Article
Content validity in the translation and cultural adaptation of the English-language Wijma Delivery Expectancy Questionnaire (W-DEQ) on fear of childbirth
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Published: | February 13, 2018 |
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Background: Around 20 percent of all pregnant women have such a pronounced fear of giving birth that it causes subjective stress and adverse effects resulting in increased risk for mother and child. To date there is no systematic approach to supporting these women in Germany. There are no available test methods to assess the severity of their fear. The Wijma Delivery Expectancy Questionnaire (W-DEQ) is an internationally recognised tool, which is, however, not available in German. A review of current WHO standards [1], PROMIS [2], ISPOR [3] and further literature demonstrates that a planned and documented approach conducted by experts with a range of professional experience and cultural Backgrounds and including a monitoring process comprising several different steps can result in a questionnaire that corresponds with the source and comparable quality criteria.
Research question: Does the German translation and cultural adaptation of the English-language W-DEQ questionnaire attain a satisfactorily high level of content validity (Content Validity Index [CVI] of over 0.78)?
Methods: Translation and cultural adaptation was conducted in three phases in line with the “Principles of Good Practice” (ISPOR) [3] and the “Guidelines for Establishing Cultural Equivalency” by Ohrbach et al. [4]. Permission to translate the W-DEQ was obtained from the author Klaas Wijma.
In phase one, a team selected the participants based on specific characteristics and planned the processes and documentation. Phase two comprised a cyclical process i.e. translation into German, back-translation into English and comparative review of the back-translation against the source document until a consensus on the translation was reached.
The translators were all required to be native speakers of their translation target language and at the same time also be familiar with the source culture. In phase three, the cultural equivalence between source text and translation was determined. The experts involved in phase three were expected to have professional experience of either languages or pregnant women, knowledge of questionnaire design or the construct of fear, or they were mothers themselves.
Findings: There was consensus on the translations of the instructions on how to complete the questionnaire and of the subdivided questions. In a first round of the cyclical process (phase two), out of 33 items, 4 items were assessed as having been inadequately translated. It was possible to improve the translation in a second round. For the most part, the CVI attained in phase three exceeded the threshold value of 0.78; a total of 6 items fell short of the threshold CVI value (0.57–0.71). Following revision and a repeat assessment, all items reached a value of between 0.86 and 1.0.
Discussion and recommendation: From a methodological perspective, the “Principles of Good Practice” [3] were fulfilled. These principles, combined with the document templates used [4], are well suited for planning and providing a transparent description of the process of translating a psychometric test.
If we were to increase the number of participants, the questionnaire would be more reliable but this would also increase the amount of work and time required for the process. In this case, the number of participants was sufficient to achieve a translation with valid content. Determining the CVI is a robust method of inter-rater reliability where the number of experts is between 8 and 12 [5].
Ethical criteria and conflict of interests: The research was submitted to an ethics committee. The work was financed by third party funds from Research Funding of the Midwife Community Assistance (HGH), Research Award of the German Society for Psychosomatic Obstetrics and Gynecology (DGPFG). There is no conflict of interest.
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