Browsing by Author "de Klerk, Susan"

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    The validity of the disabilities of the arm, shoulder and hand (DASH) questionnaire in Afrikaans for the Western Cape of South Africa
    (Stellenbosch : Stellenbosch University, 2022-12) de Klerk, Susan; van Niekerk, Lana; Buchanan, Helen; Jerosch-Herold, Christina; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Health and Rehabilitation Sciences. Occupational Therapy.
    ENGLISH SUMMARY: The Disabilities of the Arm, Shoulder and Hand (DASH) Questionnaire is a 30-item patient-reported outcome measure (PROM) designed to measure symptoms and disability in clients with upper limb injury or conditions. The measure was developed in 1996 by the Institute for Work and Health (IWH) in Canada. It has been translated and cross-culturally adapted to at least 50 languages around the world. No evidence existed for translations from the South African context. This country faces a high incidence of hand injury and conditions, especially so in the overburdened public health service sector. PROMs such as the DASH questionnaire, if validated within this context, are essential in allowing accurate self-report and demonstrating the outcomes of intervention offered. An essential requirement is however for the PROM to be available in the client’s language. The research context is that of the public health service, within the Western Cape of South Africa and specifically the Afrikaans-speaking community. This multi-phased study i) explored the evidence on the validity and clinical utility of DASH questionnaire translations from low-income to upper-middle-income countries, ii) translated and cross-culturally adapted the DASH questionnaire into Afrikaans for the Western Cape utilising the practices of Community Translation (CT) and Shared Decision Making (SDM), iii) evaluated the content validity of the new translation through an iterative process during pretesting and cognitive interviewing (CI) and iv) evaluated construct validity (specifically structural validity, internal consistency and cross-cultural validity) of the Afrikaans for the Western Cape DASH questionnaire. A sequential mixed-methods study design was followed with quantitative and qualitative components across the four phases outlined above. Phase one comprised a systematic review methodology as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the Consensus-based Standards for Selection of Health Measurement Instruments (COSMIN) guidelines. Phase two considered CT and SDM in addition to recommendations for translation and cross–cultural adaptation as per the IWH. Phase three addressed content validity as per the COSMIN guidelines. Phase four utilised Classical Test Theory (CTT). Structural validity was evaluated through both Confirmatory and Exploratory Factor Analysis (CFA & EFA) utilising appropriate fit indexes. Internal consistency was calculated through Cronbach’s alpha and cross-cultural validity was assessed during Multiple Group Confirmatory Factor analysis (MGCFA) to confirm measurement invariance between the Afrikaans for the Western Cape DASH and the South African English DASH questionnaires, demonstrated through appropriate fit indexes. Phase two to four comprised a sample of participants included as per eligibility criteria considered during each phase. CT was introduced as an approach to translation and cross-cultural adaptation in the public health service context and considered Afrikaans for the Western Cape. The process of translation and cross-cultural adaptation utilising the practices of CT and SDM (introduced for the first time in the context of translation and cross-cultural adaptation of PROMs) is reported on. The content validity of the newly translated Afrikaans for the Western Cape DASH questionnaire was confirmed, and the process of CI well described to illustrate the iterative nature thereof. Structural validity was evaluated initially via CFA and subsequently via EFA when unidimensionality was not confirmed. The Afrikaans for the Western Cape DASH questionnaire yielded a two-factor structure (with internal consistency), and cross-cultural validity was evaluated through MGCFA exploring measurement invariance between the Afrikaans for the Western Cape DASH and South African English DASH questionnaire. Scalar invariance was supported and provides evidence of cross-cultural validity. The Afrikaans for the Western Cape DASH questionnaire was successfully translated and cross-culturally adapted, with evidence of content, structural and cross-cultural validity and can be utilised within the intended context.