Cross-cultural equivalence of a brief helplessness scale for Spanish-speaking rheumatology patients in the United States

Objective. To show evidence of the cross-cultural equivalence between the o riginal English version of a 5-item scale for measuring helplessness and a translated Spanish version. Methods. English and Spanish versions of the 5 items that constitute the he lplessness factor of the Rheumatology Attitudes Index were tested in 3 sepa rate groups of patients: 1) 20 bilingual rheumatology patients; 2) 100 cons ecutive English- and 50 consecutive Spanish-speaking monolingual rheumatolo gy patients; and 3) 192 English- and 44 Spanish-speaking patients with rheu matoid arthritis who were consecutively enrolled in a cohort to study disea se outcomes. English-Spanish concordance among bilingual subjects was measu red using intraclass correlation coefficients (ICC). Infernal consistency w as measured by Cronbach's coefficient alpha. Associations between the helpl essness scale and variables measured simultaneously in English- and Spanish -speaking patients were measured by correlation analysis. Results. Agreement between the English and Spanish versions of the helpless ness scale among bilingual subjects was excellent (ICC = 0.87), and interna l consistency among monolingual subjects was acceptable (coefficient alpha = 0.73 in English and 0.87 in Spanish). The correlation between helplessnes s and most other measured variables was of similar size and direction in En glish as in Spanish (10-point pain scale r = -0.53 and -0.52; modified Heal th Assessment Questionnaire physical disability r = -0.45 and -0.43; self-a ssessed joint count r = 0.36 and 0.36; Medical Outcomes Study Short Form 36 [SF-36] physical function r = 0.37 and 0.39; SF-36 mental health r = 0.27 and 0.35; Center for Epidemiological Studies Depression scale r = -0.37 and -0.33, respectively). Conclusion. The evidence shown supports the cross-cultural equivalence betw een the original 5-item helplessness scale developed in English and our tra nslated Spanish version.