Translation, Cultural Adaptation, and Content Validity of a Modified Italian Version of the Jackson/Cubbin Pressure Injury Risk Assessment Scale for ICU Patients.

Abstract

Background/Objectives: The Jackson/Cubbin scale is a recommended tool to assess the risk of pressure injury in intensive care unit (ICU) patients. This scale is deemed to have superior predictive validity compared to the Braden scale. Many Italian nurses struggle with reading and applying the tool in English. This language barrier results in a lack of use of the Jackson/Cubbin scale clinically, meaning that patients potentially experience worse outcomes. This study aims to translate the original English version of the Jackson/Cubbin scale into the Italian language, conduct a cultural adaptation, and verify its content validity. Methods: An observational study was conducted using Beaton's five-step methodology: (1) forward translation, (2) synthesis, (3) back-translation, (4) expert committee approval using Fleiss' Kappa (κ) index, and (5) pre-testing, where participants assessed item clarity on a dichotomous scale (clear/unclear). Items deemed unclear by 20% or more of the sample were revised. Content validity was assessed using the Content Validity Index (CVI). Results: Fleiss' κ index was 0.74. Item 3 "PMH-affecting condition" was unclear to 36% of the sample and required revision. The item-level CVI (I-CVI) was >0.78 for each item. The scale-level CVI (S-CVI) and the scale-level CVI using the average method (S-CVI-Ave) were 0.92 and 0.94, respectively. Conclusions: The translation process resulted in a linguistically accurate scale requiring content modifications to reflect current evidence and reduce inter-rater variability. This may improve implementation of the Jackson/Cubbin scale in clinical practice for Italian nurses and reduce the incidence of pressure injury for ICU patients.