的适应性调整。最后，我们在 208 名 PWS 和 208 名对照者中测试了新电池。我们使用包括项目反应理论（IRT）在内的先进统计技术评估了其心理计量学特性。
埃塞俄比亚精神分裂症认知评估电池（ECAS）是由三个不同的电池发展而来。参与者报告说测试很容易完成，评估者发现测试很容易进行。所有测试的评分者间信度都很好，综合评分的重测信度非常高（ICC=0.91）。单因素结构能更好地表示数据，内部一致性非常好（α=0.81）。ECAS 在 Z 分数≤0.12 截断值时，以 77%的敏感性和 62%的特异性显著区分了 PWS 和对照组。IRT 分析表明，该电池在中度受损参与者（难度在-0.06 和 0.66 之间）中效果最佳。
ECAS 是一种实用、可耐受、可靠且有效的认知评估工具。ECAS 可以补充中低收入国家精神分裂症患者目前的评估工具，也可以用于衡量认知干预的效果。
