Validity, reliability, and diagnostic cut-off of the Kinyarwandan version of the Hamilton depression rating scale in Rwanda

Introduction: In Rwanda, major depressive disorder affects 11.9% of the population and up to 35% of genocide survivors. Mental health services remain underutilized due to stigma and lack of awareness. Increasing the ability and capacity to diagnose and treat mental disorders is considered important to close this gap. We describe the translation, validity, and reliability assessment of the Hamilton Depression Rating Scale (HDRS) as a diagnostic tool for moderate to severe depression in Rwanda. Methods: The HDRS-21 was translated by a multi-group taskforce. We validated the translation against expert assessment in a comparative study on a sample of patients living with depression and of healthy volunteers. Psychometric properties, namely internal structure, reliability, and external validity were assessed using confirmatory factor analysis, three reliability calculations, and correlation analysis, respectively. Maximized Youden's index was used for determining diagnostic cut-off. Results: The translated version demonstrated a kappa of 0.93. We enrolled 105 healthy volunteers and 105 patients with confirmed mild to severe depression. In the confirmatory factor analysis, HDRS had good factor loadings of 0.32-0.80. Reliability coefficients above 0.92 indicated strong internal consistency. External validity was shown by good sensitivity (0.95) and specificity (0.94) to differentiate depression from absence of depression. At a cut-off point of 17 for the diagnosis of depression, sensitivity and specificity were both 0.95 relative to gold standard. Conclusion: The validated HDRS in Kinyarwanda with diagnostic cut-off provides mental healthcare staff with an accurate tool to diagnose moderate to severe depression, enabling closure of the diagnosis and treatment gap

Validity, reliability and cut-offs of the Patient Health Questionnaire-9 as a screening tool for depression among patients living with epilepsy in Rwanda

Background Patients with epilepsy (PwE) have an increased risk of active and lifetime depression. Two in 10 patients experience depression. Lack of trained psychiatric staff in low- and middle-income countries (LMIC) creates a need for screening tools that enable detection of depression in PwE. We describe the translation, validity and reliability assessment of the Patient Health Questionnaire-9 (PHQ-9) as a screening tool for depression among PwE in Rwanda. Method PHQ-9 was translated to Kinyarwanda using translation-back translation and validated by a discussion group. For validation, PwE of >= 15 years of age were administered the PHQ-9 and Hamilton Depression Rating Scale (HDRS) by trained psychiatry staff at Visit 1. A random sample of 20% repeated PHQ-9 and HDRS after 14 days to assess temporal stability and intra-rater reliability. Internal structure, reliability and external validity were assessed using confirmatory factor analysis, reliability coefficients and HDRS-correlation, respectively. Maximal Youden's index was considered for cut-offs. Results Four hundred and thirty-four PwE, mean age 30.5 years (SD +/- 13.3), were included of whom 33.6%, 37.9%, 13.4%, and 15.1% had no, mild, moderate and severe depression, respectively. PHQ-9 performed well on a one-factor model (unidimensional model), with factor loadings of 0.63-0.86. Reliability coefficients above 0.80 indicated strong internal consistency. Good temporal stability was observed (0.79 [95% CI: 0.68-0.87]). A strong correlation (R = 0.66, p = 0.01) between PHQ-9 and HDRS summed scores demonstrated robust external validity. The optimal cut-off for the PHQ-9 was similar (>= 5) for mild and moderate depression and >= 7 for severe depression. Conclusion PHQ-9 validation in Kinyarwanda creates the capacity to screen PwE in Rwanda at scores of >= 5 for mild or moderate and >= 7 for severe depression. The availability of validated tools for screening and diagnosis for depression is a forward step for holistic care in a resource-limited environment

Cross-Culture Adaptation and Psychometric Properties of the DrInC Questionnaire in Tanzanian Swahili

Aims: To develop Swahili versions of the Drinker Inventory of Consequences (DrInC) and evaluate its psychometric properties among a mixed population in Tanzania.Methods: A Swahili version of the DrInC was developed by a panel of bilingual Swahili and English speakers through translation and back-translation. The translated DrInC was administered to a sample of Tanzanian injury patients and a sample of the general population. The validity and reliability of the scale were tested using standard statistical methods.Results: The translated version of the DrInC questionnaire was found to have outstanding domain coherence and language clarity. The tested scale and subscales have adequate reliability (>0.85). Confirmatory factor analysis (CFA) confirmed the five-factor solution by yielding adequate results. DrInC score is statistically significantly correlated with alcohol consumption quantity and the AUDIT score, suggesting that DrInC is able to predict alcohol use as well.Conclusions: This study presents the first validation of the DrInC questionnaire with injury patients and a general population and the first adaptations of the DrInC questionnaire in the Tanzanian and Swahili setting. DrInC instrument was found to have satisfactory psychometric properties, resulting in a new medical and social research tool in this setting

Validity and reliability of telephone administration of the patient-specific functional scale for the assessment of recovery from snakebite envenomation

Objectives: Although more than 1.8 million people survive snakebite envenomation each year, their recovery is understudied. Obtaining long-term follow-up is challenging in both high- and low-resource settings. The Patient-Specific Functional Scale (PSFS) is an easily administered, well-accepted patient-reported outcome that is validated for assessing limb recovery from snakebite envenomation. We studied whether the PSFS is valid and reliable when administered by telephone. Methods: This is a secondary analysis of data from a randomized clinical trial. We analyzed the results of PSFS collected in-person on days 3, 7, 14, 21, and 28 and by telephone on days 10, 17, and 24. We assessed the following scale psychometric properties: (a) content validity (ceiling and floor effects), (b) internal structure and consistency (Cronbach’s alpha), and (c) temporal and external validity using Intraclass Correlation Coefficient (ICC). Temporal stability was assessed using Spearman’s correlation coefficient and agreement between adjacent in-person and telephonic assessments with Cohen’s kappa. Bland Altman analysis was used to assess differential bias in low and high score results. Results: Data from 74 patients were available for analysis. Floor effects were seen in the early post-injury time points (median: 3 (IQR: 0, 5) at 3 days post-enrollment) and ceiling effects in the late time points (median: 9 (IQR: 8, 10). Internal consistency was good to excellent with both in-person (Cronbach α: 0.91 (95%CI 0.88, 0.95)) and telephone administration (0.81 (0.73, 0.89). Temporal stability was also good (ICC: 0.83 (0.72, 0.89) in-person, 0.80 (0.68, 0.88) telephone). A strong linear correlation was found between in-person and telephone administration (Spearman’s �: 0.83 (CI: 0.78, 0.84), consistency was assessed as excellent (Cohen’s κ 0.81 (CI: 0.78, 0.84), and Bland Altman analysis showed no systematic bias. Conclusions: Telephone administration of the PSFS provides valid, reliable, and consistent data for the assessment of recovery from snakebite envenomation

Validation of a tool to conduct a Built Environment Analysis in a Low Income Country Setting

Validated BEA approaches for other health events have been shown to streamline research reproducibility and comparability. BEA auditing instruments for cardiovascular health, physical activity, and healthy aging have been validated in multiple country settings {Bethlehem, 2014, The SPOTLIGHT virtual audit tool: a valid and reliable tool to assess obesogenic characteristics of the built environment}. These validated tools streamline the research for other projects on the topic, and stand as a template for research that investigates BEA with similar health events {Bethlehem, 2014, The SPOTLIGHT virtual audit tool: a valid and reliable tool to assess obesogenic characteristics of the built environment}. With increasingly more research on RTI, standardized BEA methodology now will support the growing field of research and allow for more collaboration within the field. This project aims to validate the use of a standard tool to perform a Built Environment Analysis (BEA) for capturing the environmental conditions of the road traffic injury hotspots in LMIC. The psychometrics properties such as internal construct, reliability and external validity, will be compared to validate the instrument in LMIC

Cross-Cultural Adaptation and Psychometric Properties of the SF-8 Questionnaire in Tanzanian Swahili for a Traumatic Brain Injury Population

Background: There is a great need to study and to evaluate health-related quality of life in patients with traumatic brain injury (TBI). The Knowledge about the characteristics of mental health in post-TBI people is an important point because it provides crucial information regarding the rehabilitation process. One of the ways to access people's quality of life is by using the SF-8 instrument, a shorter version of the SF-36, the most widely used patient-based assessment of health related quality of life. The aim of this research is to report the psychometric properties of the first translation and adaptation of the SF-8 to Swahili. Methods: A cross-cultural adaptation committee carried out the process of translation and content validation. The study was conducted with the participation of 192 adults who were traumatic brain injury patients from a registry in northern Tanzania. The instrument was evaluated according to confirmatory factor analysis, reliability and external validity. Results: The content analysis indicated that the translated and adapted version of the SF-8 questionnaire are clearly understandable within Tanzanian culture. Despite the parallel analysis suggested that SF-8 was best described by a two-factor model, in this study was considered only one factor, because in CFA the one factor performed better, with all items with factor loadings ranging from 0.85 to 0.99. The external validity showed that SF-8 scores correlate strongly with PHQ-9 instrument, and both dimensions (depression and anxiety) of K-6 instrument. These results confirm the instrument's ability to behave as expected in relation to the theoretical concept. Conclusions: The results show that the SF-8 instrument can provide relevant information about quality of life of TBI patients, then allow practitioners to better understand mental health and improve the treatment and follow-up of TBI patients

Contextualizing the impact of snakebite envenoming on patients: A qualitative content analysis of Patient-Specific Functional Scale activities using the International Classification of Functioning, Disability and Health

Abstract: without Background and including Keywords: 251/275 words Background: There are no disease specific theoretical models describing dysfunction in Snakebite Envenoming (SBE). The International Classification of Functioning, Disability, and Health (ICF) created by the WHO provides a conceptual basis for defining all aspects of functioning and disability within the biopsychosocial model. The Patient-Specific Functional Scale (PSFS) is a patient-centered and patient-reported outcome that assesses activities chosen by the patient as limiting and important. Objective: In this study, we analyze the PSFS activities in SBE and apply it to the existing ICF model in order to describe the impact of SBE in patients’ activities and daily lives’ that goes beyond the description of the physiological effects and to develop a theoretical SBE model of functioning. Design: This study performed a post-hoc analysis of two multi-center, prospective studies, conducted at 14 clinical sites across the southeastern United States. Participants: Patients undergoing treatment for mild, moderate and severe SBE. Main outcome measures: Activities listed in the PSFS were used for a combination of qualitative content analysis and Natural Language Processing to categorize responses using the ICF model. Results: Our sample included 86 patients. The mean age was 43.0 (SD 17.6) years, most had lower extremity injuries (62%). A total of 99 unique activities were chosen by patients when completing the PSFS, representing eight of the nine domains within the Activity and Participation component of the ICF model, with the majority in the Mobility and General Tasks and Demands domains. Conclusion: The main concerns of SBE patients are related to the ability to perform regular daily activities and to engage within their social environment, having a multifaceted impact in a variety of areas in their daily lives. Applying the ICF model to SBE can facilitate the creation of a patient centered treatment approach, moving beyond body-structural impairments towards a function-based treatment approach and facilitate early integration of rehabilitation services. Keywords: Snakebite envenoming, snake bite, PSFS, ICF, Function, Disabilit

Percepção de atletas de alto rendimento sobre o desenvolvimento e transferência das habilidades para a vida: um protocolo de revisão de escopo

O estudo se trata de uma revisão de escopo com o objetivo de mapear na literatura sobre o processo de aquisição das habilidades para a vida e a transferência para outras áreas, percebida por atletas de alto rendimento