Translation, cultural adaptation, and content validation of the Hong Kong Chinese version of Self-completion Adult Social Care Outcomes Toolkit (ASCOT-SCT4) for care service users

Background: In light of the global challenges posed by an ageing population, the evaluation of long-term care (LTC) is of particular importance. The Adult Social Care Outcomes Toolkit Four-Level Self-completion Tool (ASCOT-SCT4) is a preference-based instrument developed to measure long-term care (LTC) related quality of life (QoL). However, it is not yet available in Hong Kong (HK). This study aims to translate and culturally adapt the ASCOT-SCT4 into Chinese and evaluate its content validity in the HK context.

Methods: The study adhered to well-established international guidelines for conducting translation, cultural adaptation, and content validation of instruments. The translation process included forward, backward translations, and expert committee review. Subsequently, LTC users aged 60 or above and experts with diverse professional backgrounds in LTC were involved in content validation in terms of comprehensibility, relevance, and comprehensiveness through cognitive interviews and a content validity index (CVI) survey. For clarity and relevance, an item-level CVI (I-CVI) of ≥ 0.78 and a scale-level CVI (S-CVI) of ≥ 0.90 were considered acceptable.

Results: In the translation process, concern was raised about the literal translation of 'Control over daily life' item. During the cognitive interviews, 27 LTC users perceived the instrument's length as acceptable, and experienced no sensitive feelings while completing it. However, seven of the nine items were found to have comprehension and interpretation issues, which were mostly resolved through revisions of wordings. For the 'Food and drink' and 'Dignity' items, alternative terms were used and sentence structure was revised to improve its comprehensibility while ensuring equivalence to the original English version. The final translated version demonstrated acceptable clarity (S-CVI: 0.92, I-CVIs: 0.86-1.00) as evaluated by seven experts. Both LTC users and experts found the items relevant (S-CVI: 0.97, I-CVIs: 0.94 to 1.00), and no additional LTC-related QoL domains were identified as missing from the instrument.

Conclusions: This study provides evidence that the Chinese version of the ASCOT-SCT4 is comprehensible, relevant, and comprehensive for the HK context, which allows for further testing on psychometric properties in a larger population.