Abstract
Background: The Migraine Disability Assessment Scale (MIDAS) is one of the tools for measuring and understanding disability caused by migraine. The purpose of this study was to validate a Kiswahili translation of the MIDAS (MIDAS-K) among patients suffering from migraines in Dar es Salaam, Tanzania. Methods: A psychometric validation study of MIDAS was conducted after translation to Kiswahili. A total of 70 people with migraine were recruited by systematic random sampling and they completed the MIDAS-K questionnaire twice, 10–14 days apart. Internal consistency, split-half reliability, and test-retest reliability, convergent and divergent validity were examined. Results: 70 patients (F:M; 59:11) with median (25th, 75th) headache days of 4.0 (2.0, 7.0) were recruited. Twenty-eight out of 70 (40%) of the population had severe disability on MIDAS-K. The overall test-retest reliability of MIDAS-K was high (ICC = 0.86; 95% CI = 0.78–0.92 p < 0.001). Factor analysis showed a two-factor structure; the number of days missed and reduced efficiency. MIDAS-K had a good internal consistency of 0.78, good split-half reliability of 0.80 and acceptable test-retest reliability for all items as well as total MIDAS-K scores. Conclusion: The Kiswahili version of the MIDAS questionnaire (MIDAS-K) is a valid, responsive, and reliable tool to measure migraine-related disability among Tanzanians and other Swahili-speaking populations. Quantification of migraine disability in the region will guide policies directed at care allotment, improvement in the provision of interventions for migraine, as well as enhancement of health-related quality of life for patients with migraine in our region.
| Original language | English |
|---|---|
| Pages (from-to) | 880-888 |
| Number of pages | 9 |
| Journal | Headache |
| Volume | 63 |
| Issue number | 7 |
| DOIs | |
| Publication status | Published - 1 Jul 2023 |
Keywords
- East Africa
- Kiswahili
- assessment
- disability
- migraine
- validity
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In: Headache, Vol. 63, No. 7, 01.07.2023, p. 880-888.
Research output: Contribution to journal › Article › peer-review
TY - JOUR
T1 - Development and initial validation of the Kiswahili version of the Migraine Disability Assessment (MIDAS-K) questionnaire
AU - Nagri, Aliasgar
AU - Patel, Miten
AU - Mwansisya, Tumbwene
AU - Adebayo, Philip B.
N1 - Funding Information: The study participants were adult (18 years and older) patients with migraine who sought treatment at the neurology inpatient and outpatient services of The Aga Khan Hospital, Dar es Salaam, Tanzania. A systematic random sampling method was used to select participants from the population of treatment-seeking migraine patients. Consecutive even-numbered patients attending outpatient neurology clinics and medical admission were recruited. The participants were re-assessed if they fulfilled the criteria for a diagnosis of migraine as described in the third edition of the International Classification of Headache Disorders.9 As per the guidance to have a ratio of 10 participants per item,10 we included 70 participants who met the inclusion criteria for validity and reliability. The ethics committee of The Aga Khan University Tanzania approved the present study, and all ethical parameters were ensured according to the Declaration of Helsinki. Preceding inclusion in the study, written informed consent was obtained from all participants. This is an observational cross-sectional psychometric validation study. We analyzed the construct validity, convergent validity, discriminant validity, internal consistency, split-half reliability, and test–retest reliability of the MIDAS-K questionnaire. The study participants were adult (18 years and older) patients with migraine who sought treatment at the neurology inpatient and outpatient services of The Aga Khan Hospital, Dar es Salaam, Tanzania. A systematic random sampling method was used to select participants from the population of treatment-seeking migraine patients. Consecutive even-numbered patients attending outpatient neurology clinics and medical admission were recruited. The participants were re-assessed if they fulfilled the criteria for a diagnosis of migraine as described in the third edition of the International Classification of Headache Disorders.9 As per the guidance to have a ratio of 10 participants per item,10 we included 70 participants who met the inclusion criteria for validity and reliability. The ethics committee of The Aga Khan University Tanzania approved the present study, and all ethical parameters were ensured according to the Declaration of Helsinki. Preceding inclusion in the study, written informed consent was obtained from all participants. The MIDAS is a five-question self-administered questionnaire with a score indicating little or no disability (0–5), mild disability (6–10), moderate disability (11–20), and severe disability (21+). The MIDAS main scale has five items; items 1 and 2 indicate headache-related disability at work or school that is quantified by days missed or reduced efficiency by more than 50%, and items 3 and 4 indicate headache-related disability at household chores that are quantified by days missed or reduced efficiency by more than 50%. Item 5 indicates days missed in leisure, family, or social activities as a consequence of the headache. The other two items on the MIDAS denote average headache pain score and headache days in the previous 3 months. A bilingual expert executed an independent translation of the original English MIDAS into Kiswahili following the guideline proposed by the World Health Organization translation protocol.11 Consequently, an individual who was conversant in both English and Kiswahili, but was not aware of the original MIDAS to avoid recall bias, carried out an independent back translation. There was no loss of meaning in the back translation. Ten randomly assigned patients with migraine completed the Kiswahili version of the MIDAS in the pilot study. All 10 participants understood the questionnaire well and found no ambiguity in the wording and phrasing of the MIDAS-K except for the heading of the scale. The heading of the scale was changed from “Dodoso Kwa ajili ya MIDAS” (English: MIDAS questionnaire) to “Dodoso Kwa ajili ya Kipanda Uso” (English: Migraine Questionnaire) because patients did not understand what “MIDAS” meant. A Cronbach's alpha of 0.82 was achieved and the full study was pursued. The pilot sample was later excluded from the actual data collection to avoid contamination. Participants recorded their age, sex, marital status, level of education, and the presence of any positive first-degree relative with a history of migraine. Clinical characteristics obtained from the participants included the character, duration, location of the headache, presence of any aura symptoms, activities exacerbating the headache, and use of medications in the preceding 3 months. The MIDAS-K was administered again to the same participants after 10 to 14 days. A period of 10 to 14 days was chosen as we believe it was an adequate period to minimize recall bias and for any significant changes in the pattern of disease to occur. Data analysis was accomplished using the IBM SPSS Statistics package version 25.0 and Analysis of Moment Structures (Amos) immersed in the SPSS 25.0 was used to authenticate factorization. Demographic and clinical data were summarized with discrete variables presented as frequencies and percentages while continuous variables were summarized as means (standard deviation) for normally distributed data and median (25th and 75th percentiles) for skewed data. The assumption of normality of the data was verified by examination of skew and kurtosis and it was violated; hence, descriptive statistics of MIDAS-K were presented as median (25th–75th percentile). The homogeneity of variance was verified by the Levine test and no violation was observed. The assumption of independence was verified by a two-tailed Wilcoxon signed-rank test and no violations were found. The Kiswahili version of the MIDAS questionnaire was evaluated for its validity and reliability. This is the primary analysis of these data, which has been determined a priori. The internal consistency split-half reliability and the test–retest reliability were assessed. The internal consistency of the MIDAS-K was calculated by Cronbach's alpha; the Cronbach's alpha of 0.70 indicated that the tool has good internal consistency.12 The split-half reliability of the MIDAS-K was calculated using the Guttmann split-half coefficient (a coefficient of more than 0.7 indicated good split-half reliability). The test–retest reliability was assessed using intra-class correlation coefficients (ICC). In SPSS, the ICC was calculated using two-way mixed effects, absolute agreement, and single measurements method. Values below 0.5 indicated poor reliability, between 0.5–0.75 showed moderate reliability, 0.75–0.9 denoted good reliability, and those values above 0.9 indicated excellent reliability.13,14 The construct validity of the scale was assessed using the exploratory factor analysis (EFA) with varimax rotation. The Kaiser–Meyer–Olkin (KMO) index, a measure of sampling adequacy that examines the appropriateness of factor analysis, was calculated before EFA was performed. The KMO measure of sampling adequacy was 0.68 (a value of 0.5–1 indicates the appropriateness of factor analysis for the data). Bartlett's test of sphericity, a test statistic that provides a measure of the statistical probability that the correlation matrix has significant correlations among its components, was significant at a p-value < 0.01 (p-value < 0.05 is considered significant).15 The eigenvalues and scree plots that represent the total variance explained by each factor were assessed, and those factors having eigenvalues > 1 were selected. A factor loading of >0.50 was selected to calculate correlations between variables and factors.15 Calculating the average variance extracted (AVE) and composite reliability (CR) using the formula suggested by Hair and colleagues assessed convergent validity. An AVE > 0.5 and CR > 0.7 indicate good convergent validity.16 This formula was chosen because it does not require a comparative conceptual construct as there are no available validated constructs in a Kiswahili context. As per the Fornell and Larcker criterion, a tool is said to have good discriminant validity if the AVE is greater than the maximum shared variance (MSV) for each factor. The MSV was calculated by squaring the highest latent factor covariance.17 This method of calculating divergent validity does not require a comparative construct. Publisher Copyright: © 2023 American Headache Society.
PY - 2023/7/1
Y1 - 2023/7/1
N2 - Background: The Migraine Disability Assessment Scale (MIDAS) is one of the tools for measuring and understanding disability caused by migraine. The purpose of this study was to validate a Kiswahili translation of the MIDAS (MIDAS-K) among patients suffering from migraines in Dar es Salaam, Tanzania. Methods: A psychometric validation study of MIDAS was conducted after translation to Kiswahili. A total of 70 people with migraine were recruited by systematic random sampling and they completed the MIDAS-K questionnaire twice, 10–14 days apart. Internal consistency, split-half reliability, and test-retest reliability, convergent and divergent validity were examined. Results: 70 patients (F:M; 59:11) with median (25th, 75th) headache days of 4.0 (2.0, 7.0) were recruited. Twenty-eight out of 70 (40%) of the population had severe disability on MIDAS-K. The overall test-retest reliability of MIDAS-K was high (ICC = 0.86; 95% CI = 0.78–0.92 p < 0.001). Factor analysis showed a two-factor structure; the number of days missed and reduced efficiency. MIDAS-K had a good internal consistency of 0.78, good split-half reliability of 0.80 and acceptable test-retest reliability for all items as well as total MIDAS-K scores. Conclusion: The Kiswahili version of the MIDAS questionnaire (MIDAS-K) is a valid, responsive, and reliable tool to measure migraine-related disability among Tanzanians and other Swahili-speaking populations. Quantification of migraine disability in the region will guide policies directed at care allotment, improvement in the provision of interventions for migraine, as well as enhancement of health-related quality of life for patients with migraine in our region.
AB - Background: The Migraine Disability Assessment Scale (MIDAS) is one of the tools for measuring and understanding disability caused by migraine. The purpose of this study was to validate a Kiswahili translation of the MIDAS (MIDAS-K) among patients suffering from migraines in Dar es Salaam, Tanzania. Methods: A psychometric validation study of MIDAS was conducted after translation to Kiswahili. A total of 70 people with migraine were recruited by systematic random sampling and they completed the MIDAS-K questionnaire twice, 10–14 days apart. Internal consistency, split-half reliability, and test-retest reliability, convergent and divergent validity were examined. Results: 70 patients (F:M; 59:11) with median (25th, 75th) headache days of 4.0 (2.0, 7.0) were recruited. Twenty-eight out of 70 (40%) of the population had severe disability on MIDAS-K. The overall test-retest reliability of MIDAS-K was high (ICC = 0.86; 95% CI = 0.78–0.92 p < 0.001). Factor analysis showed a two-factor structure; the number of days missed and reduced efficiency. MIDAS-K had a good internal consistency of 0.78, good split-half reliability of 0.80 and acceptable test-retest reliability for all items as well as total MIDAS-K scores. Conclusion: The Kiswahili version of the MIDAS questionnaire (MIDAS-K) is a valid, responsive, and reliable tool to measure migraine-related disability among Tanzanians and other Swahili-speaking populations. Quantification of migraine disability in the region will guide policies directed at care allotment, improvement in the provision of interventions for migraine, as well as enhancement of health-related quality of life for patients with migraine in our region.
KW - East Africa
KW - Kiswahili
KW - assessment
KW - disability
KW - migraine
KW - validity
UR - http://www.scopus.com/inward/record.url?scp=85163025299&partnerID=8YFLogxK
U2 - 10.1111/head.14592
DO - 10.1111/head.14592
M3 - Article
AN - SCOPUS:85163025299
SN - 0017-8748
VL - 63
SP - 880
EP - 888
JO - Headache
JF - Headache
IS - 7
ER -