In order to explain the findings, the results were
organized on the basis of the defined phases as
described in the Materials and Methods sectioN.
Phase (1): The discrepancies between translations
were very few and were resolved easily in group
discussions.
Phase (2): Cultural adaptation
Although most of the measured activities in the PI
HAQ were applicable to Iranian culture, the authors
found four items to be unsuitable. Adaptation was
carried out for the following questions:
Question number 3a: Cutting meat
In Iranian culture, meat is generally not served
as a main dish but instead is an ingredient in a stew.
Therefore, the question about cutting meat is not
relevant as it is not a normal activity for most people.
However, there is nothing comparable that can be used
to replace this question. Therefore, it was suggested
that questions on the ability to cut vegetables and chop
apples be added.
Question number 5b: The ability to take a tub bath
In Iranian culture, people mostly take a shower
instead of a tub bath. Therefore, it was suggested that
the ability to use a squat toilet, which uses almost the
same muscles and joints, be added.
Question number 5c: Ability to use a toilet
Because of the different design of toilets currently
used in Iran (squat toilets or Turkish toilets), a question
about chair toilets should be added. These toilets are
designed like a chair and are very similar to western
toilets. People usually use them when sitting is more
convenient than squatting, such as the case with RA.
Question number 6: The ability to reach and pick up
a five pound object
Due to the metric system used in Iran, the pound
measurement was replaced by the equivalent in
kilogram units.
Question number 8c: Ability to carry out yard work
This was changed to the ability to sweep a yard.
These results are summarized in Table 1.
Phase 3: Face validity
In the interviews with the patients, there was no
report of any difficult or awkward questions. All 10 RA
patients clearly understood all the questions without
any confusion or misunderstanding.
Phase 4: Reliability
The correlation coefficient between responses in
the test and re-test analysis showed a high correlation
between the total scores was obtained [r=0.86,
confidence interval (CI): (0.5-0.97), p<0.001]. This
strong correlation was also observed in all the questions.
Phase 5: Internal consistency and content and
construct validity
Among the 100 RA patients (with a mean age of 51
years), 80% were female. Urban residents composed
77% of the study participants. On average, each patient
had been living with RA for 7.3 years (min=0.6 year
max=40 years) (Table 2).
Click Here to Zoom |
Table 2: Demographic variables of the rheumatoid arthritis
patients recruited in Phase 5 |
Using Cronbach's alpha coefficient, the authors
found a high internal consistency between responses to
different items (alpha=0.94). Further scrutiny showed
that these results were comparable in various subgroups,
(female=0.94 and male=0.94; urban residents=0.93 and
rural residents=0.97).
In addition, comparing the score gained from
the SF-36 questionnaire with the score of PI HAQ
questionnaire showed an acceptable Spearman’s
correlation coefficient (r=0.5; p<0.001). The correlation
was also explored in the same subgroups, with male
participants (r=0.63 versus r=0.49) and urban citizens
(r=057 versus r=0.42) showing a higher correlation
than their female and rural counterparts (Table 3).
Click Here to Zoom |
Table 3: Spearman’s correlation coefficients between the
score gained from the Personal Impact Health Assessment
Questionnaire and Short Form-36 |
The Spearman’s correlation coefficient between the
VAS and PI HAQ scores was also very high (r=0.95,
p≤0.001).
Finally, when a factor analysis was applied, it
showed that there were four hidden dimensions with
a variance over one. However, three of them had
eigenvalues very close to one (1.52, 1.23 and 1.04),
and the main dimension had a variance of over 10.
This variable explained over 50% of the eigenvalues
(eigenvalue=50.6%) (Figure 1).
Click Here to Zoom |
Figure 1: Scree plot variables in the Persian version of the PI
HAQ questionnaire. |
The component score coefficients of all questions
in the prediction of the main variable was more than
0.5. The maximum coefficient was 0.87 for the ability
to shampoo the hair, and the minimum coefficient was
0.5 for the ability to vacuum or do yard work.
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