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Cross-Cultural Adaptation of the Beta EQ-5D-Y-5L Into Chichewa (Malawi)

Ngwira, Lucky-Gift, Jelsma, J, Maheswaran, H, Kapakasa, F, Petrou, S, Niessen, Louis ORCID: and Smith, S (2022) 'Cross-Cultural Adaptation of the Beta EQ-5D-Y-5L Into Chichewa (Malawi)'. Value in Health Regional Issues, Vol 29, pp. 36-44.

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Adaptation of Chichewa EQ-5D-Y-5L submitted version3_20210823_LoN_LuN.pdf - Accepted Version
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The EuroQol Group is developing a new EQ-5D-Y-5L version with five severity levels for each of the five dimensions. The five severity levels describe different health severity and there is a potential for severity level inversion. This paper aims to report the process of cross-cultural
adaptation of the beta EQ-5D-Y-5L into Chichewa (Malawi) using the card ranking exercise which has been added to the EQ-5D-Y-5L translation protocol.
To assess correct hierarchical ordering of severity levels, the adaptation followed the EQ-5D-Y- 5L translation protocol. Cognitive interviews were undertaken to establish conceptual equivalence. Thereafter, four iterations of ranking exercises were conducted, leading to amendments of the translated Chichewa version to arrive at a final version.
The iterations were assessed by 18 participants aged 8-14 years. Health proved to be a difficult concept to translate as was ‘discomfort’. Cognitive interviews identified further conceptual issues, particularly with the ‘looking after myself’ dimension. Considerations about lack of soap or water indicated that some children did not fully comprehend this dimension as being about the ability to wash and dress themselves. The iterative card ranking exercise detected severity level inversion
between ‘a little bit’ and ‘some’, and between ‘a lot’ and ‘extreme’ and alternative Chichewa words/phrases were then tested. Ultimately, intended hierarchical severity ranking was achieved and an acceptable Chichewa version produced.
Conceptual and linguistic equivalence to the English EQ-5D-Y-5L was established for the Chichewa EQ-5D-Y-5L version. The card ranking exercise was instrumental in correcting severity level inversion and supporting the comprehensible translation.
Key words: EQ-5D-Y-5L, EQ-5D-Y, childhood, ‘health-related quality of life, HRQoL, translation, adaptation, ranking exercise, sub-Saharan Africa

Item Type: Article
Subjects: WA Public Health > WA 100 General works
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WA Public Health > Health Administration and Organization > WA 540 National and state health administration
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
Depositing User: Rachel Dominguez
Date Deposited: 23 Nov 2021 14:46
Last Modified: 23 Nov 2021 14:46


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