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Translation and Cross-cultural Adaptation of Hearing Handicap Inventory for the Elderly - Screening (HHIE-S) in the Bilingual Singapore Population - A Pilot Study

Presenting Author: Eu Chin Ho

Published online by Cambridge University Press:  03 June 2016

Eu Chin Ho ,
Deborah Lim  and
Seth Yeak
Eu Chin Ho
Affiliation:
Tan Tock Seng Hospital
Deborah Lim
Affiliation:
Tan Tock Seng Hospital
Seth Yeak
Affiliation:
Tan Tock Seng Hospital
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Abstract

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Learning Objectives: Commonly used hearing questionnaires can be translated and cross-culturally adapted into non English languages using a validated translation process.

Introduction: This study aims to to preliminarily assess the validity and reliability of a Mandarin translation of the HHIE-S questionnaire and measure its feasibility.

Method: We adopted a translation process adapted from the MAPI Institute for cross-cultural studies, involving 3 independent forward translations by clinicians, 1 back-translation by a non-clinician and final consensus by a review panel.

15 bilingual patients at Tan Tock Seng Hospital completed the Mandarin HHIE-S after their audiometric assessment. At an interval of about 30 minutes later, patients completed the English HHIE-S. They were given the same Mandarin HHIE-S and instructed to complete one week later.

Results: Mean age of all participants is 70.4 (Standard Deviation 4.42) and mean pure tone audiometry (PTA0.5,1,2,4kHz) of the better ear was 34.58 dB (Standard Deviation 14.34). Self-rated English and Mandarin language proficiencies were comparable.

Validity of Mandarin HHIE-S

  1. 1. Mandarin and English total scores are significantly correlated, showing a strong positive relationship (Pearson Coefficient 0.885, p<0.001).

  2. 2. Analysis of HHIE-S categories of non-significant hearing-loss and Significant hearing-loss with corresponding categories on Gold Standard criterion of PTA0.5,1,2,3kHz showed poor agreement (Kappa coefficient = 0.0367, <0.2). User feedback was sought regarding problematic questions.

Reliability

  1. 1. Internal consistency of the 10 items in the Mandarin HHIE-S is good with a Cronbach's alpha of 0.8499 (>0.8).

  2. 2. Test-retest reproducibility of the first and second Mandarin HHIE-S at one-week interval is strong. Among 80% of patients, difference between the 2 mandarin scores is less than 5.

User acceptance scores were positive in terms of readability, comprehensibility and relevance.

Conclusion: The Mandarin HHIE-S demonstrated high reliability though low validity. A larger scale validation study incorporating user feedback from this pilot study should be carried out in the future.