Rosenberg Noah, Buono Mia, Ndebwanimana Vincent, Niyonzima Joseph, Merchant Roland C, Beeman Aly, Staton Catherine A, Vissoci Joao Ricardo Nickenig
Department of Emergency Medicine, Duke University School of Medicine, Durham, North Carolina, United States of America.
Department of Emergency Medicine, University of Botswana, Gaborone, Botswana.
PLoS One. 2025 Feb 25;20(2):e0316993. doi: 10.1371/journal.pone.0316993. eCollection 2025.
In Rwanda, alcohol use disorder (AUD) is estimated to affect 7% of the population. The Alcohol Use Disorder Identification Test (AUDIT) is an excellent screening instrument for AUD, but a Rwanda-focused version previously was unavailable. Our objective was to develop a Rwanda- focused AUDIT and evaluate its psychometric properties. The English AUDIT was adapted to the Rwandan language through translation and back- translation by a panel of native English and Kinyarwanda speakers. Random sampling was used to recruit participants from the emergency department, outpatient clinics, and inpatient wards at a tertiary care center in Rwanda, excluding those < 18 years old, declining to participate, unable to provide consent, or when participation would interfere with care. Participants completed the Rwanda-focused AUDIT using an audio computer-assisted self-interviewing format. Internal structure was assessed using one-, two- and three-dimensional models of fit and confirmatory factor analysis (CFA), assessed by Chi-square (χ2), Root Mean Square Error of Approximation (RMSEA), Tucker-Lewis index (TLI) and comparative fit index (CFI). Of 775 patients assessed for enrollment, 7% were unable to provide consent, 12% declined to participate, 2% could not participate because it would disrupt their medical care, and 1.3% dropped out, leaving 614 included for analysis. Of the 614, the majority were male (61%), married (53%) and had only primary education (65%). Their ages were: 33% 18-30, 43% 31-50, and 25% > 50 years-old. Factor loading for the AUDIT CFA model was between 0.62 and 0.96 for all items. Model fit indices included χ2 of < 0.001, RMSA of 0.061 (0.049 - 0.073), TLI of 0.994, and CFI of 0.995. Reliability statistics included Cronbach's alpha at 0.91 (0.90 - 0.92), Omega 6 at 0.948 and composite reliability at 0.977. The Rwanda-focused AUDIT showed excellent performance for measures of internal structure with high factor loading on CFA and model fit indices meeting traditional parameters of RMSEA < 0.08, TLI > 0.90, and CFI > 0.95. In this context, χ2 should ideally be > 0.05, however a relatively large sample, such as ours, tends to depress the number. All reliability statistics were above 0.90, indicating strong internal consistency. These findings support the reliability of this screening instrument. Further research should focus on the development of brief interventions for those who screen positive.
在卢旺达，据估计酒精使用障碍（AUD）影响着7%的人口。酒精使用障碍识别测试（AUDIT）是一种出色的AUD筛查工具，但此前没有针对卢旺达的版本。我们的目标是开发一个针对卢旺达的AUDIT并评估其心理测量特性。通过一组以英语为母语和基尼亚卢旺达语为母语的人员进行翻译和回译，将英文AUDIT改编成卢旺达语。采用随机抽样的方法从卢旺达一家三级护理中心的急诊科、门诊诊所和住院病房招募参与者，排除年龄小于18岁、拒绝参与、无法提供同意书或参与会干扰治疗的人员。参与者使用音频计算机辅助自我访谈的形式完成针对卢旺达的AUDIT。使用一维度、二维度和三维度拟合模型以及验证性因子分析（CFA）评估内部结构，通过卡方（χ2）、近似均方根误差（RMSEA）、塔克 - 刘易斯指数（TLI）和比较拟合指数（CFI）进行评估。在775名接受入组评估的患者中，7%无法提供同意书，12%拒绝参与，2%因会干扰其医疗护理而无法参与，1.3%退出，最终纳入614名进行分析。在这614名参与者中，大多数为男性（61%）、已婚（53%）且仅接受过小学教育（65%）。他们的年龄分布为：33%为18 - 30岁，43%为31 - 50岁，25%大于50岁。AUDIT CFA模型中所有项目的因子载荷在0.62至0.96之间。模型拟合指数包括χ2小于0.001、RMSEA为0.061（0.049 - 0.073）、TLI为0.994、CFI为0.995。可靠性统计数据包括克朗巴哈系数为0.91（0.90 - 0.92）、欧米伽6为0.948以及组合信度为0.977。针对卢旺达的AUDIT在内部结构测量方面表现出色，CFA上具有高因子载荷，模型拟合指数符合RMSEA < 0.08、TLI > 0.90和CFI > 0.95的传统参数。在这种情况下，χ2理想情况下应大于0.05，然而像我们这样相对较大的样本往往会使该数值降低。所有可靠性统计数据均高于0.90，表明内部一致性很强。这些发现支持了这种筛查工具的可靠性。进一步的研究应聚焦于为筛查呈阳性者开发简短干预措施。
