. 2021 Sep;30(9):2649-2661.

doi: 10.1007/s11136-021-02837-x. Epub 2021 Apr 2.

Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients

Chindhu Shunmugasundaram^{1

2}, Haryana M Dhillon^{3

4}, Phyllis N Butow^{3

4}, Puma Sundaresan^{5

6}, Claudia Rutherford^{7

8}

Affiliations

¹ Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia. chindhu.shunmugasundaram@sydney.edu.au.
² Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia. chindhu.shunmugasundaram@sydney.edu.au.
³ Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.
⁴ Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia.
⁵ Radiation Oncology Network, Western Sydney Local Health District, Sydney, Australia.
⁶ Sydney Medical School, University of Sydney, Sydney, Australia.
⁷ Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.
⁸ Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, Australia.

PMID: 33797687
DOI: 10.1007/s11136-021-02837-x

Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients

Chindhu Shunmugasundaram et al. Qual Life Res. 2021 Sep.

. 2021 Sep;30(9):2649-2661.

doi: 10.1007/s11136-021-02837-x. Epub 2021 Apr 2.

Authors

Chindhu Shunmugasundaram^{1

2}, Haryana M Dhillon^{3

4}, Phyllis N Butow^{3

4}, Puma Sundaresan^{5

6}, Claudia Rutherford^{7

8}

Affiliations

¹ Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia. chindhu.shunmugasundaram@sydney.edu.au.
² Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia. chindhu.shunmugasundaram@sydney.edu.au.
³ Centre for Medical Psychology and Evidence-based Decision-making, School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia.
⁴ Psycho-Oncology Cooperative Research Group, University of Sydney, Sydney, Australia.
⁵ Radiation Oncology Network, Western Sydney Local Health District, Sydney, Australia.
⁶ Sydney Medical School, University of Sydney, Sydney, Australia.
⁷ Quality of Life Office, School of Psychology, Faculty of Science, University of Sydney, Sydney, Australia.
⁸ Sydney Nursing School, Cancer Nursing Research Unit (CNRU), University of Sydney, Sydney, Australia.

PMID: 33797687
DOI: 10.1007/s11136-021-02837-x

Abstract

Background: Head and neck cancers (HNC) and their treatments cause dysfunction and distress. Ongoing psychological assessment using disease-specific patient-reported measures may optimize clinical decision-making, facilitate interventions to reduce psychosocial burden. As most such measures are developed in English, non-English speaking patients are disadvantaged. This study translated HNC-specific measures (Body Image Scale, Patient Concerns Inventory, Zung's Self-Rating Anxiety and Depression Scales and Patient Health Questionnaire-9) into three Indian languages (Hindi, Tamil and Telugu) and linguistically validated them.

Methods: Translation followed established guidelines on translation and linguistic validation of measures. Process involved two independent forward translations, reconciliation, two independent backward translations by bilingual experts, and cognitive debriefing interviews with nine healthcare professionals (HCPs) and 29 HNC patients. Translated versions were compared with the original versions for semantic, cultural and conceptual equivalence.

Results: Overall, 17 Hindi items, 19 Tamil items and 13 Telugu items were identified to have semantic, cultural and/or conceptual issues. These were resolved to achieve equivalence with the original measures. Interviews with HCPs indicated that equivalent terms for words such as anxiety, panicky, sexuality, and self-conscious might be difficult to understand. Interviews with patients indicated all items were understandable, easy, sensitive, unambiguous and relevant. Hence, no further revisions were made.

Conclusions: The translated Hindi, Tamil and Telugu versions of the Body image scale, Patient concerns inventory, Zung's self-rating anxiety and depression scales and Patient health questionnaire-9 measures are conceptually and linguistically validated and equivalent with the original English versions. Psychometric validation of these measures with relevant patient populations is needed.

Keywords: Cognitive debriefing; Cultural adaptation; Equivalence; Linguistic validation; Patient-reported outcome measures; Translation.

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Patient-reported anxiety and depression measures for use in Indian head and neck cancer populations: a psychometric evaluation.
Shunmugasundaram C, Dhillon HM, Butow PN, Sundaresan P, Chittem M, Akula N, Veeraiah S, Rutherford C. Shunmugasundaram C, et al. J Patient Rep Outcomes. 2021 Jun 7;5(1):44. doi: 10.1186/s41687-021-00316-y. J Patient Rep Outcomes. 2021. PMID: 34097161 Free PMC article.
The Patient Concerns Inventory in head and neck oncology: a structured review of its development, validation and clinical implications.
Kanatas A, Lowe D, Rogers SN. Kanatas A, et al. Eur Arch Otorhinolaryngol. 2022 Nov;279(11):5097-5111. doi: 10.1007/s00405-022-07499-0. Epub 2022 Jul 17. Eur Arch Otorhinolaryngol. 2022. PMID: 35842858 Free PMC article. Review.
Body Image Scale: Evaluation of the Psychometric Properties in Three Indian Head and Neck Cancer Language Groups.
Shunmugasundaram C, Dhillon HM, Butow PN, Sundaresan P, Chittem M, Akula N, Veeraiah S, Huilgol N, Rutherford C. Shunmugasundaram C, et al. Front Psychol. 2022 May 12;13:779850. doi: 10.3389/fpsyg.2022.779850. eCollection 2022. Front Psychol. 2022. PMID: 35645858 Free PMC article.
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Bhardwaj T, Arora N, Rajvanshi A. Bhardwaj T, et al. Indian J Palliat Care. 2025 Apr-Jun;31(2):177-185. doi: 10.25259/IJPC_250_2024. Epub 2025 Apr 22. Indian J Palliat Care. 2025. PMID: 40837001 Free PMC article.
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Lu SC, Xu C, Kaur M, Edelen MO, Pusic A, Gibbons C. Lu SC, et al. J Patient Rep Outcomes. 2025 Jul 25;9(1):94. doi: 10.1186/s41687-025-00926-w. J Patient Rep Outcomes. 2025. PMID: 40711496 Free PMC article.

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Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients

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Enabling cross-cultural data pooling in trials: linguistic validation of head and neck cancer measures for Indian patients

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