Using content validity index methodology for cross-cultural translation of a patient-reported outcome measure for head and neck cancer.

Introduction: Translations of patient-reported measures may not account for structural and cultural differences in shared languages spoken in multiple countries, such as English, Spanish, Arabic, or Russian. The objective of this research was to create a cross-cultural Spanish translation of the New York University (NYU) Electronic Patient Visit Assessment (ePVA)^© for head and neck cancer (HNC), a patient-reported symptom measure available only in English.

Methods: Using the Content Validity Index (CVI) methodology, an expert panel of nurses (n = 6) proficient in Spanish and English independently reviewed and rated a forward translation of the ePVA, a measure consisting of 21 categories of symptoms common to HNC. The panel rated the cultural relevance (1 = not relevant, 2 = somewhat relevant, 3 = very relevant, 4 = highly relevant) and translation equivalence (1 = yes or 0 = no) of each ePVA item. The CVI cultural relevance and translation equivalence scores for each item (item CVI) were calculated as the proportion of experts agreeing that the item was very relevant or highly relevant and the translation was equivalent. The scale CVI score was an average of the item CVI scores; the minimum accepted scale CVI score was .80. Items with CVI scores <0.59 were labeled as problematic items and evaluated through cognitive interviews with native Spanish-speaking patients (N = 4) diagnosed with HNC.

Results: The translation was acceptable in cultural relevance (average CVI score = 0.95) and equivalence (average CVI score = 0.84). Cognitive interviews revealed 9 problematic items that differed in words and meaning, primarily addressing pain and swallowing symptoms. These items were refined and included in the final translation of the Spanish ePVA.

Conclusion: These study findings underscore the need for survey instrument translations that account for variations in shared languages spoken across countries.