Cross-Cultural Adaptation of the Beta EQ-5D-Y-5L Into Chichewa (Malawi)

Objectives

The EuroQol Group is developing a new EQ-5D-Y-5L version with five severity levels for each of the five dimensions. The five severity levels describe different health severity and there is a potential for severity level inversion. This paper aims to report the process of cross-cultural

adaptation of the beta EQ-5D-Y-5L into Chichewa (Malawi) using the card ranking exercise which has been added to the EQ-5D-Y-5L translation protocol.

Methods

To assess correct hierarchical ordering of severity levels, the adaptation followed the EQ-5D-Y- 5L translation protocol. Cognitive interviews were undertaken to establish conceptual equivalence. Thereafter, four iterations of ranking exercises were conducted, leading to amendments of the translated Chichewa version to arrive at a final version.

Results

The iterations were assessed by 18 participants aged 8-14 years. Health proved to be a difficult concept to translate as was ‘discomfort’. Cognitive interviews identified further conceptual issues, particularly with the ‘looking after myself’ dimension. Considerations about lack of soap or water indicated that some children did not fully comprehend this dimension as being about the ability to wash and dress themselves. The iterative card ranking exercise detected severity level inversion

between ‘a little bit’ and ‘some’, and between ‘a lot’ and ‘extreme’ and alternative Chichewa words/phrases were then tested. Ultimately, intended hierarchical severity ranking was achieved and an acceptable Chichewa version produced.

Conclusions

Conceptual and linguistic equivalence to the English EQ-5D-Y-5L was established for the Chichewa EQ-5D-Y-5L version. The card ranking exercise was instrumental in correcting severity level inversion and supporting the comprehensible translation.

Key words: EQ-5D-Y-5L, EQ-5D-Y, childhood, ‘health-related quality of life, HRQoL, translation, adaptation, ranking exercise, sub-Saharan Africa