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 original 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 helplessness factor of the Rheumatology Attitudes Index were tested in 3 separate groups of patients: 1) 20 bilingual rheumatology patients; 2) 100 consecutive English- and 50 consecutive Spanish-speaking monolingual rheumatology patients; and 3) 192 English- and 44 Spanish-speaking patients with rheumatoid arthritis who were consecutively enrolled in a cohort to study disease outcomes. English-Spanish concordance among bilingual subjects was measured using intraclass correlation coefficients (ICC). Internal consistency was measured by Cronbach's coefficient alpha. Associations between the helplessness 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 helplessness scale among bilingual subjects was excellent (ICC = 0.87), and internal consistency among monolingual subjects was acceptable (coefficient alpha = 0.73 in English and 0.87 in Spanish). The correlation between helplessness and most other measured variables was of similar size and direction in English as in Spanish (10-point pain scale r = -0.53 and -0.52; modified Health Assessment Questionnaire physical disability r = -0.45 and -0.43; self-assessed 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 between the original 5-item helplessness scale developed in English and our translated Spanish version.