title: The use of the FACT-H&N (v4) in clinical settings within a developing country: a mixed method study.
abstract: In the last decade there has been an increasing awareness about 'quality of life' (QOL) of cancer survivors in developing countries. The study aimed to cross-culturally adapt and validate the FACT-H&N (v4) in Urdu language for Pakistani head and neck cancer patients. In this study the 'same language adaptation method' was used. Cognitive debriefing through in-depth interviews of 25 patients to assess semantic, operational and conceptual equivalence was done. The validation phase included 50 patients to evaluate the psychometric properties. The translated FACT-H&N was easily comprehended (100%). Cronbach's alpha for FACT-G subscales ranged from 0.726 - 0.969. The head and neck subscale and Pakistani questions subscale showed low internal consistency (0.426 and 0.541 respectively). Instrument demonstrated known-group validity in differentiating patients of different clinical stages, treatment status and tumor sites (p < 0.05). Most FACT summary scales correlated strongly with each other (r > 0.75) and showed convergent validity (r > 0.90), with little discriminant validity. Factor analysis revealed 6 factors explaining 85.1% of the total variance with very good (>0.8) Kaiser-Meyer-Olkin and highly significant Bartlett's Test of Sphericity (p < 0.001). The cross-culturally adapted FACT-H&N into Urdu language showed adequate reliability and validity to be incorporated in Pakistani clinical settings for head and neck cancer patients.
authors.affiliation: Oral Cancer Research and Coordinating Center, University of Malays, Malaysia; Department of Community Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Sobia
authors.initials: S
authors.lastname: Bilal
authors.affiliation: Oral Cancer Research and Coordinating Center, University of Malays, Malaysia; Department of Community Dentistry, Faculty of Dentistry, University of Malaya, Kuala Lumpur, Malaysia. Electronic address: jendoss@um.edu.my.
authors.forename: Jennifer Geraldine
authors.initials: JG
authors.lastname: Doss
authors.affiliation: Regional Head and Neck Unit, Aintree University Hospital, Liverpool, UK.
authors.forename: Simon N
authors.initials: SN
authors.lastname: Rogers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D002294:Carcinoma, Squamous Cell / Q000208:ethnology / Q000523:psychology / Q000628:therapy; D003142:Communication; D003431:Cross-Cultural Comparison; D054521:Cultural Competency; D003906:Developing Countries; D016002:Discriminant Analysis; D005163:Factor Analysis, Statistical; D005260:Female; D006258:Head and Neck Neoplasms / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010154:Pakistan / Q000208:ethnology; D011594:Psychometrics; D036301:Qualitative Research; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards; D055815:Young Adult
keywords: Cross-cultural adaptation; FACT-H&N; Head and neck cancer; Quality of life