Development of a questionnaire to determine the case detection delay of leprosy: A mixed-methods cultural validation study

Background Delay in case detection is a risk factor for developing leprosy-related impairments, leading to disability and stigma. The objective of this study was to develop a questionnaire to determine the leprosy case detection delay, defined as the period between the first signs of the disease and the moment of diagnosis, calculated in total number of months. The instrument was developed as part of the PEP4LEP project, a large-scale intervention study which determines the most effective way to implement integrated skin screening and leprosy post-exposure prophylaxis with a single-dose of rifampicin (SDR-PEP) administration in Ethiopia, Mozambique and Tanzania. Methodology/Principal findings A literature review was conducted and leprosy experts were consulted. The first draft of the questionnaire was developed in Ethiopia by exploring conceptual understanding, item relevance and operational suitability. Then, the first draft of the tool was piloted in Ethiopia, Mozambique and Tanzania. The outcome is a questionnaire comprising nine questions to determine the case detection delay and two annexes for ease of administration: a local calendar to translate the patient’s indication of time to number of months and a set of pictures of the signs of leprosy. In addition, a body map was included to locate the signs. A ‘Question-by-Question Guide’ was added to the package, to provide support in the administration of the questionnaire. The materials will be made available in English, Oromiffa (Afaan Oromo), Portuguese and Swahili via https://www.infolep.org. Conclusions/Significance It was concluded that the developed case detection delay questionnaire can be administered quickly and easily by health workers, while not inconveniencing the patient. The instrument has promising potential for use in future leprosy research. It is recommended that the tool is further validated, also in other regions or countries, to ensure cultural validity and to examine psychometric properties like test-retest reliability and interrater reliability.

Assessing Momentary Well-Being in People Living With Dementia: A Systematic Review of Observational Instruments

Optimizing the possibility to lead good lives is at the core of treatment and care for people with dementia. This may be monitored by assessing well-being and quality of life. However, cognitive impairment following dementia may complicate recall-based assessment with questionnaires, and proxy-ratings from family-caregivers do not correspond well to self-reports. Thus, using observational measures represents a potentially advanced option. Systematic reviews evaluating measurement properties, interpretability and feasibility of observational instruments assessing well-being in people living with dementia are lacking. Thus, this review performed systematic searches to find peer reviewed validated instruments of relevance in the databases MEDLINE, EMBASE, PsycINFO, Web of Science, CINAHL and ProQuest. Twenty-two instruments assessing well-being were included for evaluation of measurement properties based on the systematic approach of the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The evaluation included risk of bias on study level, and assessment of measurement properties on instrument level including content validity, construct validity, structural validity, internal consistency, measurement invariance, cross-cultural validity, measurement error and inter-rater/intra-rater/test–retest reliability and responsiveness. Additionally, the feasibility and interpretability of the measures were evaluated. No single instrument could be recommended based on existing publications. Thus, we provide general recommendations about further assessment and development of these instruments. Finally, we describe the most promising instruments and offer guidance with respect to their implementation and use in clinical and research contexts.

Diagnostic Performances of an Occupational Burnout Detection Method Designed for Healthcare Professionals

Background: We aimed to assess the validity (criterion and cross-cultural validity) and reliability of the first occupational burnout (OB) detection tool designed for healthcare professionals in Belgium in the context of Swiss medical practice. Methods: First, we assessed the sensitivity and specificity of the Tool. We developed this tool based on the consultation reports of 42 patients and compared its detection to the results of the Oldenburg Burnout Inventory (OLBI), filled-in by patients before a consultation. Second, we performed an inter-rater reliability (IRR) assessment on the OB symptoms and detection reached by the Tool between a psychiatrist, two psychologists, and an occupational physician. Results: The Tool correctly identified over 80% of patients with OB, regardless of the cutoff value used for OLBI scores, reflecting its high sensitivity. Conversely, its specificity strongly varied depending on the OLBI cutoff. There was a slight to fair overall agreement between the four raters on the detection of OB and the number of OB symptoms. Around 41% of symptoms showed a substantial to an almost perfect agreement, and 36% showed a slight to a moderate agreement. Conclusions: The Tool seems useful for identifying OB of moderate and strong severity in both the Belgian and Swiss contexts.

Development and Validation of a Multi-lingual Online Questionnaire for Surveying the COVID-19 Prevention and Control Measures used in Global Workplaces

Background Despite widespread COVID-19 vaccination programs, there is an ongoing need for targeted disease prevention and control efforts in high-risk occupational settings. This study aimed to develop, pilot, and validate an instrument for surveying occupational COVID-19 infection prevention and control (IPC) measures available to workers in diverse geographic and occupational settings. Methods A 44-item online survey was developed, translated, and validated for face, content, and cross-cultural validity according to literature review, expert consultation, and pre-testing. The survey was piloted with 890 workers from diverse industries in Canada, Ireland, Argentina, Poland, Nigeria, China, the US, and the UK. Odds ratios generated from univariable, and multivariable logistic regression assessed differences in ‘feeling protected at work’ according to gender, age, occupation, country of residence, professional role, and vaccination status. Exploratory factor analysis (EFA) was conducted, and internal consistency reliability verified with Cronbach’s alpha. Hypothesis testing using two-sample t-tests verified construct validity (i.e., discriminant validity, known-groups technique), and criterion validity. Results After adjustment for occupational sector, characteristics associated with feeling protected at work included being male (AOR = 1.88; 95% CI = 1.18,2.99), being over 55 (AOR = 2.17; 95% CI = 1.25,3.77) and working in a managerial position (AOR = 3.1; 95% CI = 1.99,4.83). EFA revealed nine key IPC domains relating to: environmental adjustments, testing and surveillance, education, costs incurred, restricted movements, physical distancing, masking, isolation strategies, and areas for improvement. Each domain showed sufficient internal consistency reliability (Cronbach’s alpha ≥ 0.60). Hypothesis testing revealed differences in survey responses by country and occupational sector, confirming construct validity (p < 0.001), criterion validity (p = 0.04), and discriminant validity (p < 0.001). Conclusions The online survey, developed to identify the COVID-19 protective measures used in diverse, international workplace settings, showed strong face validity, content validity, cross-cultural validity, internal consistency, criterion validity, and construct validity. It can be used by decision makers in the distribution of IPC resources, and to guide occupational safety and health (OSH) recommendations for preventing COVID-19 and future infectious disease outbreaks.

Psychometric properties of the patient-reported outcomes measurement information system scale v1.2: global health (PROMIS-GH) in a Dutch general population

Purpose To assess the psychometric properties of the Dutch-Flemish Patient-Reported Outcome Measurement Information System Scale v1.2 – Global Health (PROMIS-GH). Methods The PROMIS-GH (also referred to as PROMIS-10) was administered to 4370 persons from the Dutch general population. Unidimensionality (CFI ≥ 0.95; TLI ≥ 0.95; RMSEA ≤ 0.06; SRMR ≤ 0.08), local independence (residual correlations < 0.20), monotonicity (H > 0.30), model fit with the Graded Response Model (GRM, p < 0.001), internal consistency (alpha > 0.75), precision (total score information across the latent trait), measurement invariance (no Differential Item Functioning [DIF]), and cross-cultural validity (no DIF for language, Dutch vs. United States English) of its subscales, composed of four items each, Global Mental Health (GMH) and Global Physical Health (GPH), were assessed. Results Confirmatory factor analyses, on both subscales, revealed slight departures from unidimensionality for GMH (CFI = 0.98; TLI = 0.95, RMSEA = 0.22; SRMR = 0.04) and GPH (CFI = 0.99; TLI = 0.97; RMSEA = 0.12; SRMR = 0.03). Local independence, monotonicity, GRM model fit, internal consistency, precision and cross-cultural validity were supported. However, Global10 (emotional problems) showed misfit on the GMH subscale, while Global08 (fatigue) presented DIF for age. Conclusion The psychometric properties of the PROMIS-GH in the Dutch population were considered acceptable. Sufficient local independence, monotonicity, GRM fit, internal consistency, measurement invariance and cross-cultural validity were found. If future studies find similar results, structural validity of the GMH could be enhanced by improving or replacing Global10 (emotional problems).

Reliability and Validity of the Korean Late-Life Function and Disability Instrument

The purpose of this study was to develop the Korean version of the Late-Life Function and Disability Instrument (K-LLFDI) and verify its reliability and validity. Fifty community-dwelling older adults aged 65 years and above with independent mobility were surveyed. The reliability and validity of the instrument were verified. The overall cultural validity of 48 items was evaluated as very high (0.95), and only one item that was not appropriate was revised. The reliability of the remaining six domains was either high or very high. Internal consistency was high (α = 0.859) in the Disability component of the instrument and very high (α = 0.914) in the Function component. The factor loading for 42 out of 48 items was above 0.04. Overall, each component was well reflected by the sub-items. The K-LLFDI is expected to be instrumental in solving the rapidly growing problems of community-dwelling older adults.

Adapting the Trauma History Questionnaire for use in a population of homeless people with severe mental illness in Tamil Nadu, India: qualitative study

Background The Trauma History Questionnaire (THQ) is one of the most widely used traumatic event inventories, but its lack of validation makes it unsuitable for the millions of homeless people with severe mental illness in India, who are particularly vulnerable to trauma exposure. Aims To translate and culturally adapt the THQ for use in a population of homeless people with severe mental illness in Tamil Nadu, India. Method We used Herdman et al's model of cultural equivalence to conduct an in-depth qualitative assessment of the cultural validity of the THQ. Following several translations, conceptual, item, semantic and operational equivalence of the THQ was assessed through four focus groups with user-survivors (n = 20) and two focus groups with mental health professionals (n = 11). Results Several adaptations, including the addition of 18 items about relationships, homelessness and mental illness, were necessary to improve cultural validity. Three items, such as rape, were removed for reasons of irrelevance or cultural insensitivity. Items like ‘adultery’ and ‘mental illness’ were reworded to ‘extramarital affair’ and ‘mental health problem’, respectively, to capture the cultural nuances of the Tamil language. Findings revealed a divergence in views on tool acceptability between user-survivors, who felt empowered to voice their experiences, and mental health professionals, who were concerned for patient well-being. Providing a sense of pride and autonomy, user-survivors preferred self-administration, whereas mental health professionals preferred rater administration. Conclusions Culture significantly affects what types of events are considered traumatic, highlighting the importance of cultural validation of instruments for use in novel populations and settings.

A Validation Study of NOVA Classification for Ultra-Processed Food on the USDA Food and Nutrient Database

Objectives In the last years, a group of Brazilian researchers has proposed a new food classification system, named NOVA, based on the extent of food processing. However, the feasibility of such classification has been debated, together with its cross-cultural validity. The present work assessed the NOVA classification feasibility, conducting a validation study on the USDA Food Composition Database. Methods Two independent reviewers rated each food reported in the 2015–2016 USDA Food and Nutrient Database to be or not ultra-processed food (UPF) according to the criteria presented in the manuscripts published by Monteiro CA et al. in 2016 and 2019 presenting the NOVA classification. A third independent reviewer solved disagreements. The Cohen's Kappa was calculated to evaluate the agreement between the two independent reviewers. Results The agreement between the reviewers was only moderate, with a Cohen's Kappa of 0.58. The disagreement pertained mainly the mixed dishes since it was difficult for the two independent reviewers to rate (UPF or not) the single food components of the mixed dishes. Conclusions Such work provides insights on the difficulties encountered in applying the NOVA classification to a real-word food database outside the cultural context in which the NOVA classification was developed. Funding Sources N/A.