Translation, Validation, and Cultural Adaptation of CLEFT-Q© for use in Indonesia

Prasetyanugraheni Kreshanti; Kasih Rahardjo Djarot; Fransiska Kaligis; Dewi Friska; Jordan W Swanson; Jessica Blum; Valencia Jane Martin; Kristaninta Bangun

doi:10.1177/10556656231160392

Translation, Validation, and Cultural Adaptation of CLEFT-Q^© for use in Indonesia

Cleft Palate Craniofac J. 2023 Mar 22:10556656231160392. doi: 10.1177/10556656231160392. Online ahead of print.

Authors

Prasetyanugraheni Kreshanti¹, Kasih Rahardjo Djarot¹, Fransiska Kaligis², Dewi Friska³, Jordan W Swanson⁴, Jessica Blum⁴, Valencia Jane Martin¹, Kristaninta Bangun¹

Affiliations

¹ Cleft and Craniofacial Center Dr. Cipto Mangunkusumo Hospital, Division of Plastic Reconstructive and Aesthetic Surgery, Department of Surgery, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
² Department of Psychiatry, Dr. Cipto Mangunkusumo Hospital, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
³ Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia.
⁴ Division of Plastic, Reconstructive and Oral Surgery, 6567Children's Hospital of Philadelphia, Philadelphia, PA, USA.

PMID: 36949554
DOI: 10.1177/10556656231160392

Abstract

Objective: To translate and validate CLEFT-Q^©, patient-reported outcome measure for patients with cleft lip and/or palate (CL and/or P), into Indonesian. CLEFT-Q^© covers the domains of appearance, facial function, health-related quality of life and consists of scales describing outcomes after cleft surgery.

Design: The CLEFT-Q^© instrument was translated according to the International Society of Pharmacoeconomics and Outcomes Research guidelines, including translation, cognitive debriefing, and field-testing.

Setting: Dr. Cipto Mangunkusumo Hospital, Indonesia; independent CL and/or P support groups.

Patients: Patients ages 8-29 with a history of repaired CL and/or P were grouped based on age. Those unable to complete the questionnaire independently were excluded.

Interventions: The primary objective was reliable translation of the CLEFT-Q® instrument. Each scale was assessed for its internal consistency (Cronbach's alpha) and validity (inter-item correlation), and sub-group analyses were performed based on age group.

Results: Forward and back translation revealed 25(13.3%) and 12(6.3%) of items were difficult to translate. Cognitive debriefing revealed 10(5.3%) items were difficult to understand, with the lowest reliability on the facial appearance scale (α=0.27). Other scales demonstrated acceptable to excellent reliability (α=0.53-0.68). Field testing revealed acceptable reliability and validity of the translation (α = 0.74-0.92; 69% ideal range of inter-item correlation). Sub-group analyses revealed patients in the <11y.o. and >18y.o. groups had the lowest scores on the "cleft lip scar" scale while those 11-18y.o. had the lowest scores on the "nostrils" scale.

Conclusion: Iterative translation and cultural adaptation of CLEFT-Q^© into Indonesian demonstrated reliability and validity of the tool, supported by acceptable to excellent internal consistency and ideal inter-item correlation.

Keywords: counseling; nonsyndromic clefting; psychological assessment; psychosocial adjustment; quality of life; speech perception.