Cross-cultural validation of the Educational Needs Assessment Tool in RA in 7 European countries

Vliet Vlieland, Thea P.M.; Zangi, Heidi A.; Ndosi, Mwidimi; Tennant, Alan; Bergsten, Ulrika; Kukkurainen, Marja Leena; Machado, Pedro; Vliet Vlieland, Thea PM; De La Torre-Aboki, Jenny; Zangi, Heidi A; Hill, Jackie

Abstract

Background: The Educational Needs Assessment Tool (the ENAT) is a 39-item patient questionnaire originally developed in the UK to assess educational needs of patients with rheumatoid arthritis (RA). The objective of this study was to assess the cross-cultural validity of the ENAT in 7 European countries. Methods. The ENAT was translated into Dutch, Finnish, Norwegian, Portuguese, Spanish and Swedish versions by using Beaton's cross-cultural adaptation process, and was completed by a convenience sample of patients with RA in each country. The generated country-specific data were assessed for construct validity and were then pooled and assessed for cross-cultural invariance using Rasch analysis. Results: Individual country-specific analysis showed adequate fit to the Rasch model after adjustment for local dependency within domains. When data from the different countries were pooled, the 39 items deviated significantly from Rasch model's expectations (X2 = 977.055, DF = 351, p = 0.000, PSI = 0.976). Again, most items within domains were found to be locally dependent, significantly affecting the fit. Consequently each domain was treated as a unit (i.e. testlet) and the ENAT was re-analysed as a seven-testlet scale resulting into a good fit to the Rasch model (X2 = 71.909; DF = 63; p = 0.207, PSI = 0.951). A test of strict unidimensionality confirmed that all domains contributed to measuring a single construct. Cross-cultural non-invariance was discounted by splitting domains for DIF maintaining an excellent fit to the Rasch model. This allowed calibration of the ENAT into an interval scale. Conclusion: The ENAT is a simple tool, which is a valid measure of educational needs of people with RA. Adjustment for cross-cultural non-invariance is available if data from the 7 European countries are to be pooled or compared. © 2011 Ndosi et al; licensee BioMed Central Ltd.

• Journal Article Type: Article
• Acceptance Date: May 24, 2011
• Publication Date: May 26, 2011
• Deposit Date: May 26, 2017
• Publicly Available Date: May 26, 2017
• Journal: BMC Musculoskeletal Disorders
• Print ISSN: 1471-2474
• Electronic ISSN: 1471-2474
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 12
• Issue: 1
• DOI: https://doi.org/10.1186/1471-2474-12-110
• Keywords: cross-cultural validation, outcome research, patient education, Rasch Analysis, rheumatoid arthritis
• Public URL: https://uwe-repository.worktribe.com/output/962398
• Publisher URL: http://dx.doi.org/10.1186/1471-2474-12-110
• Contract Date: May 26, 2017