Psychometric properties of End Stage Renal Disease-Adherence Questionnaire-Sinhalese version among patients receiving haemodialysis.

The chronic kidney disease is a leading public health concern, particularly in low-to middle-income countries, while the number of patients receiving haemodialysis is rapidly increasing. Adherence to a complex treatment regimen is vital for those patients on maintenance haemodialysis though the precise evaluation is reported inadequately. This study aimed to evaluate the psychometric properties of Sinhalese version of End Stage Renal Disease-Adherence Questionnaire (SINESRD-AQ) to assess treatment adherence behaviour among patients receiving haemodialysis in a Sri Lankan hospital. The cultural adaptation of ESRD-AQ involved forward and back translation, expert committee consolidation and pretesting among patients (n = 10). Face and content validity of the questionnaire was evaluated using a modified Delphi technique. Construct validity of the subscales of SINESRD-AQ was evaluated using confirmatory factor analysis (CFA). A descriptive cross-sectional study among a consecutive sample of 150 patients receiving haemodialysis in a selected Teaching hospital, Sri Lanka was involved in performing CFA. Reliability was confirmed with test-retest reliability. Excellent face and content validity were reported with Item level content validity index (0.83-1.0), Average Item level content validity index for whole scale (0.93), Item level content validity ratio (0.67-1.0) and modified kappa statistic coefficient (0.81-1.0). CFA of two subscales demonstrated better indices closure to the model fit with five- item two factor model for direct adherence behaviour subscale and eight-item two factor model for attitude/perception subscale. The intra class correlation coefficient of 0.837 (p<0.001) and 0.752 (p<0.001) indicated acceptable test-retest reliability of direct adherence behaviour and attitude/perception subscale respectively. The study confirmed SINESRD-AQ as a valid and reliable measure which enables periodic assessment of treatment adherence behaviour of the patients receiving haemodialysis in a Sri Lankan hospital.

Psychometric Properties of an Instrument to Determine the Factors Affecting Treatment Adherence Among Patients Receiving Hemodialysis in Sri Lanka.

Nonadherence is a widespread problem among patients receiving hemodialysis, while contributing factors are underexplored due to lack of a validated instrument. The study aimed to develop and validate a new disease-specific instrument determining the factors affecting treatment adherence behaviors among patients receiving hemodialysis in a Sri Lankan hospital. The content validation process using a modified Delphi technique suggested 42-item instrument with an average Item-level Content Validity Index (I-CVI) of 0.94. Subsequent principal component analysis (PCA) revealed 5 components with 17 items (patient-centered psychological and physical factors, factors associated with health care, hemodialysis therapy-related factors, socioeconomic factors, and factors associated with the continuity of the treatment), explaining 67.24% total variance. The reliability estimate based on Mislevy and Bock for each component greater than 0.8 and overall standardized Cronbach's alpha of 0.605, indicated acceptable internal consistency reliability. Root mean square residual (RMSR) and weighted root mean square residual (WRMR) indices of 0.084 and 0.059, respectively, indicated acceptable model fit. The final 17-item instrument provides a valid measure for the factors affecting treatment adherence behaviors of the patients receiving hemodialysis in a Sri Lankan hospital.

Evaluating psychometric properties of the Short Form Brief Pain Inventory Sinhala Version (SF BPI-Sin) among Sinhala speaking patients with cancer pain in Sri Lanka.

BACKGROUND: Pain is one of the most common and unpleasant symptoms of patients with cancer. The Short Form Brief Pain Inventory (SF-BPI), has been psychometrically validated in several languages and widely used globally. Availability of a validated pain tool in Sinhala is a current requirement enabling the use among the majority of Sinhala-speaking cancer patients in Sri Lanka. The purpose of the study was to evaluate the psychometric properties of Sinhala translated version of SF BPI. METHODS: The translation was done by forward-backward translation method. Content and face validity were evaluated by a panel of experts and patients with cancer pain respectively. The study included 151 participants with cancer pain, registered at the Pain Clinic, Apeksha Hospital, Sri Lanka. The reliability, discriminant and convergent validity were assessed. The confirmatory factor analysis (CFA) was conducted and evaluated the two factor (severity, interference) and three factor models (severity, affective/ activity interference). In the three factor model-1, item 'sleep' was included within the affective interference along with mood, relationship with others and enjoyment of life. In the three factor model-2, item 'sleep' was included within the activity interference along with general activities, walking and normal works. Ethical approval was obtained from the Ethics Review Committee, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka. RESULTS: A total of 151 participants (79 males, 72 females) with a mean age of 54.6 (+/- 13.2) years were included. The composite reliability (0.902, 0.879), average variance extracted (AVE) (0.647, 0.568) and Cronbach's alpha (0.819, 0.869) calculated for each severity and interference subscales were acceptable. The discriminant validity assessed with the heterotrait-monotrait criterion was 0.18. According to the Fornell-Larcker criterion, the square root of AVE of severity and interference factors (0.804, 0.753) greater than the correlation between the factors (0.140) demonstrated the discriminant validity. The CFA supported the three-factor model-2 (CFI-0.959, SRMR-0.0513, RMSEA-0.0699) and the values for two-factor and three-factor model-1 were marginally acceptable. CONCLUSIONS: The Sinhala version of SF BPI is a reliable and valid instrument for the assessment of cancer pain among Sinhala speaking patients in Sri Lanka.