Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)

BackgroundPreterm infants are especially vulnerable to pain. The intensive treatment often necessary for their survival unfortunately includes many painful interventions and procedures. Untreated pain can lead to both short- and long-term negative effects. The challenge of accurately detecting pain has been cited as a major reason for lack of pain management in these non-verbal patients. The Premature Infant Pain Profile (PIPP) is one of the most extensively validated measures for assessing procedural pain in premature infants. A revised version, PIPP-R, was recently published and is reported to be more user-friendly and precise than the original version. The aims of the study were to develop translated versions of the PIPP-R in Finnish, Icelandic, Norwegian, and Swedish languages, and to establish their content validity through a cultural adaptation process using cognitive interviews.MethodsPIPP-R was translated using the recommendations from the International Society for Pharmacoeconomics and Outcomes Research and enhanced with cognitive interviews. The respondent nurse was given a copy of the translated, national version of the measure and used this together with a text describing the infant in the film to assess the pain of an infant in a short film. During the assessment the nurse was asked to verbalize her thought process (thinking aloud) and upon completion the interviewer administered probing questions (verbal probing) from a structured interview guide. The interviews were recorded, transcribed, and analyzed using a structured matrix approach.ResultsThe systematic approach resulted in translated and culturally adapted versions of PIPP-R in the Finnish, Icelandic, Norwegian and Swedish languages. During the cultural adaptation process several problems were discovered regarding how the respondent understood and utilized the measure. The problems were either measure problems or other problems. Measure problems were solved by a change in the translated versions of the measure, while for other problems different solutions such as education or training were suggested.ConclusionsThis study have resulted in translations of the PIPP-R that have content validity, high degree of clinical utility and displayed beginning equivalence with each other and the original version of the measure.</p

Cultural adaptation and harmonization of four Nordic translations of the revised Premature Infant Pain Profile (PIPP-R)

Publisher's version (útgefin grein)Background: Preterm infants are especially vulnerable to pain. The intensive treatment often necessary for their survival unfortunately includes many painful interventions and procedures. Untreated pain can lead to both shortand long-term negative effects. The challenge of accurately detecting pain has been cited as a major reason for lack of pain management in these non-verbal patients. The Premature Infant Pain Profile (PIPP) is one of the most extensively validated measures for assessing procedural pain in premature infants. A revised version, PIPP-R, was recently published and is reported to be more user-friendly and precise than the original version. The aims of the study were to develop translated versions of the PIPP-R in Finnish, Icelandic, Norwegian, and Swedish languages, and to establish their content validity through a cultural adaptation process using cognitive interviews. Methods: PIPP-R was translated using the recommendations from the International Society for Pharmacoeconomics and Outcomes Research and enhanced with cognitive interviews. The respondent nurse was given a copy of the translated, national version of the measure and used this together with a text describing the infant in the film to assess the pain of an infant in a short film. During the assessment the nurse was asked to verbalize her thought process (thinking aloud) and upon completion the interviewer administered probing questions (verbal probing) from a structured interview guide. The interviews were recorded, transcribed, and analyzed using a structured matrix approach. Results: The systematic approach resulted in translated and culturally adapted versions of PIPP-R in the Finnish, Icelandic, Norwegian and Swedish languages. During the cultural adaptation process several problems were discovered regarding how the respondent understood and utilized the measure. The problems were either measure problems or other problems. Measure problems were solved by a change in the translated versions of the measure, while for other problems different solutions such as education or training were suggested. Conclusions: This study have resulted in translations of the PIPP-R that have content validity, high degree of clinical utility and displayed beginning equivalence with each other and the original version of the measure.Not applicable.Peer Reviewe

Pain assessment for premature infants PIPP-R. Translation and cultural adaptation

Bakgrunnur: Fyrirburar og veikir nýburar þurfa oft að gangast undir sársaukafull inngrip vegna meðferðar eða veikinda. Mat á verkjum er nauðsynlegt ef veita á árangursríka verkjameðferð. Fjölmörg verkjamatstæki hafa verið þróuð með það að markmiði að bæta verkjameðferð þessa skjólstæðingahóps. Eitt þeirra er PIPP-R sem hefur reynst vel við rannsóknir og í klínískum aðstæðum. Við val á verkjamatstæki er mikilvægt að taka tillit til réttmætis og áreiðanleika en einnig hagnýtingu og notagildis. Það felur meðal annars í sér að verkjamatstækið sé skiljanlegt þeim sem notar það. Þegar matstæki er þýtt er mikilvægt að eiginleikar þess haldi sér. Þessi rannsókn gerir grein fyrir þýðingarferli og menningarlegri aðlögun PIPP-R á íslensku. Aðferð: Um er að ræða lýsandi rannsóknarsnið með eigindlegri aðferð þar sem PIPP-R er þýtt á íslensku og farið eftir leiðbeinandi skrefum ISPOR um bestu aðferð við þýðingu matstækja. Með tilgangsúrtaki voru valdir tíu hjúkrunarfræðingar af íslenskri nýburagjörgæslu sem í gegnum djúpviðtöl lögðu mat á þýðingu. Í kjölfarið var þýðingin löguð að menningarumhverfi notendahóps. Niðurstöður: Á fyrstu skrefum þýðingarferlis og í gegnum djúpviðtöl komu fram vandamál sem höfðu áhrif á endanlega íslenska útgáfu PIPP-R. Vandamálin voru flokkuð eftir því hvort þau tengdust verkjamatskvarðanum sjálfum eða notkun hans. Vandamál sem tengdust verkjamatskvarðanum voru flokkuð eftir því hvort þau snéru að þýðingu eða upprunalegri útgáfu. Vandamál sem tengdust notkun voru flokkuð eftir því hvort þau mætti leysa með þjálfun og fræðslu til notenda eða hvort þau snéru að notkun myndbands og skráðrar lýsingar í djúpviðtölum. Ályktun: Afrakstur þessarar þýðingarrannsóknar er íslensk þýðing PIPP-R sem hefur verið löguð að menningarumhverfi á íslenskri nýburagjörgæslu. Í framhaldinu er þörf á að meta áreiðanleika matstækisins á íslensku við verkjamat fyrirbura og veikra nýbura til þess að unnt sé að nota PIPP-R á íslenskri nýburagjörgæslu. Lykilorð: Verkjamat, verkjamatskvarði, fyrirburar, veikir nýburar, þýðing matstækis.Background: Premature infants and sick newborns often have to undergo painful procedures either due to treatment or illness. Pain assessment is crucial if pain treatment is to be successful. Multiple pain assessment tools have been developed to improve pain treatment as the primary goal in this population. PIPP-R is one of those assessment tools and has been used with good progress both in research and in clinical context. When choosing a pain assessment tool, validity and reliability has to be taken into consideration as well as it’s clinical utility and feasibility. It also has to be interpretet in the right way by the users. When translating an assessment tool it is important that its content be preserved. This study describes the translation process and the cultural adaptation of the PIPP-R to Icelandic. Method: The study is descriptive and qualitative in its approach where the PIPP-R is translated into Icelandic using the ISPOR’s ten recommended steps in translating a questionnaire. Ten Icelandic neonatal intensive care nurses, chosen with a purposive sampling assessed the Icelandic translation through cognitive interviewing. Following the translation it was culturally adapted through briefings with the users. Results: Some problems arose during the first stages of the translation process and cognitive interviews which affected the final translation of the PIPP-R. These issues where categorized as problems with the scale itself or in the use of the scale. Problems with the scale where narrowed down to problems with the translation or originated in the original version. Problems regarding the use of the scale where, either considered being due to the use of video and written vignette in the interviews, or solvable with training and education. Conclusion: The product of this translation study is an Icelandic culturally adapted translation of the PIPP-R. It is recommended that the translated version be tested for reliability in clinical situations with pain assessment in premature infants and sick newborns in order to use it in an Icelandic neonatal intensive care unit. Keywords: Pain assessment, pain assessment scale, premature, sick newborns, translation of instruments.Félag íslenskra hjúkrunarfræðinga, B-hluti vísindasjóð