Validation of the Asian constipation assessment initiative questionnaire: a cross-sectional study on symptom reporting and constipation awareness.

Objective: Current patient-reported outcome measures (PROMs) for chronic constipation (CC) have been predominantly developed for Western populations, often neglecting cultural factors critical to Asian contexts. This study aimed to psychometrically validate the Asian Constipation Assessment Initiative Questionnaire (ACAIQ), codesigned with patients experiencing CC and clinicians in Singapore, and examine the effect of constipation awareness on symptom reporting.

Methods: A cross-sectional study enrolled 259 participants with CC (Rome IV criteria) and 153 healthy controls between 9 December 2022 and 19 March 2024. Participants completed the ACAIQ alongside established PROMs. Structural validity, internal consistency, test-retest reliability and criterion validity were evaluated following Consensus-based Standards for the Selection of Health Measurement Instruments guidelines. The influence of constipation awareness on symptom reporting and Rome IV criteria was analysed using non-parametric statistical tests.

Results: ACAIQ-SYM (symptom severity scale) demonstrated strong structural validity (comparative fit index=0.968, Tucker-Lewis Index=0.958, root mean square error of approximation=0.06), internal consistency and reproducibility (α=0.88, intraclass correlation coefficient≥0.70). However, the ACAIQ-QoL (quality of life scale) exhibited structural inconsistencies, necessitating further refinement. Aware participants reported more severe symptoms than unaware and controls (p<0.05). Notably, 71.4% of participants with CC were unaware of their condition, underscoring the importance of constipation awareness in symptom perception and reporting.

Conclusion: ACAIQ-SYM is a valid tool for assessing constipation symptoms in Asian populations. The significant impact of awareness on symptom reporting highlights the need for patient education. Further refinement of ACAIQ-QoL is necessary to ensure a comprehensive evaluation of QoL. Once optimised, ACAIQ could improve digital health platforms, patient-clinician engagement and personalised CC management strategies.