Psychometric properties and cultural adaptation of Sleep Disturbance Measures in Arabic Speaking Populations: A Systematic Review
Authors
No
Author
Credentials
Titles
PhD Student
Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
2
3
Physiotherapy Department, Cancer Centre, Belfast Health and Social Care Trust, Belfast, UK
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Professor and Department Chair, Science of Nursing Care, Indiana University School of Nursing, and Visiting Professor, Ulster University.
School of Nursing, Indiana University, USA
5
Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
6
Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
Running Title: Psychometric properties for Arabic Sleep Disturbance Scales
Disclosures and Acknowledgement:
I certify that there is no actual or potential conflict of interest in relation to this article. This review was conducted as part of PhD thesis, which was funded by the Ulster University Vice-Chancellor's Research Scholarship.
Authors contributorship
Al Maqbali completed the data collection, statistical support and provided analysis. All authors contributed to the conceptualization and design and the manuscript preparation.
Text word count
Summary:
The aim of this review was to evaluate the psychometric properties and cross-cultural adaptation of sleep disturbance scales that have been translated into Arabic or originally developed in Arabic and to identify appropriate scales that can be used in research and clinical practice intended for Arabic speaking participants. The following databases were searched: CINAHL (2003 - 2019), MEDLINE (1946 - 2019), EMBASE (1980 - 2019), PsycINFO (1806 - 2019), and Cochrane Library (1806 - 2019). This review was conducted following PRISMA guidelines. Terwee et al. (2007) quality assessment was used to evaluate the psychometric properties of the studies and cross-cultural adaptation was assessed using criteria from Guillemin et al. (1993). Seven studies met the inclusion criteria, which included 4 scales: the Epworth Sleepiness Scales (ESS), Insomnia Severity Index (ISI), Pittsburgh Sleep Quality Index (PSQI) and Arabic Scale of Insomnia (ASI). Cross-cultural adaptations scored between good and poor; psychometric properties information was missing for most scales. The review suggested that PSQI may be a useful scale to measure sleep disturbance, as the scale show good cultural adaptation and acceptable psychometric properties in an Arabic population. Further, the scales measures seven different aspects of sleep quality. This review provides options to help researchers and clinicians select the most appropriate instrument for their practice. Further psychometric testing and cultural adaptation is required for sleep scales used in Arabic clinical populations to ensure validity and reliability in outcome measurement for research studies.
Key words: Sleep disturbance; Arabic; Review; Cross-cultural adaptation; Measurement properties.
Introduction:
Sleep disturbance is a significant stressor that can affect the psychological and physical health along with quality of life in healthy and clinical populations. The National Institutes of Health defined sleep disturbance as ‘dysregulation of sleep homeostasis, sleep deficiency, sleep fragmentation, insufficient sleep or impairment of sleep quality or quantity caused by a sleep disorder’ (National Institutes of Health, 2011). In the general population, the prevalence rate of sleep disturbance ranges between 36% to 50% (Heinzer et al., 2015; Nowicki et al., 2016). However, research studies have reported the prevalence of sleep disturbance among specific clinical populations such as cancer to be between 50% to 75% (Ancoli-Israel, 2015; Berger et al., 2005), psychiatric disorders between 40% to 50% (Walia and Mehra, 2016) and cardiovascular disease between 47% to 83% (Kasai et al., 2012; Matsuda et al., 2017)
Sleep disturbances are associated with decreased quality of life, increased use of the health care resources and poor mood. This is evidenced by surveys from the United States of America and 5 European countries which found that people with insomnia had significantly worse health related quality of life compared to people with normal sleep (DiBonaventura et al., 2015). Sleep disturbance can cause changes in metabolism, (Zimberg et al., 2012), immune pathways (Besedovsky et al., 2012) and endocrine functioning (Morgan and Tsai, 2015). In addition, sleep disturbance can significantly increase the risk of developing type 2 diabetes (Holliday et al., 2013), hypertension (Anothaisintawee et al., 2016) and increase the risk of cardiovascular disease (Khan and Aouad, 2017). Moreover, it is important to note that consequences of sleep disturbance is not confined to the individual; they may also have implications at a societal level, in terms of public health and economic burdens (Colten et al., 2006). Although objective tests, such as polysomnography, are the gold standard for diagnosing sleep disorders, such as sleep apnea, self-reporting scales are a brief and efficient method to assess sleep disturbance which provide information on the individuals’ assessment of their sleep health.
Despite the 300 million people that have Arabic as their native language across 27 countries in the Middle East and North Africa, evidence regarding the prevalence of sleep disorders in this population is limited (Horesh and Cotter, 2016). The main reason for this may relate to the fact that there is a lack of sleep disturbance scales that have been specifically developed for Arabic speaking populations. Some studies have translated or back translated English versions of scales into Arabic (Al-Abri et al., 2013; Suleiman et al., 2012) and compared the psychometric properties of the translated scale to the original version. There can be linguistic problems in relation to idiomatic expressions that may not be present in the target language and also a need to adjust verb tenses. Hence, validating a scale for use in another language and culture is not as simple as back translation (Acquadro et al., 2014). In addition, the original scale may not take into consideration cultural differences, such as sleeping habits associated with decreases in afternoon activity and temporal aspects of religious obligations (Ahmed, 2014; Epstein et al., 2015); therefore researchers need to consider cross cultural adaptation of scales (Beaton et al., 2000; Bullinger et al., 1998). With this in mind, the aim of this review is to explore the validity, reliability and cultural adaptation of sleep disturbance scales that have been translated into Arabic or originally developed in Arabic in order to identify scales that can be used in research and clinical practice in Arabic countries.
Methods:
Sleep disturbance scales were identified by searches utilising the following electronic databases CINAHL (1937 until 10/February/2019), MEDLINE (1946 to 10/February/2019), EMBASE (1980 until 10/February/2019), PsycINFO (1806 until 10/February/2019) and Cochrane Library (1980 until 10/February/2019). The search method used both text words and MeSH terms of the following terms : "Medicine, Arabic" OR "Arabs" OR "Arabic", "Scales", "Instrument Validation", "Psychometrics" OR "Measurement Issues and Assessments", "Outcome Assessment" OR "Measurement Issues and Assessments", "daytime sleepiness", "Narcolepsy", "Insomnia", sleep disturbances, "Sleep" OR "Sleep Apnea, Central" OR "Sleep Disorders, Circadian Rhythm" OR "Sleep Apnea, Obstructive" OR "Sleep-Wake Transition Disorders" OR "Sleep Disorders, Intrinsic" OR "Sleep Disorders". Footnote chasing was used to identify articles by backwards chaining references that were cited in previous studies on the topic (Booth et al., 2013). The time setting was not restricted, and all papers published in English were included.
Assessment of measurement:
Quality assessment of psychometric studies evaluating sleep disturbance scales that had been translated into Arabic, or originally developed in Arabic, were assessed using Terwee et al's., (2007) quality assessment criteria for evaluating the psychometric properties of scales and Guillemin et al’s (1993) guidelines for cultural adaptation of scales. Psychometric properties included 9 aspects: content validity, internal consistency, criterion validity, construct validity, reproducibility, responsiveness, floor and ceiling effects, and interpretation. For each of these attributes, a specific criterion was defined by which the instrument should be reviewed (See table1). The 9 aspects were scored as: ‘+’ positive rating; ‘?’ indeterminate rating; ‘-’ negative rating; ‘0’ no information available. Terwee et al., (2007) recommended presentation of the results in tabular form, rather than utilising an overall quality score. This is because an overall score would assume an equal importance of each of the psychometric properties, but in practice this is not the case.
For cross-cultural adaptation, studies were evaluated on the extent to which they employed the five steps suggested by Guillemin et al. (1993) that are used to preserve the sensibility of a scale and target culture: (1) translations, (2) back-translations, (3) committee review, (4) pre-testing and (5) re-examination of the weighting of scores (See table 2).
Translation is recommended using at least two translators with experience in the use of the scale to translate from the original language to the target language (Brislin, 1970). Back-translation comprises two independent translators translating the new target language version back to the original language. This step is to ensure that the translated new version reflects the content of the original instrument. The third step constitutes a committee review to develop the pre-final version for pre-testing. The fourth step is pre-testing which seeks to test the pre-final version on 30-40 participants of the target population. The last step is weighting scores, which is the consideration of the weights of scores to the cultural context. Each step of Guillemin et al., (1993)was assessed by applying one of the following scores: 1=poor, 2=moderate and 3=good. The overall score was calculated by taking the mean of the items measured. However, if the instrument was developed in Arabic, the steps of translation and back translation were not required, therefore not be assessed. This review has been reported according to the Preferred Reporting Items Systematic Reviews and Meta-Analysis (PRISMA) guidelines (Moher et al., 2010).
Selected Criteria:
The studies were eligible for inclusion in the review according to the following criteria. All types of study designs that validated scales in terms of sleep disturbance in Arabic speaking population, in participants over the age of 18 years. Protocol papers and conference abstracts were excluded.
Results:
Studies selection:
The search strategy identified 55 studies, these were reviewed by abstract and title (Figure 1 shows the PRISMA flow chart). Seven studies met the inclusion criteria; these studies evaluated four sleep disturbance scales. (See table 3 for description of the studies included in the review).
Identification of Sleep Disturbance Scales
Three sleep disturbance scales had been translated into Arabic: The Epworth Sleepiness Scales (ESS, (Ahmed, 2014; Ahmed et al., 2014; Al-Abri et al., 2013), the Insomnia Severity Index (ISI, Ahmed, 2015; Suleiman and Yates, 2011) and the Pittsburgh Sleep Quality Index (PSQI, (Suleiman et al., 2012; Suleiman et al., 2010). One scale was originally developed in the Arabic language and validated in an Arabic population – the Arabic Scale of Insomnia (ASI, Abdel-Khalek, 2008).(See table 4 for description of scales)
Quality Assessment:
A critical evaluation of the psychometric reporting employed in the studies was guided by the Terwee et al., (2007) checklist (see table 5 for a summary of the evaluation). The review evaluated 7 studies, one of which reported on two scales (Ahmed, 2014).
Content validity was assessed in 5 studies and only 3 received a positive rating (Ahmed et al., 2014; Al-Abri et al., 2013; Suleiman et al., 2010), two of these were assessed as being intermediate in reporting the content validity (Ahmed, 2014; Suleiman et al., 2012). Internal consistency was tested in all the studies. Only two studies achieved a positive score for criterion validity (Abdel-Khalek, 2008; Suleiman and Yates, 2011). Six studies gave information about construct validation, two with intermediate ratings (Ahmed, 2014; Suleiman et al., 2012) and 4 with positive ratings (Abdel-Khalek, 2008; Ahmed et al., 2014; Suleiman et al., 2010; Suleiman and Yates, 2011). Agreement was assessed by one study (Al-Abri et al., 2013), which received a positive score. Two studies tested reliability (test-retest) and had positive score ratings (Abdel-Khalek, 2008; Ahmed et al., 2014), whereas the remaining 5 studies did not provide any information. Responsiveness, floor and ceiling effects and interpretation were not reported in any of the studies.
A description of how studies adequately addressed cross-cultural adaptation is provided in table 6. Three of the sleep scales had been translated from English to Arabic (PSQI, ISI and ESS) and only one, the ASI, was originally developed in Arabic and validated in an Arabic population. The method of cultural adaptation, reported in 4 studies, was heterogeneous. Only one study (Suleiman et al., 2010) solely relied on translation from source to target language, whereas the PSQI employed all five steps of the cultural adaptation and scored 3 overall, indicating that cross-cultural adaptation was adequately addressed. One study involving the Insomnia Severity Index (ISI) included a four-step process but failed to complete committee review. The ISI translation achieved a moderate weighting score of 1.5 overall. Studies investigating the Epworth Sleepiness Scale (ESS) reported the translations and back-translations steps only and received a score of between 1.3 to 3 of the three studies (Ahmed et al., 2014; Ahmed, 2014; Al-Abri et al., 2013).
Pittsburgh Sleep Quality Index (PSQI):
The Pittsburgh Sleep Quality Index (PSQI) is a 19-item instrument designed to measure different aspects of sleep quality and sleep disturbance (Buysse et al., 1989). The scale reports sleep quality over the previous month. The PSQI is divided into 7 subscale scores: subjective sleep quality, sleep latency (time of full sleep), duration, habitual sleep efficiency (proportion between total sleep time and time in bed), sleep disturbances (waking up during the night), use of sleeping medication, and daytime dysfunction (difficulty staying awake during daytime). The overall score ranges between 0-21, and a high score indicates poor sleep quality.
The original PSQI was tested with psychiatric patients and also with a normal population; it has been validated in different clinical populations, such as cancer (Beck et al., 2004; Otte et al., 2013), renal transplant (Burkhalter et al., 2011), diabetes (Cunha et al., 2008), multiple sclerosis (Moreira et al., 2008), rheumatoid arthritis (Nicassio et al., 2014), heterogeneous patients (Carpenter and Andrykowski, 1998) and those with sleep disorders (Backhaus et al., 2002).
The PSQI has been translated into 51 languages including: Spanish (Hita-Contreras et al., 2014), Sinhala (Anandakumar et al., 2016), Hungarian (Takács et al., 2016), Chinese (Lin et al., 2016), Persian (Chehri et al., 2016) and German (Lang et al., 2017). Suleiman et al., (2010) translated the PSQI into Arabic and tested it in 35 healthy Arabic bilingual participants. The original PSQI (Buysse et al., 1989) showed very good internal consistency (Cronbach's alpha = .89); however, the translated Arabic PSQI demonstrated borderline acceptability (Cronbach's alpha = .65) (Buysse et al., 1989). Another psychometric study that investigated the PSQI in Arabic cardiac patients found the internal consistency reliability was 0.74 (Suleiman et al., 2012). Based on the review findings, the PSQI meets the quality assessment criteria for content, construct validity, internal consistency; however, criterion validity agreement, reliability, responsiveness, floor and ceiling effects and interpretation have not been reported. The translation process of PSQI Arabic was deemed to be good, as it reported the five steps, recommended by Guillemin et al. (1993), resulting in a score of 3.
Epworth Sleepiness Scales (ESS)
Epworth Sleepiness Scales (ESS) was constructed to assess the daytime sleepiness and diagnose sleep disorders using 8 items on a 4-point Likert scale (Johns, 1991). The total score ranged between 0 (normal sleep) to 24 (very sleepy). Johns (1991) reported the internal consistency as reliable (Cronbach's alpha = 0.72). The scale was translated and validated into Greek (Tsara et al., 2004), Korean (Cho et al., 2011), Norwegian (Beiske et al., 2009), Portuguese (Bertolazi et al., 2009) and Dutch (Sauter et al., 2007).
Three studies tested the psychometric properties of ESS in an Arabic population. Ahmed et al., (2014) involved 90 healthy participants from Saudi Arabia and found the internal consistency to be very good (Cronbach's alpha= 0.86) and test-retest reliability was r=0.86. The results seem to indicate that the Arabic version of the ESS is a reliable and valid measure of daytime sleepiness, however the author only addressed two aspects of cross cultural adaptation (Translation and Back Translation).
Al-Abri et al., (2013) use the Bland Altman plot method in validating the ESS in an Arabic population. The researchers recruited 97 healthy, bilingual (English/Arabic) participants to compare the Arabic translated version with the original English version. Pearson's correlation coefficients among the two versions was excellent at r=0.914. Furthermore, Bland and Altman's method indicated an agreement between the Arabic and English versions of ESS. The cross-cultural adaptation was not adapted for all 5 steps, with only two steps reported, translated and back translated, with an overall score of 2.
Ahmed, (2015) conducted a further validation study with 83 Sudanese participants and reported acceptable internal consistency reliability of the Arabic version (Cronbach's alpha = 0.84). Three steps were used to address cultural adaption, but the author did not provide a detailed description of the process. The overall score was 1.3.
Based on the review findings, the ESS meets the quality assessment criteria for content, construct validity, internal consistency, agreement, reliability; however, criterion validity responsiveness, floor and ceiling effects interpretation has not been assessed. Cross cultural adaptation of the Arabic version of the ESS only employed the translation process by back-translation, and there was very little description about committee approach step.
Insomnia Severity Index (ISI)
The Insomnia Severity Index (ISI) is a 7 item, 5-point Likert scale with three subscales assessing the nature, severity and impact of insomnia, over the last two weeks. Overall scores range between 0-28, with higher scores indicating more severe insomnia. The total score can be categorized as follows: 0-7 (absence of insomnia); 8-14 (sub-threshold insomnia); 15-24 (moderate insomnia) and 22-28 (severe insomnia). Bastien et al., (2001) recommended that a cut-off score of 10 should be used for categorising insomnia in community sample.
Suleiman and Yates, (2011) validated the ISI with 35 healthy Arabic participants; the internal consistency reliability was acceptable (Cronbach's alpha = 0.84), however the sample size was very small (n=35). Additionally, Ahmed, (2015) validated the ISI with 83 Sudanese participants, resulting in acceptable internal consistency (Cronbach's alpha = 0.87). The ISI was originally developed to assist with the clinical evaluation of patients. However, the samples of both studies were healthy participants which may have implications for generalisation of findings. It would appear that in a healthy population, the ISI meets the quality assessment criteria for content, criterion, construct validity, internal consistency, but further work is needed in agreement, reliability, responsiveness, floor and ceiling effects and interpretation in clinical populations. The cultural adaptation of ISI translation process fulfilled 3 steps of the Guillermin et al (1993) guidelines; translation process by back-translation and committee approach steps was reported. However, the steps were not clearly described and overall score was 2.3 for Suleiman and Yates (2011) and 1.3 for Ahmed (2014).
Arabic Scale of Insomnia (ASI)
The Arabic Scale of Insomnia (ASI) was developed by Abdel-Khalek, (2008) for measuring sleep disorders amongst the Arabic population, as an Arabic version. The ASI comprises 12-items. Participants were asked to respond to each item on a 5-point Likert scale. The scales of ASI were translated into English. The study involved three categories from the general population: adolescents (n= 5044), college students (2210) and government employees (1247). The internal consistency reliability of ASI was acceptable (Cronbach's alpha between = 0.84 to 0.87). The scale was test-retested after one week and the Cronbach's alpha was between 0.70 and 0.90. Based on the review findings, the ASI meets the quality assessment criteria for content, criterion, construct validity, internal consistency reliability. Further work is needed in agreement, responsiveness, floor and ceiling effects, and interpretation has not been reported. The ASI was translated into English but the cross-cultural adaption cannot be assessed, as the author did not give details about the process. The scale received an overall score of 1.5 in translation to English.
Discussion
Measuring sleep disturbance is important as it is a problem that can involve complex aetiologies with many associated factors (Roth, 2007), such as comorbid depression or pain. Understanding the links between such comorbidities and sleep disturbance is critically important; thus, reliable and valid scales to assess sleep disturbances are needed. There are a limited number of scales developed and validated in the Arabic population that measure sleep quality. Devine et al., (2005) published a literature review to identify scales that were used to measure sleep dysfunction and found twenty-two that were validated in English, however the present review found only 4 scales that have been validated in an Arabic population. Most of these scales have been tested psychometrically in English clinical populations, such as dementia, cancer, back pain (Marin et al., 2006; Savard M et al., 2005; Spira et al., 2012). It is apparent from the results of the current review that there is need to validate these scales further, using Arabic clinical populations, in order to assess their utility, psychometric properties and cross-cultural sensitivity.
The cross-cultural adaptation of studies included in the review was evaluated by Guillemin criteria of forward translation, back-translations, testing on lay panels, committee review, and re-examination of the weighting of scores (Guillemin et al., 1993). However, after assessing each study using the Guillemin criteria, it was apparent that most of the studies in this review were lacking in some of the steps involved in cross-cultural adaptation. Only one study, using the PSQI (Suleiman et al., 2010), employed all five steps proposed by Guillemin. It is suggested that researchers consider employing Guillemin’s guidelines to translate sleep disturbance scales into Arabic to maximize the linguistic structure and cultural equivalence of the instrument. This may help to ensure that the sensitivity of such scales is not contaminated or confounded by cultural or language differences within the target population, and that the instrument measures what it was originally intended to measure.
This review used guidelines by Terwee et al., (2007) to evaluate the psychometric properties of the scales. The importance of this was to identify the strengths and weaknesses of the scales. Analysis indicated that comprehensive psychometric testing of sleep disturbance scales to be used in the Arabic population has not been fully realized; indeed, many psychometric properties remain untested. This is worrisome as it can impact on the generalizability and interpretation of the outcome measures. Hence, clinicians and researchers need to exercise caution in using these sleep scales, as there is uncertainty in whether they can be useful in their Arabic cultural setting and with clinical populations.
In terms of selecting the best instrument to measure sleep disturbance, there are several factors that need to be taken into consideration for clinical practice or research purposes (Cole et al., 2007). It is necessary to determine what exactly the questionnaire is deemed to measure, for example, to diagnose, screen, or monitor sleep disorder in specific population clinical or nonclinical. Secondly, the instrument scoring system such as only PSQI have seven subscales and each one has own scores whereas the other three scales (ISI, ESS and ASI) did not have subscales which calculated total. Thirdly, how sleep has been defined in terms of being insomnia or poor sleep. In addition, the length of the scale, duration over which insomnia or poor sleep is measured (presently, last month or last two weeks), assessment of dimensions (subscales needed to measure), validity, reliability and cultural adaption of the scale are important considerations.
This review found that most of the studies had incomplete reporting of the cross-cultural adaptation and translation steps and this may have resulted in imprecise use of Arabic terminology. Only the PSQI had reported all steps of cultural adaptation recommended by Guillemin et al., (1993). Moreover, no study met all of the Tewee’s quality assessment criteria that evaluated the psychometric properties of sleep related measurements (Terwee et al., 2007). Further assessment is needed regarding criterion validity, reliability, agreement, floor and ceiling effects, responsiveness and interpretation (Table 4). The psychometrics properties of the instrument may vary due to the different populations and settings (Streiner et al., 2015). Investigating different populations and using different methods may help to improve the psychometrics properties of the instrument. The judgment of the instrument use depends on the purpose and applicability in terms of population, disease and treatment (Hyland, 2002).
The results of the review indicated that the PSQI, which measures different aspects of sleep disturbance, with seven components has been culturally adapted for use in Arabic population. The PSQI was found to have acceptable psychometric properties and, may be of use in Arabic clinical or non-clinical populations, but further testing is required in criterion validity, agreement, reliability, responsiveness, floor and ceiling effects and interpretation.
Conclusion:
The review has provided information for researchers and clinicians to facilitate the choice between the existing Arabic versions of sleep disturbance scales for certain applications in specific populations and countries. This review showed inadequate evidence of psychometric and cultural adaptation of the scales; it is therefore recommended that further investigation of the performance of Arabic versions of sleep disturbance measurement properties is carried out.
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Property
Definition
Content validity
+
?
-
2
Internal
Consistency
+
?
-
Cronbach's alpha (s)! 0.70 or O0.95, despite adequate design and method;
0
3
Criterion validity
+
?
-
Correlation with gold standard! 0.70, continuous adequate design and method;
0
4
Construct validity
+
?
-
Less than 75% of hypotheses were confirmed, despite adequate design and Methods;
0
5
Reproducibility
5.1. Agreement
+
?
-
MIC> SDC OR MIC equals or inside LOA, despite adequate design and method;
0
5.2. Reliability
+
?
-
ICC or weighed Kappa! 0.70, despite adequate design and method;
0
6
Responsiveness
Clinically important changes over time
+
?
-
SDC or SDC> MIC OR MIC equals or inside LOA OR RR <1.96 OR AUC! 0.70, despite adequate design and methods
0
7
Floor and ceiling Effects
+
?
-
<15% of the respondents achieved the highest or lowest possible scores, strict adequate design and methods;
0
8
Interp4retatability
+
?
Doubtful design or method OR less than four subgroups OR no MIC defined;
0
No information found on interpretation.
MIC= minimal important change; SDC=smallest detectable change; LOA=limits of agreement; ICC=Intraclass correlation; SD, standard deviation.
a + = positive rating; ?=indeterminate rating; - =negative rating; 0=no information available.
b Doubtful design or method= lacking of a clear description of the design or methods of the study, sample size smaller than 50 subjects (should be at
least 50 in every (subgroup) analysis), or any important methodological weakness in the design or execution of the study.
* This table adapted from Terwee et al. 2007 page 39
Table 2: Guidelines to preserve equivalence in cross-cultural adaptation of measures
Translation Technique
Back-Translation Technique
Committee Approach
Use appropriate back-translators
Membership of the committee should be multidisciplinary
Use structured techniques to resolve discrepancies Modify instructions or format, modify/reject inappropriate items, generate new items
Ensure that the translation is fully comprehensible
Verify cross-cultural equivalence of source and final versions
Check for equivalence in source and final versions using a pre-test technique Either use a probe technique
Or submit the source and final versions to bilingual lay people
Immigrants: Choose the language of administration or use a dual-format measure
Consider adapting the
* This table adapted from Guillemin et al. 1993 page 1422
Table 3: Characteristics of the Studies Including the Review
Scale with references
(Suleiman et al., 2010)
Cronbach’s α ranges from .36 to .84
PSQI (Suleiman et al., 2012)
Jordan
Cross-sectional
Insomnia Severity Index(ISI) (Suleiman and Yates, 2011)
USA
Cross-sectional
Cronbach’s α ranges from .49 to 0.92
ISI (Ahmed, 2014)
Epworth Sleepiness Scale (ESS) (Ahmed et al., 2014)
Saudi Arabia
Re-test 0.98
Oman
Cross-sectional
NR
Arabic Scale of Insomnia (ASI) (Abdel-Khalek, 2008)
Kuwait
Cross-sectional
Very large sample
Author tested in on other study in clinical population
Table 4: Description of the identified Sleep Disturbance Scales (Arabic Version)
Instrument
Item
19
0 to 3
1-5 good sleeper
5-21 poor sleeper
No subscale
8
0
No subscale
Less than 5 min
12
0
5 min
Past month
Table 5: The assessment of measurement properties of Sleep Disturbance Scales
Instrument
+
+
?
+
+
+
(Abdel-Khalek, 2008)
Study and instrument
3
3
3
3
3
3
2
2
NR
NR
NR
2
(Abdel-Khalek, 2008)
2
1
NR
NR
NR
1.5
Rating: 3 = good, 2 = moderate, 1 = poor, NR = information not reported, NA: not applicable
17