Pain in amaXhosa Women Living With HIV/AIDS: Translation and Validation of the Brief Pain Inventory-Xhosa

Abstract

Context: Pain has been reported as the second most commonly reported symptom in people living with HIV/AIDS. In South Africa, there are more than five million people living with HIV/AIDS. Approximately, two million belong to the Xhosa cultural group. The prevalence of pain in amaXhosa living with HIV/AIDS was unknown at the commencement of the study. A culturally appropriate, valid, and reliable instrument is required to measure pain and its impact in this population.

Objectives: The objectives of this article are to document the process of translation of the Brief Pain Inventory (BPI) into the BPI-Xhosa and to present the results of the validity and reliability testing of the instrument.

Methods: A six-stage forward-backward translation process was followed using bilingual and bicultural translators to ensure decentering of the process. The translated BPI-Xhosa, a demographic questionnaire and the European Quality of Life-5 Dimensions Xhosa version (EQ-5D-Xhosa) health-related quality of life instrument were administered to 229 amaXhosa women living with HIV/AIDS in a resource-poor urban settlement in South Africa.

Results: A 74.24% (95% CI: 68.2-79.47) prevalence of pain was recorded. The BPI-Xhosa had good concurrent validity when compared with the previously validated EQ-5D-Xhosa. Factor analysis confirmed that the BPI-Xhosa had a two-factor structure (pain severity and pain interference). The instrument had good internal reliability, with Cronbach alphas of 0.77 and 0.83 for the pain severity and pain interference subscales, respectively.

Conclusion: The BPI-Xhosa is a valid instrument which can be used to measure pain prevalence, severity, and interference in amaXhosa women living with HIV/AIDS.

Keywords: Brief Pain Inventory; HIV/AIDS; pain; reliability; validity.