Validation study of the Amharic version Safety Attitudes Questionnaire (SAQ) in public hospitals of Addis Ababa, Ethiopia: a cross-sectional study.

BACKGROUND: In Ethiopia, there is a growing concern about improving patients' safety in healthcare facilities. However, the lack of a valid and reliable instrument sensitive to the Ethiopian culture for measuring health professional practice environment leads to difficulty in constructing evaluations of safety climate and further linking organizational research to outcomes research. This research study examined the psychometric properties of the Safety Attitude Questionnaire (SAQ) in the Amharic language within an Ethiopian healthcare context. METHOD: A hospital-based cross-sectional study design was conducted. The SAQ was meticulously translated into Amharic using forward and backward translation methods. Content validity was evaluated with input from seven patient safety and healthcare quality experts. Face validity was established through feedback from healthcare professionals. Then, the Amharic SAQ (SAQ-A) was distributed to 648 participants working in 11 public hospitals, and a total of 611 valid questionnaires were completed and returned (95.2% response rate). Cronbach's alpha, McDonald's omega, composite reliability, correlation analysis, and average variance estimation were calculated, and confirmatory factor analysis was performed. Descriptive analyses were performed to describe socio-demographic characteristics. A P-value of ≤0.05 was considered statistically significant. Tables, figures, charts, and texts are used for data presentation. RESULT: The overall internal consistency (Cronbach's alpha) for the 31-item SAQ-A was 0.903, indicating excellent reliability. Confirmatory factor analyses demonstrated a good model fit for each dimension and the entire construct (χ2=1086.675, df=412, p<0.001, comparative fit index (CFI)=0.923, Tucker Lewis index (TLI)=0.913, and root mean square error of approximation (RMSEA)=0.052). The positive response rate of healthcare workers in hospitals was 32.1%. The positive response rates of the six dimensions were teamwork climate (59.7%), safety climate (41.9%), job satisfaction (57.1%), working conditions (37.5%), perception of management (37.6%), and stress recognition (46.2%). CONCLUSION: The Amharic translation of the SAQ showed good psychometric properties, making it a valuable tool for assessing safety attitudes among Amharic-speaking Ethiopian healthcare practitioners.

Reliability and validity of the Amharic version of immune thrombocytopenia life quality index tool for assessment of the health-related quality of life in Ethiopian patients of immune thrombocytopenia: Cross-sectional study.

Background: Platelet count and bleeding risk are frequently used in clinical assessments of the severity of immune thrombocytopenia. On the other hand, immune thrombocytopenia also influences patients' health-related quality of life. The immune thrombocytopenia life quality index is a new tool for evaluating health-related quality of life in immune thrombocytopenia patients. Objective: To assess the psychometric properties of the Amharic version of the immune thrombocytopenia life quality index tool for immune thrombocytopenia patients in Ethiopia. Methods: The facility-based cross-sectional study was carried out from 15 September to 30 October 2022. The school of pharmacy institutional ethics review board provided ethical clearance and approval of the study protocol (approval number: ERB/SOP/487/14/2022). Both written informed consent and family or legal guardian consent were obtained for participants aged 14-18 years and informed consent for participants aged >18 years. The tool was forward-backward translated before being pretested on five immune thrombocytopenia patients. Descriptive statistics were used to report sociodemographic and clinical data. The psychometric properties of the immune thrombocytopenia life quality index in Amharic were evaluated for acceptability, reliability, and construct validity. Results: This study included 100 participants, at the age of diagnosis of immune thrombocytopenia, the median with inter-quartile range of platelet count (×109/L) was 15.00 (18.00). The majority of study participants (79, 79%) received prednisolone alone as first-line therapy. The tool psychometric test was reliable; the correlation coefficient between items ranged from 0.147 to 0.956, and the overall Cronbach's alpha coefficient was 0.956. Furthermore, the tool was construct-valid, with factor analysis between components revealing that Item-1 had an eigenvalue greater than one and explained 72.532% of the total variance among all 10 immune thrombocytopenia life quality index domains. The immune thrombocytopenia life quality index total (alternative score) had a strong (r = 0.9) correlation with Item-8 and a moderate (r = 0.317) correlation with Item-5. Conclusion: The Amharic version of the immune thrombocytopenia life quality index tool is a valid and reliable tool that can be used to assess the health-related quality of life of immune thrombocytopenia patients in Ethiopia.

Cross-Cultural Adaptation, Validity, and Reliability Testing of the Tilburg Frailty Indicator (TFI) Amharic Version for Screening Frailty in Community-Dwelling Ethiopian Older People.

Background: Frailty is a global health problem, including in African countries. Despite this, no reliable or valid frailty instruments incorporate any African language, and no research exists to cross-culturally adapt and test the validity and reliability of instruments commonly used in other countries for use within African countries. The Tilburg Frailty Indicator (TFI) is a reliable and validated instrument with the potential to be relevant for older populations living in Africa. This study aimed to develop the TFI Amharic (TFI-AM) version for use within Ethiopia. Methods: This study employed psychometric testing and the evaluation of a translated and adapted instrument. The original English language version of the TFI was translated and culturally adapted into Amharic using the World Health Organization process of translation and adaptation of an instrument. A convenience sample of ninety-six community-dwelling older people 60 years and over was recruited. Cronbach's alpha was used for the analysis of the internal consistency of the TFI Amharic (TFI-AM) version using IBM SPSS 26.0 (IBM Corp., Armonk, NY, USA). Face and content validities of the TFI-AM were determined. Results: The TFI-AM total mean score was 5.76 (±2.89). The internal consistency of the TFI-AM was very good with an overall Cronbach alpha value of 0.82. The physical domain showed the highest reliability with a 0.75 Cronbach's alpha value while the social domain was the lowest with a 0.68 Cronbach's alpha value. The Cronbach's alpha reliability coefficients of the instrument ranged from 0.68 to 0.75. The item content validity index value ranged from 0.83 to 1.0 and the total content validity index average for the instrument was 0.91. Conclusion: The TFI-AM is reliable, valid, and reproducible for the assessment of frailty among community-dwelling older populations in Ethiopia. TFI-AM proved an easy-to-administer, applicable and fast instrument for assessing frailty in community-dwelling older populations.

Cross-cultural translation, adaptation, and validation of the stroke-specific quality of life (SSQOL) scale 2.0 into Amharic language.

BACKGROUND: The stroke-specific quality of life 2.0 (SSQOL 2.0) scale is a valid, reliable instrument which has been widely used as a patients reported outcome measure among stroke survivors. However, the SSQOL scale has not been validated and used in any Ethiopian language. This study aimed to translate, culturally adapt, and test the psychometric properties of the SSQOL scale 2.0 in Amharic, which is the official and working language with about 34 million (23%) speakers in Ethiopia. METHODS: The adapted English version of the SSQOL 2.0 scale was translated into Amharic and then back-translated to English. An expert committee translated and created a final Amharic version of SSQOL (SSQOL-AM) scale. Pre-field testing (pilot and cognitive debriefing) was conducted with 15 post-stroke subjects. The SSQOL-Am was administered to 245 stroke survivors from four referral hospitals to determine the psychometric properties. Cronbach's alpha and Intra-class correlation coefficient were used to calculate the internal consistency and test-retest reliability, spearman's correlation for the convergent validity of the SSQOL-Am scale. The Standard Error of Measurement (SEM), Minimum Detectable Change (MDC), Bland Altman Limit of Agreement (LOA), Confirmatory Factor Analysis, and Exploratory Factor Analysis were also determined. RESULTS: The SSQOL-Am demonstrated excellent test-retest reliability (ICC = 0.93), internal consistency (Cronbach's alpha = 0.96), SEM 0.857, MDC 1.94, and good LOA. As postulated, the mobility domain of the tool demonstrated a significantly strong correlation with the physical function domain of the SF-36 (rho = 0.70, p < 0.001). CONCLUSIONS: The SSQOL-Am is a valid and reliable outcome measure. The tool can be used in both clinical practice and research purposes with Amharic speaking post-stroke survivors.

The Fear of COVID-19 Scale: Psychometric Properties of the Ethiopian Amharic Version.

Fear is an adaptive response that alerts individuals to the presence of a danger or threat. However, in the context of the current novel coronavirus disease 2019 (COVID-19) pandemic, the fear experienced could be intense because the number of victims of the virus is continuously increasing globally and is inducing severe mental health concerns. The seven-item Fear of COVID-19 Scale (FCV-19S) assesses the severity of fear related to COVID-19 and has already been validated in many languages. The present study evaluated the psychometric properties of the Amharic (Ethiopian) version of the FCV-19S. An online survey including the Amharic versions of the FCV-19S and the six-item UCLA Loneliness Scale (ULS-6) was administered to 307 Amharic-speaking participants using convenience sampling. The participants' age ranged between 18 and 70 years. In the evaluation process, confirmatory factor analysis, Item Response Theory, concurrent validity, and reliabilities (Cronbach's alpha, McDonald's omega, Guttman's lambda, and composite reliability) of the Amharic version of the FCV-19S were performed. The uni-dimensional structure of the FCV-19S was confirmed and the Amharic version of the FCV-19S had strong psychometric properties. All reliability coefficients of the Amharic FCV-19S were satisfactory, with sound concurrent validity shown by significant and positive correlations with loneliness. The results indicate that the FCV-19S can be used in research to assess the fear of COVID-19 among Amharic-speaking populations.

Confirmatory and Exploratory Factor Analysis for Validating Allen and Meyer Organizational Commitment Questionnaire for Health Professionals in Ethiopia-Amharic Language.

Background: Ethiopia does not have validated tools for assessing organizational commitment. The aim of this study was to develop an Ethiopian version of the organizational commitment questionnaire (OCQ-Eth) and to evaluate its psychometric properties in the assessment of organizational commitment in healthcare organizations in Ethiopia. Methods: A cross-sectional study was conducted in 14 healthcare facilities of the Bench-Sheko zone. The collected data were entered into EpiData version 3.1. The data were then exported into STATA version 14.1 and SPSS version 22 for analysis. Confirmatory factor analysis and exploratory factor analyses were performed for psychometric evaluation of OCQ in the Ethiopian context. Results: Confirmatory factor analysis showed the original model for organizational commitment did not meet the acceptable model fit. After confirmatory factor analysis, exploratory factor analysis was performed and subsequent confirmatory factor analysis resulted in the development of OCQ-Eth with 16 items classified under four factors (continuance, affective, normative, and concern for the organization) which explained 61.2% of cumulative variance. The three measures of organizational commitment exhibited discriminant and convergent validity. The model fit was improved after exploratory factor analysis. Conclusion: The extracted factor structure exhibited acceptable goodness of fit. The instrument was fit to evaluate the organizational commitment of healthcare professionals of Ethiopia.

Psychometric Properties of the Caring Behaviors Inventory-16 in Ethiopia.

Background: The Caring Behaviors Inventory-16 (CBI-16) is a comprehensive instrument measuring caring behaviors as experienced by patients. The study aimed to translate, culturally adapt and evaluate the psychometric properties of the CBI-16 among adult patients who speak the Amharic language. Methods: The measure was completed by 304 hospitalized patients. Construct validity was evaluated via exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and contrasted groups' validity. Total CBI-16 scores were compared between groups that differed in self-rated satisfaction with care (Patient Satisfaction Instrument) to examine the contrasted groups' validity. Reliability was assessed using internal consistency (Cronbach's alpha). Results: The EFA suggested a four-factor model accounting for 66.1% of the total variance. The items loaded onto the subscales were similar to the CBI-24. The CFA supported the four-factor model with acceptable fit indices: normed Chi-square value 2.65 (X2 = 259.60, df = 98), SRMR = 0.06, and RMSEA = 0.07, CFI = 0.88 and TLI = 0.86. The contrasted groups' validity was supported by significantly higher CBI-16 scores reported by patients more satisfied with their care (t = 3.66, p < 0.001). The reliability of the instrument was satisfactory (Cronbach's alpha = 0.83). Conclusions: The Amharic version of the CBI-16 displayed a four-factor solution and was shown to be a valid and reliable instrument for the assessment of the perceptions of caring behaviors in Ethiopia.

Providing Stroke and Hypertension Education in Amharic for Ethiopian Persons Living in Dallas, Texas, United States.

BACKGROUND: The purpose of this study was to compare knowledge of a stroke education module provided to bilingual members of the Ethiopian immigrant population in Dallas, Texas, presented in the Amharic language as compared to in English. METHODS: A convenience sample of 84 participants were recruited using a snowball technique and randomly assigned to receive education in English or Amharic. The participants completed a pre- and posttest of their knowledge about strokes, a demographic survey, and a satisfaction survey. Data was analyzed using a general linear model and chi-square analysis. RESULTS: There were no statistically significant differences between satisfaction scores comparing those educated in Amharic versus English (χ2 = 6.5108, p = .0107). Although mean pretest (10.8) and posttest (16.4) stroke knowledge scores were higher across all groups (p < .001), the mean posttest scores were lower for subjects who watched the Amharic versus the English video (14.9 vs. 18.1, p = .003). CONCLUSION: This study did not show a statistically significant increase in knowledge about stroke when presented learning materials in subjects' native language compared to in English. The use of video to present stroke and stroke-risk educational content can be used in future research and global health initiatives to increase stroke knowledge in the Amharic-speaking community.

Reliability and validity of Amharic version of EORTC QLQ-C30 and QLQ-BR23 modules for assessing health-related quality of life among breast cancer patients in Ethiopia.

BACKGROUND: Breast cancer is the most common cancer among women and it affects quality of life of those women. So far, the two most frequently used tools for assessing health related quality of life in breast cancer patients, EORTC QLQ-C30 and EORTC QLQ-BR23 modules, were not validated in Ethiopia. Hence, the present study aimed to assess the psychometric properties of the tools among Ethiopian breast cancer patients. METHODS: Institutional based longitudinal study was conducted from January 1 to May 1, 2017 GC at only nationwide oncology center, Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia. A total of 146 patients who visited the facility during that period, with no missing quality of life data, were selected for analysis. The psychometric properties of the EORTC QLQ-C30 and EORTC QLQ-BR23 were evaluated in terms of reliability, convergent, divergent, construct and clinical validity using SPSS version 22. RESULTS: Satisfactory internal consistency reliability (Cronbach's α coefficients > 0.7) was confirmed, except for cognitive function (α = 0.516) of EORTC QLQ-C30 and body image (α = 0.510) of EORTC QLQ-BR23. Multiple-trait scaling analysis demonstrated a good convergent and divergent validity. No scaling errors were observed. Most items in EORTC QLQ-BR23 possessed a weak or no correlation with its own dimension in EORTC QLQ-C30 (r < 0.4) except with some of symptom scales. A statistically significant chemotherapy induced quality of life scores changes (P ≤ 0.05) were observed in all dimensions of both instruments between baseline and the end of first cycle chemotherapy, except for body image (P = 0.985) and sexual enjoyment (P = 0.817) of EORTC QLQ-BR23, indicating clinical validity. CONCLUSION: Amharic version of the EORTC QLQ-C30 and EORTC QLQ-BR23 modules are valid and adequately reliable tool and can be used for clinical and epidemiological cancer researches to study the health related quality of life (HRQoL) of women with breast cancer in Ethiopia.

Reliability and validity of the Amharic version of European Organization for Research and Treatment of cervical Cancer module for the assessment of health related quality of life in women with cervical cancer in Addis Ababa, Ethiopia.

BACKGROUND: Cervical cancer is among the leading gynecological cancers affecting women worldwide. Maintenance and improvement of cervical cancer patients'health related quality of life (HRQoL) is an important issue. The cervical cancer specific quality of life module of the European Organization for Research and Treatment of Cancer (EORTC QLQ-CX24) is the most commonly used tool, however, it is not validated in Ethiopia. Hence, the present study aimed to assess the psychometric properties of the tool among Ethiopian cervical cancer patients. METHODS: Hospital based cross-sectional study was done in Tikur Anbessa Specialized Hospital (TASH), Addis Ababa, Ethiopia from January to February, 2018. The module was translated through forward-backward translation approach and pilot tested according to the EORTC Guidelines. One hundered and seventy one patients with confirmed cervical cancer were enrolled for the study. Amharic versions of EORTC QLQ-C30 and EORTC QLQ-CX24 were used to collect data along with socio-demographic and clinical characteristics. Descriptive statistics were used to assess socio-demographic and clinical characteristics of patients. The Psychometric properties of the EORTC QLQ-CX24 were evaluated in terms of acceptability, internal consistency, construct, concurrent and known group validity using SPSS version 22. RESULTS: One hundred seventy one cervical cancer patients were enrolled in the study, with a mean age of 52.15 ± 10.4 years. The EORTC QLQ-CX24 was found to be acceptable with high compliance and low missing responses. The Cronbach's alpha ranged from 0.70-0.84, indicating the reliability of the scales. Convergent and discriminant validity in multitrait scaling analysis was adequate. The EORTC QLQ-C30 subscales and EORTC QLQ-CX24 subscales had a weak to strong correlation, indicating concurrent validity. The scales and single-item measures were able to discriminate between subgroups of patients differing with regard to performance status, cancer stage and treatment status, indicating clinical validity. CONCLUSION: Amharic version of the EORTC QLQ-CX24 questionnaire is a valid and reliable tool and could be used for clinical and epidemiological cancer researches to study the HRQoL of patients with cervical cancer in Ethiopia.

Validation of the Amharic version of the Pelvic Organ Prolapse Symptom Score (POP-SS).

INTRODUCTION AND HYPOTHESIS: We aimed to translate and culturally adapt the Pelvic Organ Prolapse Symptom Score (POP-SS) into Amharic and evaluate its psychometric properties. METHODS: We followed an intercultural adaptation procedure to translate and adapt the POP-SS. One hundred and eighty-six women with POP symptoms completed the Amharic POP-SS and Prolapse Quality of Life (P-QoL) questionnaires. All women were examined using a simplified Pelvic Organ Prolapse Quantification (SPOP-Q) system and were divided into four groups based on the POP-Q scores as stage 1, 2, 3, and 4. Internal consistency and test-retest reliability were determined using Cronbach's alpha and the intraclass correlation coefficient (ICC), respectively. Criterion validity was assessed against the SPOP-Q stage and the P-QoL scale. Furthermore, we tested construct validity using exploratory factor analysis. RESULTS: The POP-SS score was successfully translated and achieved good content validity. It had high internal consistency (Cronbach's alpha = 0.86) and test-retest reliability (ICC = 0.81; p < 0.001). There was a statistically significant difference among four groups of stages in POP-SS score. and women with stage 3 had the highest median score (Kruskal-Wallis test; p < 0.05). The POP-SS score was also significantly correlated with the P-QoL score (Spearman's correlation coefficient = 0.28, p < 0.001). The exploratory factor analysis identified two factors, namely, physical symptoms and evacuation symptoms. CONCLUSIONS: The POP-SS scale was successfully translated to Amharic and appears reliable and valid for women with symptoms of POP. However, further studies are needed to evaluate its responsiveness.

Validation of the Amharic Version of the Brief Fatigue Inventory for Assessment of Cancer-Related Fatigue in Ethiopian Cancer Patients.

BACKGROUND: Although cancer-related fatigue (CRF) is a highly prevalent and distressing symptom associated with cancer and its treatment, it is mostly underscreened, underassessed, and undertreated. The Brief Fatigue Inventory (BFI) is a reliable and valid instrument to assess CRF. OBJECTIVE: To validate the Amharic version of the BFI (BFI-Am) for assessment of CRF in Ethiopian cancer patients. METHODS: The BFI-Am was developed from its original English version through standard forward-backward translation approach. Two hundred eight consented cancer patients filled the questionnaires, along with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30, version 3. In addition, sociodemographic and clinical information were collected. Psychometric properties of the BFI-Am were evaluated in terms of acceptability, internal consistency, construct validity, concurrent validity, and known group validity. Linear regression analysis was performed to identify possible predictors of fatigue severity. RESULTS: Two hundred two cancer patients completed the questionnaires and included in the data analysis. The BFI-Am had an overall Cronbach's alpha of 0.97. The results of the principal axis factor analysis suggested a one-factor solution explaining 78.4% of the variance, supporting the hypothesis of unidimensionality of the BFI-Am. The global BFI-Am interference items score was highly correlated with fatigue subscale score of European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 than single items, showing an inverse correlation between the BFI-Am and the global health status/quality of life (r = -0.324; P = 0.000). The BFI-Am significantly detected the differences in fatigue severity in patients with poor performance status (P < 0.001), indicating known group validity. CONCLUSION: The BFI-Am is an excellent assessment tool with adequate psychometric properties for use in both clinical management and symptom research of CRF in Ethiopian cancer patients.

Validation of the Amharic Version of the Brief Pain Inventory for Utility in Ethiopian Cancer Patients.

BACKGROUND: Pain is a highly prevalent and distressing symptom in patients with cancer but at the same time inadequately treated in many of these patients. The major reason for such imbalance is inappropriate pain assessment. To overcome such a barrier, the use of a valid and reliable pain assessment tool in the language the patient understands is invaluable. Unfortunately, until now, no such standardized tool has been utilized in Ethiopian patients with cancer for both clinical and research purposes. OBJECTIVES: This study tried to validate the Amharic language version of the Brief Pain Inventory (BPI-Am) and evaluate the adequacy of cancer pain management using the Pain Management Index (PMI). METHODS: A standard forward/backward translation technique was used for translating the BPI from its original English version into Amharic (BPI-Am). The BPI-Am was administered to 291 Ethiopian patients with cancer who fulfilled the inclusion criteria. Factor analysis was used to identify the underlying constructs of the tool. Mean comparison was used to confirm the sensitivity of the BPI-Am to known patient groups that differed based on their performance status. Cronbach's α and intraclass correlation coefficients, respectively, were used to assure internal consistency and test-retest reliability of the BPI-Am. The PMI was calculated to identify the level of inadequate pain management in the current sample. Stepwise logistic regression was used to identify potential predictors of inadequate pain management. RESULTS: Factor analysis yielded 3 factors-pain severity, physical activity interference, and psychosocial interference-with Cronbach's α coefficients of 0.85, 0.87, and 0.77, respectively. The BPI-Am showed the capacity to detect higher mean pain severity and mean pain interference scores in patients with poor performance status as compared with those having a good performance status (P < 0.001). Intraclass correlation coefficients for test-retest reliability were 0.75 and 0.78 for the pain severity and pain interference composite scores, respectively. Sixty-seven percent of patients in the current sample were inadequately treated for their pain according to the PMI. Good performance status (odds ratio [OR] = 2.9, P < 0.01), absence of cancer-related complications (OR = 2.1, P < 0.05), and being unemployed (OR = 2.6, P < 0.01) were identified as predictors of inadequate pain management. CONCLUSION: The BPI-Am is a valid and reliable tool for use in Ethiopian patients with cancer. The inadequacy of cancer pain management in these groups of patients is high, which calls for needed attention.

Validation of the Amharic Version of the M. D. Anderson Symptom Inventory and Assessment of Symptoms in Ethiopian Cancer Patients.

CONTEXT: Cancer patients often face a variety of symptoms that impact their quality of life. The management of these symptoms is highly dependent on the accurate appraisal of their severity through the use of a standardized symptom assessment tool. The M. D. Anderson Symptom Inventory (MDASI), developed in English, is one of such tools that contain 13 core cancer related symptoms that can easily be rated on a scale of 0-10. OBJECTIVES: The present study tried to develop and validate the Amharic language version of the MDASI (MDASI-Am). METHODS: The MDASI-Am was developed by the standard forward/backward translation of the original English version of the MDASI. The MDASI-Am was completed by or administered to 145 randomly selected Ethiopian cancer patients. Factor analysis, Cronbach α coefficient, and mean comparison, respectively, were used to establish construct validity, internal consistency, and known-group validity (Eastern Cooperative Oncology Group Performance Status). RESULTS: Factor analysis identified three symptom constructs interpreted as general, gastrointestinal, and neuropsychiatric symptoms, with Cronbach α coefficients of 0.70, 0.80, and 0.82, respectively. The MDASI-Am significantly detected differences in symptom severity and interference levels in patient groups categorized according to Eastern Cooperative Oncology Group Performance Status (P < 0.01), establishing known-group validity. The most prevalent severe symptoms identified in the current sample were pain, sadness, numbness, distress, and fatigue. CONCLUSION: The MDASI-Am is a valid and reliable tool for measuring symptom severity and symptom interference with daily living in Ethiopian cancer patients.

The structure and reliability of the amharic version of the hospital anxiety and depression scale in orphan adolescents in addis ababa.

BACKGROUND: The Hospital Anxiety and Depression Scale was developed as a self-assessment tool to identify anxiety and depression in patients of age 16-65 years. Its use in younger age groups and illiterate populations is not well examined. The purpose of this study was to examine the structure, reliability, and applicability of its Amharic version in a community sample of early orphan adolescents. METHODS: Secondary data primarily collected from randomly selected 804 orphans using the Amharic version of the Hospital Anxiety and Depression Scale by interview technique in March 2010 in Addis Ababa was used with permission. Confirmatory factor analysis with principal components extraction and oblique rotation (delta=0) was computed. The internal consistency of the subscales was assessed using Cronbach's alpha and the correlation between the subscales was assessed using Pearson correlation. RESULTS: In the whole sample (age 11-18 years), two factors: anxiety and depression, explaining a total of 45.9% of the variance were found. In the 11-15 years sub-sample, the same two factors were extracted explaining a total of 45.7% of the variance. The Amharic-HADS had Cronbach's alpha of 0.81 and 0.76 in the whole sample for the anxiety and depression sub-scales, respectively. In the 11-15 years sub-sample the corresponding alpha values for anxiety and depression scales were 0.80 and 0.77, respectively. The correlation between the anxiety and the depression subscales were 0.66 (p<0.001) and 0.67 (p< 0.001) for the whole sample and for the 11-15 years group, respectively. CONCLUSION: Administering the Amharic version of the Hospital Anxiety and Depression Scale by interviewers gave meaningful data starting from the age of 11 suggesting successful applicability of the scale with further validation.