Translation, Cultural Adaptation, and Validation of the Korean Version of the Multimorbidity Treatment Burden Questionnaire.

Abstract

Background: Patients with hypertension and comorbidities face greater difficulties in managing their diseases than patients without comorbidities. Treatment burden is defined as individuals' effort to manage their health and the impact it has on well-being. Treatment burden is negatively associated with both health-related quality of life and adherence to treatment in patients with multimorbidity. Thus, it is important to measure the treatment burden in patients with hypertension and comorbidities with psychometrically sound instruments.

Purpose: In this study, the Multimorbidity Treatment Burden Questionnaire (MTBQ) was translated and culturally adapted for use in Korea and evaluated in terms of its psychometric properties for use on patients with hypertension and comorbidities.

Methods: A descriptive, cross-sectional design was used. The MTBQ was translated from English into Korean and culturally adapted using forward-backward translation. Patients with hypertension and comorbidities were recruited as participants using convenience sampling. The participants completed cognitive interviews (n = 6) and an online survey (n = 376) to examine the psychometric properties of the developed Korean instrument (K-MTBQ). Participant characteristics and item properties were described using descriptive statistics and correlation coefficients. Cronbach's alpha was used to measure internal consistency (reliability) and factor analysis was used to examine the dimensions. To assess construct validity, prespecified hypotheses were examined including: (1) the association between treatment burden and the number of comorbidities and all domains of health-related quality of life and (2) the association between the three treatment burden groups and two groups with different health-related quality of life.

Results: In the cognitive interviews, the participants suggested adding examples to improve the clarity of two items, and reported the contents of all other items of the K-MTBQ were applicable and easily comprehensible. The Cronbach's alpha coefficient of the K-MTBQ was .93, and factor analysis suggested a one-factor model. Treatment burden was associated with the number of comorbidities and all domains of health-related quality of life. However, using the cutoff scores suggested in the original study, the difference in the proportion of patients with poor health-related quality of life was not clearly distinguished between the no-to-low treatment burden group and the medium treatment burden group.

Conclusions/implications for practice: The results indicate the K-MTBQ has good content validity, reliability, and construct validity for use on patients with hypertension and comorbidities. Further studies are needed to establish appropriate cutoff values for distinguishing among the different levels of treatment burden. The K-MTBQ may be used to help identify Korean patients facing difficulties managing multiple chronic conditions as well as the areas in which they require additional support.