Initial Psychometric Testing of a Pain Quality Pictogram Tool Among Hmong Limited English Proficient and Bilingual Community Members and Healthcare Practitioners

Purpose

To assess the matching and content validity of a pain quality pictogram tool with a Hmong community.

Design

A Qualtrics survey was administered to two groups of participants.

Methods

Sixty Hmong participants (n = 49 limited English proficiency and bilingual Hmong community members in group 1; n = 11 bilingual Hmong healthcare practitioners in group 2) participated in this study. Hmong community members in group 1 were asked to identify the pain pictogram that best matched a pre-recorded Hmong pain quality phrase. The practitioners in group 2 were asked to evaluate how well each pain pictogram represented the pre-recorded Hmong pain quality phrase it intended to measure. To assess the matching, we assessed agreement between the pain concept in the phrase and the pictogram intended to represent it, using group 1. A content validity index (CVI) was calculated to assess the content validity of the tool using group 2.

Results

Among the community participants, 8 of the 15 pictograms were matched with the intended phrase almost perfectly, and 3 were matched by a substantial majority. There were no differences in matching by patient gender and language proficiency. Among practitioners, 11 of 15 pain pictograms met the CVI threshold of 0.70 for all three dimensions (i.e., representativeness, relevance, and comprehension).

Conclusion

Findings support including most of the pain pictograms in the tool but suggest specific areas for improvement.

Clinical Implications

Findings provide insights for redesigning the selected pain pictogram tool to be used in clinical settings with LEP Hmong patients.