Developing the Polish Educational Needs Assessment Tool (Pol-ENAT) in rheumatoid arthritis and systemic sclerosis: a cross-cultural validation study using Rasch analysis

Objectives: To undertake cross-cultural adaptation and validation of the educational needs assessment tool (ENAT) for use with people with rheumatoid arthritis (RA) and systemic sclerosis (Ssc) in Poland. Methods: The study involved two main phases: (i) cross-cultural adaptation of the ENAT from English into Polish and (ii) Cross-cultural validation of Pol-ENAT. The first phase followed an established process of cross-cultural adaptation of self-report measures. The second phase involved completion of the Pol-ENAT by patients and subjecting the data to Rasch analysis to assess the construct validity, reliability and cross-cultural invariance. Results: An adequate conceptual equivalence was achieved following the adaptation process. The dataset for validation comprised a total of 278 patients, 237 (85.3%) of which were female. In each disease group (145, RA and 133, SSC), the 7 domains of the Pol-ENAT were found to fit the Rasch model, 2(df)=16.953(14), p=0.259 and 8.132(14), p=0.882 for RA and SSc respectively. Reliability (person separation index, PSI>0.85) was high. Cross-cultural differential item functioning (DIF) was detected in some subscales and DIF-adjusted conversion tables were calibrated to enable cross-cultural comparison of data between Poland and the UK. Conclusion: Pol-ENAT is a robust measure of educational needs for people with RA and SSc in Poland. The tool has been shown to have sufficient cross-cultural validity to enable data pooling and comparisons between Poland and the UK

Cross-cultural validation of the Portuguese version of the Educational Needs Assessment Tool (PortENAT)

Objectives: To undertake a cross-cultural adaptation and validation of the educational needs assessment tool (ENAT) into Portuguese. Methods: The first phase of this research (cross-cultural adaptation) utilised a well-established translation method comprising five sequential steps: forward- -translation, synthesis of translations, back-translation, expert committee and field-testing of the adapted version. The second phase involved collecting data from 123 patients and subjecting them to Rasch analysis for validity testing including cross-cultural invariance. Results: The translation and field-testing phase went smoothly giving rise to minor adjustments in the phrasing of some items. The preliminary analysis of the 39 items, revealed some deviations from the model with the overall item-person interaction fit statistics 2(df) = 56.025 (39), p = 0.038. Significant item-item correlations caused artificial inflation of the internal consistency, therefore violating the model assumption of local independence of items. To correct this, all locally dependent items were then grouped into their respective domains, creating a 7 testlet-scale which demonstrated a good fit to the Rasch model, 2(df) = 2.625 (7), p = 0.917 and internal consistency PSI = 0.975. Analysis of the pooled (Portuguese and the English) data revealed cross-cultural DIF, requiring adjustments in two testlets: ‘treatments’ and ‘support’ which ensured cross- -cultural equivalence. Conclusions: This study confirms the Portuguese ENAT is a robust unidimensional tool with which to assess the educational needs of Portuguese people with RA. Cross-cultural adjustments are required only if the data from Portugal and the UK are pooled or compared. The tool is now available for use in clinical practice and research