PDB55 LINGUISTIC VALIDATION, INCLUDING CULTURAL ADAPTATION, OF AN UPDATED ADKNOWL, DIABETES KNOWLEDGE QUESTIONNAIRE, FOR INTERNATIONAL USE

OBJECTIVES: Linguistic validation of a diabetes knowledge questionnaire that is internationally acceptable and detects common misunderstandings and important educational needs. A rigorous methodology was employed to ensure conceptual equivalence and cultural relevance as well as harmonisation across countries. METHODS: The Audit for Diabetes Knowledge (ADKnowl) (104 Items in 23 sections) was developed in UK English (Speight and Bradley; 2001) and most recently updated in 2008 in consultation with UK diabetologists, a diabetes specialist nurse (DSN), a dietician, and a podiatrist. A conceptual definition of each item was provided by the developer, forward translations were produced in Germany and Spain. Results of the first translations and questions were discussed with the developer and a diabetologist, DSN, dietician and the translation team in each country. The initial UK version was revised. The German and Spanish versions were back translated into UK English and tested for acceptability and comprehension during cognitive debriefing interviews with eight people with diabetes in each country, before final language versions were established. RESULTS: First results obtained after the forward translation and discussion in Spain and Germany showed that diabetes management differs somewhat across countries and differences in dietary habits and alcohol use necessitated some adaptation to the questions. The establishment of a harmonized questionnaire required some rewording of items and reordering. Challenges encountered, including those concerning diet and alcohol, and how these were dealt with during all steps of the process will be described in the presentation. CONCLUSIONS: An internationally acceptable version of the ADKnowl was developed following a rigorous methodology to facilitate international comparison and pooling of data. This project demonstrates the importance of assessing the suitability of the item content of a knowledge measure to the clinical and cultural context of the target countries.