Assessing local instrument validity and reliability: a field-based example from Northern Uganda

Dept. of Population and International Health, François-Xavier Bagnoud Center for Health and Human Rights, Harvard School of Public Health, Boston, MA 02115, USA.
Social Psychiatry (Impact Factor: 2.54). 02/2009; 44(8):685-92. DOI: 10.1007/s00127-008-0475-1
Source: PubMed


This paper presents an approach for evaluating the reliability and validity of mental health measures in non-Western field settings. We describe this approach using the example of our development of the Acholi psychosocial assessment instrument (APAI), which is designed to assess depression-like (two tam, par and kumu), anxiety-like (ma lwor) and conduct problems (kwo maraco) among war-affected adolescents in northern Uganda. To examine the criterion validity of this measure in the absence of a traditional gold standard, we derived local syndrome terms from qualitative data and used self reports of these syndromes by indigenous people as a reference point for determining caseness. Reliability was examined using standard test-retest and inter-rater methods. Each of the subscale scores for the depression-like syndromes exhibited strong internal reliability ranging from alpha = 0.84-0.87. Internal reliability was good for anxiety (0.70), conduct problems (0.83), and the pro-social attitudes and behaviors (0.70) subscales. Combined inter-rater reliability and test-retest reliability were good for most subscales except for the conduct problem scale and prosocial scales. The pattern of significant mean differences in the corresponding APAI problem scale score between self-reported cases vs. noncases on local syndrome terms was confirmed in the data for all of the three depression-like syndromes, but not for the anxiety-like syndrome ma lwor or the conduct problem kwo maraco.

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Available from: Ivelina Borisova, Jun 23, 2014
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    • "Depression/anxiety is a subscale of the Acholi Psychosocial Assessment Instrument (APAI). APAI is a 40-item field-based self-report questionnaire previously developed for use in Northern Uganda [41]. The measure comprises: depression/anxiety, conduct problems, pro-social behaviours, and somatic complaints without medical cause. "
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    • "Although the field of humanitarian psychology is new and research in this field is less than 20 years old, fortunately, progress has been made in designed measures based on indigenous idioms of psychological distress. For example, the African Youth Psychosocial Assessment Instrument (Betancourt et al., 2009) is a 40-item measure developed in northern Uganda after extensive qualitative consultation with the youth, caregivers, and mental health workers. It is the only African-developed, validated questionnaire of internalizing and externalizing behavior and contains symptoms of distress, which do not appear in " Western-developed " measures (e.g., muttering to oneself, not following the rules of the community, sitting with your head in your hand, feeling pain in your heart, believing people are chasing you). "
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