Review of Health Measurement Scales for the Welsh Language
Introduction
Since its establishment as an Infrastructure Support Service, LLAIS has been
proactive in promoting Welsh language awareness across CRC Cymru and developing
its research portfolio on language appropriate services in health and social care. The
lack of validated, standardised health measurement scales for the Welsh language can
hinder the progress of health and social care research in Wales and present challenges
in establishing the validity and generalisability of research findings. LLAIS was thus
prompted to undertake a review of health measurement scales for the Welsh language
and identify measures in need of development. This paper outlines the main findings
of the review and proposes recommendations for future developments.
Health Measurement Scales and their Adaptation
In light of the recent emphasis in healthcare on assessing the impact of healthcare
interventions from the patient’s perspective, there is an increasing demand for
accurate and appropriate measures in order to assess matters such as functional status
and health-related quality of life. One obvious way in which a measure may fail to be
accurate and acceptable is if it is administered in a language that is unfamiliar or
inappropriate to respondents. Indeed, there is evidence to suggest that language
barriers may compromise the validity and reliability of such measures (Fitzpatrick et
al 1998). For example, research has shown that patient scores can be adversely
affected if the Mini Mental State Examination (Folstein et al 1975) is not
administered in the patient’s preferred language (Escobar et al 1986).
Translation of health measurement scales for the target language can overcome many
of these problems and this process has received a large amount of recent attention in
the literature (Dunckley et al 2003). Nevertheless, direct translation alone may fail to
capture the reality of the experience for respondents who have very different cultural
and language orientations (Fitzpatrick et al 1998). Thus rigour is required in order to
ensure equivalence between the original and translated version of the measure. The
general consensus amongst authors is that this should include conceptual, item,
semantic and operational equivalence (Streiner & Norman 2003).
Recent reviews of the instrument translation process recommend that minimum
standards of application should include forward and back-translation together with
testing amongst target language speakers in order to identify and correct discrepancies
of translation and evaluate the appropriateness of the translated instrument (Streiner &
Norman 2003; Maneesriwongul & Dixon 2004). Further to this, measurement
equivalence should be established by testing the psychometric properties of the
translated scale and undertaking reliability and validity studies.
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In Wales, the vast majority of health measurement scales are primarily validated for
English speakers and they may thus be inappropriate for respondents whose preferred
language is Welsh. There is therefore an urgent need to review the availability of
Welsh language health measurement scales and prioritise future requirements.
Review of Welsh Language Health Measurement Scales
Literature Review
The aim of the review was to identify from the healthcare literature the availability of
Welsh language health measurement scales. These may have been developed in
translation or originally established through the medium of Welsh as a target
language. In view of their increasing usage across many healthcare disciplines, it was
anticipated that health measurement scales would arise from a range of professional
spheres, including medicine, nursing, physiotherapy and occupational therapy as well
as from clinical and research domains. After locating the Welsh language scales the
intention of LLAIS was to determine the extent to which they have been standardised
and validated and their availability and accessibility for healthcare and health research
personnel.
Papers published between 1995 and 2006 were sought via the following electronic
databases: Medline, CINAHL, British Nursing Index, ASSIA, PsycInfo, Social
Sciences Citation Index, Sociological Abstracts, Linguistic Abstracts on Line and
Web of Science. Key terms included assessment, assessment tool, assessment scale,
language, Welsh, Welsh language, and translating.
3 citations were identified in total from the search strategy and retained for review.
Of these three papers, one reported on the development of a Welsh language version
of the EQ-5D Health Related Quality of Life Measure (Muntz et al 2005); another
reported on a study that compared the performance of Welsh speaking people with
dementia on the Welsh and English versions of the Mini Mental State Examination
(MMSE) (Folstein et al 1975) (Morgan and Crowder 2003); and another reported on a
study that collated and categorised Welsh pain descriptors as a basis for chronic pain
assessment (Roberts et al 2003).
Expert Panel Review
In view of the limited findings of the literature review, an expert panel review was
undertaken in order to locate any further Welsh language health measurement scales
that had not been published and to identify current work in progress. Experts were
identified through LLAIS’ personal and professional networks and through the
National Research Register. Experts in this context included researchers who were
known to have used Welsh health measurement scales or were involved in the
development of such scales. As part of this review, all TRN and ISS leads and coordinators of CRC Cymru were approached via a postal questionnaire in order to
establish their use of Welsh language health measurement scales and their future
requirements.
The expert panel review yielded a total of 14 Welsh language health measurement
scales at various stages of development (Table 1) with a further 10 scales identified in
need of development for the Welsh language, as outlined below:
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Table 1: Review of Welsh Language Health Measurement Scales
Health Measurement Scale
1. Welsh Health Impact Assessment Support
Unit (WHIAS) Health Impact Assessment Tools
2. The General Practice Assessment
Questionnaire (GPAQ)
3. Mini Mental State Examination (MMSE)
(Folstein, Folstein, & McHugh, 1975)
4. Cambridge Examination for Mental Disorders
of the Elderly (CAMCOG-R)
(Roth, Huppert, Mountjoy, & Tym, 1998)
5. Speed and Capacity of Language Processing
Test SCOLP
(Baddeley, Emslie & Nimmo-Smith, 1992)
6. Short Form (SF) -36v2 Health Survey
(Questions 18-28 Welsh Health Survey)
7. Hospital Anxiety and Depression Scale
(Zigmond & Snaith, 1983)
8. Psychological Consequence Questionnaire
(PCQ)
(Cockburn, De Luise, Hurley & Clover, 1992)
9. Short Explanatory Questionnaire (SEQ)
(Lloyd 2005)
Standardised Validation
Translation
√
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Access
www.whiasu.wales.nhs
.uk
www.intimedata.com
Contact for Further Details
to be confirmed
√
√
√
√
to be confirmed
√
√
to be confirmed
In progress
In progress
to be confirmed
√
√
√
In progress
√
√
to be confirmed
http://new.wales.gov.uk Jayne.Daniels@velindre/topics/statistics/public tr.wales.nhs.uk
ations/publicationarchive/healthsurvey200304/?lang=cy
Jayne.Daniels@velindretr.wales.nhs.uk
Jayne.Daniels@velindretr.wales.nhs.uk
Jayne.Daniels@velindretr.wales.nhs.uk
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Health Measurement Scale
10. EQ-5D Health-Related Quality of Life
Measure
11. Assessing the Needs of Family Carers: A
Guide for Practitioners
(Nolan et al 1998)
12. Reynell Development Language Scales
13. Test of Articulation
14. Cwlwm
Standardised Validation
Translation
√
√
www.euroqol.org
to be confirmed
√
www.llais.org
to be confirmed
howis.wales.nhs.uk
howis.wales.nhs.uk
howis.wales.nhs.uk
to be confirmed
to be confirmed
to be confirmed
√
√
√
√
√
√
Access
Contact for Further Details
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Health Measurement Scales identified in need of development for the Welsh
Language
Pain Verbal Rating Scale
McGill Pain Questionnaire
Godin Leisure Time Exercise Scale
Short Form (SF) -12
BREQ-2
Social Support and Exercise Survey
General Self-efficacy Scale
European Organisation for Research and Treatment of Cancer (EORTC) QLQ C30
Beck’s Depression Inventory
Quality of Life Scale for Children (Juniper et al 1996)
Conclusions
1. Although a modest number of health measurement scales for the Welsh
language have been developed over the years, there is a dearth of published
material in this arena.
2. Healthcare professionals and researchers across Wales are often unaware of
the availability of these scales.
3. Experts identify a number of measures in need of translation for the Welsh
language.
Recommendations
1. LLAIS to establish on their web-site an on-line information database of health
measurement scales for the Welsh language.
2. LLAIS, in discussion with the Methodology Group, to identify and prioritise
further health measurement scales required for the Welsh language.
3. LLAIS to convene a research development group to establish a staged costed
proposal for the development and validation of further health measurement
scales for the Welsh language, as appropriate.
References
Baddeley A, Emslie H & Nimmo-Smith I (1992) Speed and Capacity of Language
Processing. Thames Vallley Test Company, Bury St Edmunds.
Cockburn J, De Luise T, Hurley S & Clover K (1992) Development and validation of
the PCQ: a questionnaire to measure the psychological consequences of screening
mammography. Soc Sci Med 34, 10, 1129-34.
Dunckley M, Hughes R, Addington-Hall J, Higginson I (2003) Translating clinical
tools in nursing practice. Journal of Advanced Nursing 44, 4, 420-426.
Escobar J, Burnam A, Karno M, Forsythe A, Landsverk J & Golding J (1986) Use of
the Mini Mental State Examination (MMSE) in a community population of mixed
ethnicity: Cultural and linguistic artefacts. Journal of Nervous and Mental Disease
174, 10, 607-614.
Fitzpatrick R, Davey C, Buxton M & Jones D (1998) Evaluating patient-based
outcome measures for use in clinical trials. Health Technology Assessment 2, 14.
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Folstein M, Folstein S & McHugh P (1975) ‘Mini-mental state’: a practical method
for grading the cognitive state of patients for the clinician. Journal of Psychiatric
Research 12, 3, 189-198.
Maneesriwongul W & Dixon J (2004) Instrument translation process: a methods
review. Journal of Advanced Nursing 48, 2, 175-186.
Morgan T & Crowder R (2003) Mini Mental State Examinations in English: are they
suitable for people with dementia who are speaking Welsh? Dementia 2, 2, 267-272.
Muntz R, Tudor Edwards R, Tunnage B, Prys C & Roberts G (2005) Development of
a Welsh language version of the EQ-5D Health-Related Quality of Life Measure.
Stage one: Transition. The Psychologist in Wales 18, 21-25.
Nolan M, Grant G & Keady J (1998) Assessing carers' needs: A practitioner's guide.
Pavilion Press, Brighton.
Roberts G, Kent B, Prys D & Lewis R (2003) Describing chronic pain; towards
bilingual practice. International Journal of Nursing Studies 40, 889-902.
Roth M, Huppert F, Montjoy C, Tym E. (1999) CAMCOG-R: the Cambridge
examination for mental disorders of the elderly. Cambridge University Press,
Cambridge.
Streiner D & Norman G (2003) Health Measurement Scales: A Practical Guide to
Their Development and Use. Oxford University Press, Oxford.
Zigmond A & Snaith R. (1983) The Hospital Anxiety And Depression Scale. Acta
Psychiatr Scand 67, 361-70.
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