OBJECTIVE: To translate and cross-culturally adapt the COPD in Low- and middle-income countries (LMICs) Assessment (COLA) questionnaire into Brazilian Portuguese, a case-finding instrument for chronic obstructive pulmonary disease (COPD).
METHODS: Translation and cross-cultural adaptation were completed in six steps: the original version was translated into Brazilian Portuguese by two native speakers of the target language; the translated versions were synthesized; back-translation was performed by two native speakers of the original language; the back-translation and the Brazilian Portuguese version of the COLA were reviewed and harmonized by an expert committee of specialists; and, then, the pre-final version was tested by 30 health professionals who were asked if the items were clear to understand. The acceptability, clarity, and understandability of the translated version were evaluated. A final review of the questionnaire was produced by the authors and approved by the author of the original questionnaire.
RESULTS: Some idiomatic, semantic, and experiential inconsistencies were identified and properly adjusted. Item 3 was considered the most unclear item (23,3%). Items 7, 8, and 9 presented clarity above 80% (93%, 90%, and 90%, respectively). Suggestions were discussed and incorporated into the tool and COLA was found to be clear and easy to understand.
CONCLUSIONS: The Brazilian version of the COLA was easily understood by healthcare professionals and adapted to Brazilian culture. Translation and cultural adaptation of the COLA instrument into Brazilian Portuguese can be an important case-finding instrument for chronic obstructive pulmonary disease in Brazil.

BACKGROUND: Modelling academic self-concept through second-order factors or bifactor structures is an important issue with substantive and practical implications; besides, the bifactor model has not been analysed with a Chinese sample and cross-cultural studies in the academic self-concept are scarce. Likewise, latent structure validity evidence using network psychometrics has not been carried out.
OBJECTIVE: The aim of this study is twofold: to analyse (1) the internal structure of ASC through the Self-Description Questionnaire II-Short (SDQII-S) in Chinese and Spanish samples using two approaches, structural equation modelling and network psychometrics conducting an exploratory graph analysis; and (2) the measurement invariance of the best model across countries and investigate the cross-cultural differences in ASC.
METHODS: The sample was composed by 651 adolescents. Seven models of ASC were tested.
RESULTS: Results supported the multi-dimensional nature of the data as well as the reliability. The best-fitted model for the two subsamples was the three-factor ESEM model, but only the configural invariance of this model was supported across countries. The graph function shows that the school dimension appears more related to the verbal factor in the Spanish subsample and to the math dimension in the Chinese subsample. Likewise, the relationship between verbal and math factors in Spanish students is non-existent, but this connection is more relevant for Chinese students.
CONCLUSIONS: These two differences may be behind the difficulty in finding invariance using SEM models. It is a question of the construct\'s nature, less related to analytical phenomena, and deserves deeper discussion.

The exploration of conceptual equivalence within the process of the cross-cultural adaptation of tools is usually neglected as it generally assumed that the theoretical construct of a tool is conceptualized in the same way in both the original and target culture. This article attempts to throw light on the contribution of the evaluation of conceptual equivalence to the process of adaptation, and for tool development. To illustrate this premise, the example of the cross-cultural adaptation of the Patients\' Perception of Feeling Known by their Nurses (PPFKN) Scale is presented.
An adapted version of the Sousa and Rojjanasrirat (Journal of Evaluation in Clinical Practice, 2011, 17(2), 268-274) guidelines was used to translate and culturally adapt the PPFKN Scale to Spanish language and culture. A qualitative descriptive study was added to the traditional process of translation and pilot study to explore the concept in the target culture and recognize conceptual equivalence.
Experts in the tool concept, bilingual translators and the author of the tool participated in the translation of the original tool into Spanish. A pilot study of the Spanish version with a sample of 44 patients and a panel of six experts from different fields evaluated its clarity and relevance. In addition, seven patients participated in a descriptive qualitative study using semi-structured individual interviews to explore the phenomenon in the new culture. A content analysis following the Miles, Huberman & Saldaña (Qualitative data analysis, a methods sourcebook, 2014) approach was used to analyze qualitative data.
The cross-cultural translation and adaptation of the PPFKN scale into Spanish required a thorough revision. More than half of the items needed discussions to reach consensus regarding the most appropriate Spanish term. In addition, the study confirmed the four attributes of the concept identified in the American context and allowed for new insights within those attributes to appear. Those aspects reflected characteristics of the phenomenon of being known in the Spanish context and were added to the tool in the format of 10 new items.
A comprehensive cross-cultural adaptation of tools should incorporate, together with the study of linguistic and semantic equivalence, the analysis of the conceptual equivalence of the phenomenon in both contexts. The identification, acknowledgment and study of the conceptual differences between two cultures in relation to a phenomenon becomes an opportunity for deeper study of the phenomenon in both cultures, for understanding of their richness and depth, and for the proposal of changes that may enhance the content validity of the tool.
The evaluation of conceptual equivalence of tools within the process of cross-cultural adaptation will make it possible for target cultures to rely on tools both theoretically sound and significant. Specifically, the cross-cultural adaptation of the PPFKN scale has facilitated the design of a Spanish version of the tool that is linguistically, semantically and theoretically congruent with Spanish culture. The PPFKN Scale is a powerful indicator that evidences nursing care contribution to the patient\'s experience.

Elder abuse is globally considered a hidden problem with great variations in its conceptualization across cultures, non-uniformity in understanding, and manifestations of abuse and neglect. Currently, there are no validated or culturally adapted screening measures for elder abuse in South Africa. The aim of this study was to test the cultural appropriateness of the Elder Abuse Screening Tool (EAST) and the Caregiver Abuse Screen (CASE) in two regions and four languages in South Africa. Using a cognitive interviewing methodology, 23 carers and 19 older adults were interviewed. Findings show that questions in the EAST and CASE are generally well understood, but that adaptations of both tools are necessary for use within South Africa. Fear, knowledge, and experience of crime also showed that strangers, like family, deliberately use deception to build trust and abuse. Further validation is needed to determine suitable scoring and use by health and social care practitioners.

Assessments of treatments for \'subjective symptoms\' are problematic and potentially contentious. These are symptoms without ascertainable pathophysiology, also referred to as \'medically unexplained.\' Treatments of them may be assessed from different perspectives, and an assessment as seen from one perspective may be discrepant with an assessment as seen from another perspective. The observational study described in the paper represents one perspective. Patients in the study were treated with acupuncture for the subjective symptom of low back pain in a Traditional Chinese Medicine Clinic in China; acupuncture is a form of TCM, which is indigenous to China. Shortly after treatment began and six months afterward, patients reported \'clinically important improvements\' on a variety of standard, cross-culturally validated outcome measures, including pain intensity, physical functioning, and emotional functioning; this assessment is consistent with numerous assessments of acupuncture in China and other Southeastern Asian countries. On the other hand, clinical trials represent another perspective from which to assess acupuncture. Although assessments based on trials are not uniform, several assessments based on them, including those published in journals such as Lancet and New England Journal of Medicine, conclude that acupuncture is not effective. These trials, however, were mainly situated in the U.S., western European countries, and other WEIRD (Western, Educated, Industrialized, Rich, Democratic) countries. This is notable, because the population of China, the indigenous context of acupuncture, is greater than populations of WEIRD countries combined. Patients\' expectations of a treatment such as acupuncture and their prior familiarity with it vary among contexts, and patients\' experiences of treatment outcomes may vary accordingly. In short, although clinical trials constitute a test of truth in biomedicine and inform authoritative assessments in WEIRD countries, they do not necessarily represent the truth from the perspective of those experiencing outcomes of especially indigenous treatments for subjective symptoms in non-WEIRD contexts.

The chronic illness trajectory and its outcomes are well explained by the concept of illness identity; the extent to which ill individuals have integrated their diagnosed chronic illness into their identity or sense of self. The capacity to measure illness identity in people living with HIV (PLHIV) is still relatively unexplored. However, this is potentially useful to help us understand how outcomes for PLHIV could be improved and sustained. This paper aims to explore the cross-cultural adaptation of a Belgian developed Illness Identity Questionnaire (IIQ) and validate the instrument using a sample of South African adults living with HIV. We followed a phased scale adaptation and validation process which included an investigation of conceptual, item, semantic and operational equivalence and also examined the psychometric properties of the IIQ. The concept of illness identity with its four factors; engulfment, rejection, acceptance and enrichment in PLHIV, was found to be relevant within this context. Five items from the original IIQ were excluded from the adapted IIQ due to either semantic insufficiency and/or inadequate measurement equivalence. The mode of administration of the IIQ was changed to accommodate current study participants. The original four factor 25-item model did not fit current data, however, a better contextualized, four-factor, 20-item model was identified and found valid in the current setting. The results showed adequate statistical fit; χ2/d.f. = 1.516, RMSEA = 0.076, SRMR = 0.0893, and CFI = 0.909. Convergent and discriminant validity were also tenable. The cross-cultural adaptation and validation of the IIQ was successful, resulting in the availability of an instrument capable of measuring illness identity in PLHIV in a high HIV prevalence and resource-constrained setting. This therefore addresses the paucity of information and expands on knowledge about illness identity.

People differ in their personal commitment to fighting climate change and protecting the environment. The question is, can we validly measure people\'s commitment by what they say and what they claim they do in opinion polls? In our research, we demonstrate that opinions and reports of past behavior can be aggregated into comparable depictions of people\'s personal commitment to fighting climate change and protecting the environment (i.e., their environmental attitudes). In contrast to the commonly used operational scaling approaches, we ground our measure of people\'s environmental attitudes in a mathematically formalized psychological theory of the response process-the Campbell paradigm. This theory of the response process has already been extensively validated, and its relevance for manifest behavior has repeatedly been shown as well. In our secondary analysis of Eurobarometer data (N = 27,998) from 28 European countries, we apply the Campbell paradigm to a set of indicators that was not originally collected to be aggregated into a single scale. With our research, we propose a distinct way to measure behavior-relevant environmental attitudes that can be used even with a set of indicators that was originally atheoretically compiled. Overall, our study suggests that the Campbell paradigm provides a sound psychological measurement theory that can be applied to cross-cultural comparisons in the environmental protection domain.

Grounded by the ecological systems perspectives proposed by Bronfenbrenner (1977, 1979) and Fivush and Merrill (2016), the present study was conducted to examine whether autobiographical memory (AM) and self-construal differed in young adults raised in the same macrosystem, but with unique microsystems. European American (EA) participants were born in the United States to mothers who were born in the United States (n = 61) and Chinese American (CA) participants were born in the United States to mothers who were born in China (n = 47). Participants completed an online study in which they reported on and rated aspects of their earliest memory; they also completed measures of self-construal and acculturation. EA participants identified more with mainstream American culture relative to CA participants, who identified to a greater extent with their heritage culture. EA participants also talked and thought more about their earliest memories relative to CA participants; interactions between group and sex were found for social words. Group differences were not observed on measures of self-construal. These findings indicate that microsystem-level factors are associated with differences in AM in young adults even when individuals are born and raised in the same macro-level cultural environment.

Complex dissociative disorders (CDD) include dissociative identity disorder (DID) and the most common other specified dissociative disorder (OSDD, type 1). While consensus-based treatments for CDD are lacking in several international guidelines, patients suffering from CDD show high levels of impairment, treatment utilization and costs. Migrants and refugees often present risk factors for trauma-related and dissociative disorders and need effective and culturally adapted treatments. Schema Therapy (ST) is an integrative psychotherapy that has been recently proposed as a treatment for CDD. This case study examined the process of individual ST, in a three phases-based approach, with a 38-year-old male Yemeni refugee with OSDD, type 1, posttraumatic stress disorder and borderline personality disorder. The treatment was provided in a Western country and the setting included two Western therapists (co-therapy) and an Arabic interpreter/cultural mediator. We assessed the patient\'s change by using self-report assessments of dissociative and PTSD symptoms, cognitive schemas over 2-year and 4-months treatment periods and a 6-months follow-up. Posttreatment and follow-up reliable change analyses showed significant improvements in dissociative and PTSD symptoms as well as in some cognitive schemas. Despite any firm conclusion cannot be drawn due to the limitations of this study (i.e., single case study), the findings suggest that ST integrated in a phase-oriented approach may be an effective treatment for CDD. Additionally, our study provides some preliminary elements about cross-cultural validity of the schema modes construct as well as cross-cultural effectiveness of ST. More research based on larger samples and specific cross-cultural focused design is needed to confirm these assumptions.

Objective This study is a comprehensive approach to psychic conflicts encountered by young women confronted with divergent cultural models. It relates the tensions experienced by Renuka, Tamil born in France, in her marital choices between cultural verticality and interbreeding. Method Renuka\'s matrimonial journey is explored through in-depth semi-structured interviews analyzed using Devereux\'s complementarist method. Results In a multicultural space, there is a difficulty of positioning. Marital choices reveal intrapsychic tensions that can be overcome by mobilizing strategies, processes and mechanisms articulating identificatory models. Conclusion This study explores the issues of marriage in a migratory context and its effects on the psychic life of individuals and relates the major issues of our mixed societies.