title: Cross-cultural adaptation of the stroke action test for Italian--speaking people.
abstract: BACKGROUND
  Assessing the level of public stroke awareness is a prerequisite for development of community educational campaigns aimed at reducing prehospital delay of stroke patients. The Stroke Action Test (STAT) is a validated instrument specifically developed in the United States with the objective to assess the public's readiness to respond to stroke. Our purpose was to perform the cross-cultural adaptation of the original version of STAT to be applied to the Italian population.
  
  
  METHODS
  The process of cross-cultural adaptation has been performed according to guidelines, intended for questionnaires of self-report health status measures, following five steps: forward translation, synthesis, back translation, approval by an Expert Committee and test of the pre-final version. For this last step, 31 adults were asked to rate each item in terms of adequacy of content, clarity of wording and usefulness, according to a 3-point scale. The final version has been administered to a sample of 202 volunteers to assess its acceptability and reliability in terms of the internal consistency.
  
  
  RESULTS
  The pre-final version of the STAT was developed taking into accounts few and minimal discrepancies between the two back translations and the original version of the instrument. Most items were judged as adequate, easy to understand and useful, according to the frequency of high scores (>50 %) given by the adaptation sample. As for further testing of the adapted final version, completeness of item response was very good. Distribution of scores ranged from 0 to 100 %, without any floor or ceiling effect, with a percentage of the lowest scoring of 1.5 % for the 28-item test and 2.5 % for the 21-item test and a percentage of the highest scoring of 1 % for both tests. Internal consistency was high for both the 28-item and 21-item tests (Cronbach alpha = 0.85 and 0.84, respectively).
  
  
  CONCLUSIONS
  The process used to perform the cross-cultural adaptation of the questionnaire was successful. The Italian version of STAT demonstrated good acceptability and psychometric properties and is now available to assess stroke awareness in Italian people.
authors.affiliation: Geriatric Clinic University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy. ldenti@ao.pr.it.
authors.forename: Licia
authors.initials: L
authors.lastname: Denti
authors.affiliation: Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy. bmarcomini@ao.pr.it.
authors.forename: Barbara
authors.initials: B
authors.lastname: Marcomini
authors.affiliation: Geriatric Clinic University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy. silvia.riva@usi.ch.
authors.forename: Silvia
authors.initials: S
authors.lastname: Riva
authors.affiliation: Institute of Communication and Health, Università della Svizzera Italiana, Via G. Buffi 6 CH, 6900, Lugano, Switzerland. peter.schulz@usi.ch.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Schulz
authors.affiliation: Research and Innovation Unit, University Hospital of Parma, Via Gramsci 14, 43100, Parma, Italy. ccaminiti@ao.pr.it.
authors.forename: Caterina
authors.initials: C
authors.lastname: Caminiti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001364:Awareness; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation*; D020521:Stroke; D011795:Surveys and Questionnaires / Q000592:standards*; D014177:Translations; D055815:Young Adult