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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    • "The instrument used in this study is a modified version of African Youth Psychosocial Assessment Instrument . APAI is a field-based measure with very good psychometric properties previously developed and used in Northern Uganda[35,36]. Stigma and community relations were used with similar populations in Sierra Leone (West Africa)[37]. "
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    ABSTRACT: Background: Although sexual violence in war is associated with long-term mental health problems, little is known about its association with general functioning and the factors that explain this association. This study aims to illuminate the path from sexual violence to poor functioning. The prevalence of sexual violence among formerly abducted girls in Northern Uganda was assessed as well as the extent to which stigma and community relations explain the association between sexual violence and general functioning. Method: In a cross-sectional analysis using data from the WAYS study (N = 210, baseline age 22.06, SD = 2.06, minimum-maximum 18-25), the extent of mediation of the association between sexual violence and general functioning was assessed in multiple regression models. Results: Sexual violence was found to be associated with increased stigma, poor community relations, and poor general functioning. The association between sexual violence and general functioning was mediated by stigma and community relations. The bootstrap results indicated significant mediation by stigma of 47 % (95 % confidence interval [CI] 35 to 78 % and by community relations of 67 % (95 % CI: 52 to 78 %) in the association between sexual violence and general functioning. Conclusion: Thus, poor functioning among formerly abducted girls is largely mediated by stigma and poor community relations. However, due to the relatively small effect sizes of the associations, targeted interventions to prevent impaired functioning may have only modest benefits to the formerly abducted girls. Interventions to alleviate the toxic effects of sexual violence in formerly abducted girls would benefit from a holistic approach that targets stigma and poor relationships within communities.
    Full-text · Article · Dec 2015 · BMC Public Health
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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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    ABSTRACT: Background Globally, suicide is a public health burden especially in the aftermath of war. Understanding the processes that define the path from previous war experiences (WE) to current suicidal ideation (SI) is crucial for defining opportunities for interventions. We assessed the extent to which different types of previous WE predict current SI and whether post-war hardships and depression mediate the relations between WE and SI among former child soldiers (FCS) in Northern Uganda.Methods We performed cross-sectional analyses with a sample of 539 FCS (61% male) participating in an on-going longitudinal study. The influence of various types of previous WE on current SI and mediation by post-war hardships and depression were assessed by regression analyses.ResultsThe following types of war experiences: ¿witnessing violence¿, ¿direct personal harm¿, ¿deaths¿, ¿Involvement in hostilities¿, ¿sexual abuse¿ and ¿general war experiences¿ significantly predicted current SI in a univariable analyses whereas ¿direct personal harm¿, ¿involvement in hostilities¿, and ¿sexual abuse¿ independently predicted current SI in a multivariable analyses. General WE were linked to SI (ß¿=¿0.18 (95% CI 0.10 to 0.25)) through post-war hardships (accounting for 69% of the variance in their relationship) and through depression/anxiety (ß¿=¿0.18 (95% CI 0.10 to 0.25)) accounting for 65% of the variance in their relationship. The direct relationship between previous WE and current SI reduced but remained marginally significant (ß¿=¿.08, CI: (.01, .17) for depression/anxiety but not for post-war hardships (ß¿=¿.09, CI: (¿.03, .20).Conclusion Types of WE should be examined when assessing risks for SI. Interventions to reduce SI should aim to alleviate post-war hardships and treat depression/anxiety.
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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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