MATRICSCT CrossCultural Adaptation of Intermediate Measures

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MATRICS-CT Cross-Cultural Adaptation of
Intermediate Measures
The MATRICS Cross-Cultural Subcommittee

• D. Velligan UTHSCSA
• S. Dube Lilly
• E. Stover NIMH
• D. Mayo NIMH
• N. Schooler SUNY Downstate Med Ctr

• K. Nuechterlein UCLA
• S. Talbot BMS
• R. Buller Lundbeck
• N. Peters sanofi-aventis
• J. Jaeger Astra Zeneca
• M. Frederick UTHSCSA
• M. Rubin - UTSA

No longer on committee
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Cross-Cultural Adaptation of MATRICS-CTCultural
Subcommittee

• Devise a method to examine the cross-cultural
  applicability of the intermediate measures of
  functional outcome being examined in the VIM
  study (UPSA, ILS, TABS, CAI)
• Using that method, determine which intermediate
  measures determined by VIM to have good
  psychometric properties could be appropriately
  administered across cultures
• Identify the specific issues and problems in
  cross-cultural adaptation of each measure
  selected by VIM

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Cross-Cultural Adaptation Rating Scale (C-CARS)

• 10-item scale
• first 9 items have to do with general
  acceptability of items or sections for typical
  patients in each country as well as for specific
  subgroups based upon gender, SES, and rural/urban
  residence
• Tenth item regards how easy the scale would be to
  alter to fix the problems identified

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Cross-Cultural Adaptation Rating Scale (C-CARS)

• Raters examined the format and content of each
  VIM measure item/section
• Each rating is a composite reflecting the how
  comfortable individuals in the culture would be
  with the test section, how familiar they would be
  with the content and structure of the section and
  how appropriate the section would be for the
  culture or subgroup
• Scores on the C-CARS range from 1-7 with lower
  scores indicating poorer adaptability to the
  culture

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Example C-CARS Item
2. Rate the extent to which the section/item
would work in in your country with typical
patients
1
2
3
4
5
6
7
Doesnt Work At all
Works Extremely Well
Comment (If you gave a rating of 4 or lower)
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Cultural Adaptation of Intermediate Measures
CIM-Study

• Goal was to have 31 sites participate each with
  a bilingual PI and at least one bilingual
  research assistant.
• More sites (n5) were recruited from
  less-westernized countries Fewer (n2) from more
  westernized countries
• Specific countries were chosen based upon
  languages for MCCB translation Germany Russia,
  India, China, Spain, Argentina, and Mexico. U.S.
  sites were included for baseline comparison
• All data was sent to the coordinating site
  (UTHSCSA) for entry and subsequent analysis

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Instructions to participating sites

• Review the manual and all test materials for the
  measure
• Watch the administration video
• Practice giving the measure to one another
• Make rating on the C-CARS

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Total number of raters per countryTotal n55
planned n62
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Do the measures work across all countries?
Mean of C-CARS items 1-9 Scores collapsed
across all ex U.S. countries
all means LSMs All measures in the
acceptable range overall
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Do the measures work across subgroups?
C-CARS 1-9 Collapsing across all EX-US
countries
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How well does the UPSA work in individual
countries?
7
6.01
6
5.89
5.98
5.67
5.5
5
5.1
4.73
C-CARS Score
4.34
4
3
Spain
Germany
Mexico
Argentina
US
Russia
China
India
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How well do the Brief Measures do in the
individual countries?
7
6.17
6.07
5.79
6
5.53
6.14
5.55
5.15
5.04
5.79
5.64
4.60
5
C-CARS Score
5.35
5.00
4.79
4.71
4
3.99
UPSA TABS
3
Spain
Mexico
Germany
Argentina
US
India
Russia
China
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How easy would it be to adapt the scale to work?

• Results mirrored data on how well the scales
  worked. In countries in which the scales dont
  work well, the raters were more skeptical that
  problems could be addressed.

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Are there specific sub-tests that do better than
others across cultures?
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Are there individual subtests that do not work
well in some countries?-UPSA
7
6
Finance
Communication
C-CARS Score
5
Org/Planning
Transportation
Household Management
4
3
Spain
Mexico
Germany
Argentina
India
China
Russia
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Are there individual subtests that do not work
well in some countries?-UPSA

• The Full UPSA may be less culturally relevant in
  China, India and Mexico than other countries.
• The subtest with the most consist performance
  across countries was Household Management
• Four of the six subtests fail to make the cut off
  of 5 or higher in at least two countries

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UPSA Transportation
Subject required to look at bus schedules and
maps and plan use of public transportation.
C-CARS Comments

• Buses too frequent in urban areas task too easy
• Bus schedules are unusual, maps not usually
  available and are not familiar to the culture.
• Difficulties to interpret maps, not part of the
  culture regardless of gender or SES.
• The public traffic system in rural areas is not
  good, there aren't many buses so a bus schedule
  for them is strange.
• The bus schedule should be simpler to suit for
  Chinese people.

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UPSA- Organization and Planning
Subject is asked to read an article about the
opening of a new Water Theme Park and to identify
opening and closing times, activities they could
do, and 7 things they may really need to bring or
wear if they were going to spend the day.
GRAND OPENING OF NEW WATER PARK! Wild Water is
the states newest and largest water theme park
with

• C-CARS comments
• The theme is not usual, may be difficult to
  identify with this
• form of recreation.
• Respondents are not familiar with parks and
  recreation like this.

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UPSA-Household Management
Patients are provided with a recipe for rice
dessert and an array of items available in their
pantry. The must read the recipe, check the
pantry, and then prepare a list of the items
needed to make the dessert.
C-CARS Comments

• In China, few people make dessert, usually they
  aren't familiar with dessert. We never prepare
  the rice dessert like described.
• Reading instructions, having a pantry at home and
  buying items for a recipe is an unfamiliar
  situation in rural, poor and minority
  communities.
• Men are less involved in cooking and may find it
  difficult to look for unfamiliar ingredients
  included in this recipe.
• Some males don't cook in China.

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Are there individual subtests that do not work
well in some countries?-UPSA-Brief
7
6.42
5.88
6.28
5.87
6
5.17
5.06
5.92
4.73
5.63
C-CARS Score
5
3.83
4.83
4.75
4.7
4
Finances Communication
3.76
3
Spain
Mexico
Argentina
Germany
China
Russia
India
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UPSA Brief Subtest Description-Finance
Subject must count money, make change and pay a
mock bill from an Electric Company
Franklin Gas and Electric Company Previous
Payments Current New Balance
Received Payments Balance
C-CARS Comments

• Large portion of the population don't have access
  to the services provided by a corporation.
• People living in remote rural areas may not have
  regular bills or have shared bills.
• We don't have quarters but we have half dollar
  coins.
• This is not a typical bill format.
• Switch the money to Euros.
• Payments are made in cash respondents would not
  be familiar with the concept of getting a bill in
  the mail.

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UPSA Brief Communication
101 FIRST AVE., STE 8 FAIRVIEW, BT
84162 Appointment Scheduled for You are
scheduled to have a blood draw at this
appointment DO NOT EAT ANY FOOD OR DRINK
Please remember to bring with you the
following

• C-CARS comments
• We don't have medical
• appointment letter (reminder card)
• or voicemail
• Different numbers for emergency
• and directory assistance
• Most people dont make
• appointments walk-in service
• Most dont have insurance cards
• Access to telephone and
• answering machines is limited

MPMG
Subject is asked to read the letter, call the
correct number, give the correct information to
reschedule and remember what to bring after the
letter is concealed.
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Are there individual subtests that do not work
well in some countries?-TABS Brief
7
7
6.67
6.75
6.38
6.22
6
5.82
5.53
5.46
C-CARS Score
5
4.68
4.47
4.39
4.49
4
3.5
3.43
3
Spain
Argentina
Mexico
Germany
Russia
China
India
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Medication Management
Subjects must fill a pill container for weekly
use, identify that there are not enough
antipsychotic pills, demonstrate how to refill
the prescription, and remember to call back the
pharmacy
C-CARS comments

• In Argentina patients need to call the doctor,
  not the pharmacy.
• Refills don't exist
• Medications in Germany are supplied in branded
  blisters and are not dispensed
• individually-labeled by the pharmacy.
• Not too many people use medicine containers
  outside geriatric institutions.
• There are no prescription numbers and no
  telephone number on bottles in China.

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Work and Productivity
The subject must organize the tasks, Identify
that some handouts are upside down, or reversed,
and must Make packets to be mailed out.
C-CARS comments Uncommon for rural dwellers
literacy may be an issue for some. Higher SES
would be reluctant to do such a simple task. In
Russia, males might be less accurate and precise
with such a task.
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Results and Conclusions

• All tested measures collapsed across countries
  and subscales meet the cutoff selected on the
  C-CARS
• Some subscales work better than others across
  countries. Scales may not be measuring the same
  thing across countries.

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Results and Conclusions, Continued

• China, India, and Mexico are countries where the
  scales were rated lowest on adaptability.
• These countries may need specialized adaptations
  for use in clinical trials
• Alternatively, trials could be planned in
  countries where adaptation is easier

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Results and Conclusions Continued

• Neither the Brief UPSA nor the Brief TABS include
  the subscales rated highest for adaptability to
  other cultures.
• It may be possible to suggest alternative brief
  scales by examining the psychometric properties
  of other subscale combinations.