Open AccessThe Hausa Back Beliefs Questionnaire: Translation, cross-cultural adaptation and psychometric assessment in mixed urban and rural Nigerian populations with chronic low back pain
Author(s) -
Aminu A. Ibrahim,
Mukadas O. Akindele,
Sokunbi O. Ganiyu,
Bashir Kaka,
Bashir Bello
Publication year - 2021
Publication title -
plos one
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.99
H-Index - 332
ISSN - 1932-6203
DOI - 10.1371/journal.pone.0249370
Subject(s) - cronbach's alpha , intraclass correlation , medicine , exploratory factor analysis , construct validity , hausa , convergent validity , confidence interval , physical therapy , psychometrics , reliability (semiconductor) , clinical psychology , low back pain , cross sectional study , psychology , internal consistency , philosophy , linguistics , power (physics) , physics , alternative medicine , pathology , quantum mechanics
Introduction Negative attitudes and beliefs about low back pain (LBP) can lead to reduced function and activity and consequently disability. One self-report measure that can be used to assess these negative attitudes and beliefs and to determine their predictive nature is the Back Beliefs Questionnaire (BBQ). This study aimed to translate and cross-culturally adapt the BBQ into Hausa and assess its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP. Methods The BBQ was translated and cross-culturally adapted into Hausa (Hausa-BBQ) according to established guidelines. To assess psychometric properties, a consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the questionnaire along with measures of fear-avoidance beliefs, pain catastrophizing, functional disability, physical and mental health, and pain. One hundred of the 200 patients completed the questionnaire twice at an interval of 7–14 days to assess test-retest reliability. Internal construct validity was assessed using exploratory factor analysis, and external construct validity was assessed by examining convergent, divergent, and known-groups validity. Reliability was assessed by calculating internal consistency (Cronbach’s α), intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC 95 ), and limits of agreement using Bland-Altman plots. Reliability (ICC, SEM and MDC 95 ) was also assessed separately for rural and urban subgroups. Results The factor analysis revealed a four-factor solution explaining 58.9% of the total variance with the first factor explaining 27.1%. The nine scoring items loaded on the first factor hence supporting a unidimensional scale. The convergent and divergent validity were supported as 85% (6:7) of the predefined hypotheses were confirmed. Known-groups comparison showed that the questionnaire discriminated well for those who differed in education ( p < 0.05), but not in age ( p > 0.05). The internal consistency and ICC (α = 0.79; ICC = 0.91) were adequate, with minimal SEM and MDC 95 (1.9 and 5.2, respectively). The limits of agreements were –5.11 to 5.71. The ICC, SEM and MDC 95 for the urban and rural subgroups were comparable to those obtained for the overall population. Conclusions The Hausa-BBQ was successfully adapted and psychometrically sound in terms of internal and external construct validity, internal consistency, and test-retest reliability in mixed urban and rural Hausa-speaking populations with chronic LBP. The questionnaire can be used to detect and categorize specific attitudes and beliefs about back pain in Hausa culture to prevent or reduce potential disability due to LBP.