In this issue of Journal of Neuroscience Nursing, Zehirlioglu and colleagues1 report the findings of the psychometric testing of the Turkish version of Motivation for Changing Lifestyle and Health Behavior for Reducing the Risk of Dementia (MCLHB-DRR) scale. The article is an excellent example of the procedures that are necessary when translating a scale to a new language including psychometric testing involved.
Study Purpose
The purpose of the study was to test the validity and reliability of the Turkish version of the MCLHB-DRR scale.
Significance
Dementia is a growing problem among the aging population in Turkey, with no modifying treatment available at this time. Prevention of dementia is possible with a healthy lifestyle, but no study in Turkey has examined the levels of knowledge and behavioral tendencies for the purpose of reducing the risk of dementia. Furthermore, there is no tool that can be used to measure the awareness, beliefs, attitudes, and motivation with regard to changing lifestyle to prevent dementia.
Methods
The participants (N = 220) were 40 years or older recruited from a primary clinic using convenience sampling. The participants were literates, spoke and understood Turkish, and agreed to participate voluntarily in the study. Individuals with dementia or psychiatric disorders, and visual and/or hearing impairments were excluded from the study.
The Scale
The MCLHB-DRR, which was designed to evaluate beliefs and attitudes concerning lifestyle and behavioral changes in dementia, was developed in Australia. The scale has 27 items, with 7 subscales including perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, general health motivation, and self-efficacy. The items are rated on a 5-point Likert scale (1, strongly disagree; 5, strongly agree), and the total score ranges from 27 to 135. Higher score indicates high motivation to change lifestyle and health behaviors to reduce the risk of dementia.
Development of the Turkish Version of MCLHB-DRR
The scale was translated from English to Turkish and back-translated. Clarity was ensured by comparing the original version with the translated version and consulting with the author of the original version about items that were unclear.
Content validity was confirmed by experts in psychometric analysis and dementia care. The experts' opinions regarding scale-level content validity (S-CVI) and item-level content validity index (I-CVI) were ranked using Davis Technique.
After administering the MCLHB-DRR scale to 34 individuals, within 2 to 3 weeks, the individuals were reevaluated to assess the test-retest reliability. The internal consistency reliability was evaluated using a paired t test. After language and content validity was confirmed, a pilot study was conducted with 20 individuals.
Statistical Analysis
The level of concordance of these rankings was analyzed using a nonparametric Kendall W analysis. To assess for construct validity, confirmatory factor analysis was used, and Pearson [chi]2, degree of freedom, root mean square error of approximation, goodness-of-fit index, comparative fit index, and normal fit index were used for analysis purposes. The Cronbach [alpha] value was calculated for reliability analysis.
Results
The mean (SD) age of 220 individuals who participated in the study was 57.64 (12.02) years. Most of them were married (75%), women (69.5%), and retired or unemployed (62.7%); 63.6% reported their income to equal to their expenses, 69.6% were living with their spouse and children, and 51.8% were living with at least 1 chronic disease.
There were no significant differences between scores given by experts for each item: Kendall W = 0.223, P = .06. The lower limit of acceptability for a CVI is 0.80; an I-CVI of 0.78 or higher and an S-CVI of 0.90 or higher are the minimum acceptable indices. The CVI of the MCLHB-DRR Turkish version was 0.99, the I-CVIs for the 27 items were between the ranges of 0.88 and 1, the S-CVI for 6 subscales was 1.0, and it was 0.97 for perceived barriers. The confirmatory factor analysis results showed that factor loads were greater than 0.30 and that the data were consistent with the model and confirmed the factor structure. The Cronbach [alpha] coefficient was .80 (higher than the acceptable .60) and indicates that the scale has high reliability. The test-retest scores showed a significant correlation (P < .05), and the test-retest reliability that should be at least 0.20 also was positive and greater than 0.20 (P < .05).
Implications
The key indicators of the quality of an instrument are the reliability and validity of the measures. The quality of research depends on use of valid and reliable measures. The psychometric results of this study show that the translated version of the MCLHB-DRR scale is a valid, reliable, and suitable tool for use among individuals 40 years and older in Turkey. Thus, the MCLHB-DRR Turkish scale can serve as an instrument that researchers can use to determine individuals' level of motivation and engagement in appropriate healthy lifestyle behaviors in Turkey.
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