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CLDQ-SG culturally acceptable by Mandarin-speaking residents in Singapore

Stephen Padilla
13 Feb 2019

The Mandarin-speaking population in Singapore (SG) has deemed the translated Chronic Liver Disease Questionnaire (CLDQ) culturally acceptable, with only two items that needed revision in the finalized CLDQ-SG, according to a recent study.

“The CLDQ-SG is culturally acceptable by our local Chinese population. A few modifications were necessary to suit the Singaporean Chinese population. CLDQ-SG has been validated in another larger study and will be reported separately,” researchers said.

For part one of the study, questions beginning with “recent” (最近) 2 weeks in Mandarin were changed to “last” (过去) 2 weeks during the cognitive debriefing process. For part two, 18 patients were recruited (mean age 49±13 years; 50 percent male). It took the participants 15±8 minutes to complete the CLDQ-SG, and the mean score was 5.1±0.5. [Proceedings of Singapore Healthcare 2019;28:48-54]

There was a satisfactory reliability of measurement for all domains, with an intraclass correlation coefficient ≥0.8. On the other hand, further restructuring was needed for items one and four. No discrepancies were observed between CLDQ and CLDQ-SG.

“The cognitive debriefing aspect of this study serves to elicit cognitive response from study participants on their understanding, appropriateness and complexity of the questionnaire,” researchers said.

In previous studies, findings showed that incomplete or incorrect self-administration of health-related quality of life (HRQOL) questionnaires is commonly caused by lack of patient understanding. Psychosocial factors and education levels potentially influence this trend. [J Neurol Neurosurg Psychiatry 2005;76:5-63; Qual Life Res 2004;13:417-426]

“This study emphasized the importance of local adaption of the CLDQ as SG Mandarin differs from China Mandarin. In fact, several versions of the Mandarin CLDQ have been adapted locally for use in different provinces in China because of differences in language and culture, but none is suitable for use in SG,” researchers said. [PLoS ONE 2016;11:e0162763; World J Gastroenterol 2009;15:3288-3297; World J Gastroenterol 2013;19:3494-3501; http://www.huayuqiao.org/articles/zhouqinghai/zhouqh01.htm]

The present study was done based on the International Society for Pharmacoeconomics and Outcomes Research Principles of Good Practice. It consisted of two parts. Part one involved cognitive debriefings and cultural adaptation of CLDQ, and part two was a pilot study on the first version of CLDQ-SG among adult patients with CLD in a tertiary hospital.

This study was limited by the small number of participants and potential selection bias for participants who were more highly educated. Part two of this study required participants who were bilingual.

“This was only an initial pilot study with the aim of translation and cultural adaption, focusing on the process of cognitive debriefing,” researchers said. “[T]he validity of CLDQ-SG for assessment of HRQOL in the Mandarin-speaking Chinese population with CLD in Singapore will need to be separately assessed in a larger study.”

CLDQ is a validated questionnaire to assess HRQOL in patients with CLD.

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