JMIR Publications

ABSTRACT

Background:

Modification is an important process to adapt an instrument to be used for another culture. However, how to modify an instrument to be appropriately used in another culture was not fully understand.

Objective:

This study aims to synthesize the modification strategies used in the cross-cultural adaptation process for instruments measuring health beliefs about cancer screening.

Methods:

A systematic review design was used for conducting this study. Key words including constructs about instrument modification, health belief, and cancer screening were searched in the databases of PubMed, Google scholar, CINAHL®, and PsycINFO. Bowling's checklist was used to evaluate methodological rigor of the included articles. Results were reported using the PRISMA approach with a narrative method.

Results:

A total of 1,312 articles were initially identified in the databases. After removing duplications and assessing titles, abstracts and texts of the articles, 18 studies met the inclusion criteria in the study. The modification strategies used in the cross-cultural instrument adaptation process generally had two levels and three types. The two levels of modification were scale level and item level (which consisted of modification on the question statement and response options). The three types of modification were changing, deleting and expanding, which specifically included 1) changing wordings, 2) deleting redundant or irrelevant content, and 3) expanding the original instrument. Debate solution strategies used in the instrument modification process were 1) consultation with experts or literature search, 2) following the majority, and 3) consultation with the author who developed the scales.

Conclusions:

This study provides guidance for researchers who want to modify an instrument to be used in another culture. It can potentially help cross-cultural researchers get insight into modification strategies and have a better understanding of the modification process in cross-cultural instrument adaptation. More research could be done to help researchers better modify cross-cultural instruments.