Setswana translation of the Leicester Cough Questionnaire

Abstract

Background: Chronic cough negatively influences those who suffer from it, often leading to poor health- related quality of life (QoL). The treatment options for managing chronic cough remain limited. The Leicester Cough Questionnaire (LCQ) is a patient-reported outcome measure (PROM). When used, it provides healthcare practitioners insights into the effect of chronic cough on patients’ QoL. The LCQ evaluates three health domains: the physical, the psychological, and the social. This study aimed to create a preliminary Setswana version of the LCQ that can undergo further psychometric property testing in a patient population in the future. The specific objectives were to translate the original LCQ into Setswana, establish the content validity of the Setswana version, and describe the perceptions and experiences of experts when reviewing the preliminary Setswana LCQ. The availability of a Setswana LCQ will allow for testing the in Setswana population to prevent exclusion from future studies and possible treatment modalities. Method: The study consisted of two phases. Phase one was the forward translation, synthesis of this translation, back translation, and subsequent expert review to facilitate the cultural adaption of the LCQ into Setswana. Best practice guidelines for the translation and cross-cultural adaptation of a PROM were followed. During Phase Two of this study, the content validity of the Setswana LCQ was determined by expert review using the item content validity index (I- CVI) and the scale content validity index (S-CVI). Meetings were audio-recorded, transcribed verbatim, and analysed using thematic content analysis to create an audit trail, thereby enhancing the credibility of the process. Results: Five individuals participated in the translation and cross-cultural adaption of the original LCQ to the preliminary Setswana version. The majority of the participants were female (n=4, 80%), with a mean age of 48.60 (SD 12.01) years. Linguistic differences were highlighted during the translation process, and agreements between translators were reached that a more traditional Setswana dialect would be acceptable. Linguistic challenges were identified during the v translation and cross-cultural adaptation process when working with the LCQ instructions and the following questions: 2, 3, 6, 9, 12 to 15, and 18. Categories identified as barriers in the translation process included cultural alignment and aspects related to linguistics. The latter category was further divided into sub-categories consisting of the dialect, the descriptive nature of the language, and the mode of delivery. Items 9,13, and 17 did not translate well and scored 0.67 on the I-CVI, which is below the recommended score of 1.0. The S-CVI/Ave was 0.93, indicating excellent Scale content validity. Conclusion: A Setswana version of the LCQ with excellent S-CVI was compiled and is ready to be used in further studies to determine if it retains the psychometric properties of the original version. Using patient interviews can further assist in identifying whether terms and concepts on the Setswana version of the LCQ are understandable and highlight any risk of cultural bias.