Cross-cultural adaptation of AD-8 into Amharic for operationalizing the detection of cognitive impairment in a primary care setting of Ethiopia

Background: Cross-Cultural adaptation of a cognitive screening instrument requires careful planning and its implementation is complex, expensive and time consuming. This study aims to cross culturally adapt AD8 using the WHO translation and adaptation process guidelines in preparation for the development of a mobile health based dementia screening app at the primary care center of Ethiopia. Methods The panel discussed forward and backward translated AD8 instrument items alongside with the original English version of AD8 and Lawshe’s CVR critical value to adapt them to the interim final and the reconciled Amharic versions of AD8 respectively. The reconciled Amharic version was pilot tested, a cognitive interview was conducted, and the results were analyzed and a summary report was generated to adapt it to the final Amharic version of AD8. Results The Lawshe’s CVR value was less than the expected CVR critical value (0.75) for all of the forward translated items of AD8 except for the ‘Question items # 3 &7’. The panel substituted words and/or phrases in the title, instructions and ‘Question items # 1 & 6’; and added ‘Radio’ to the Question item # 4. The Lawshe’s CVR value (1.0) was greater than the expected CVR critical value (0.75) for all of the backward translated instrument items of AD8. The internal reliability of the reconciled Amharic version of AD8 was very good with a Cronbach’s alpha value of 0.875. Cognitive interview study participants verbalized lived experiences to reason and explain the way the reconciled Amharic version of AD8 question items was understood. The reconciled Amharic version was adapted without any modification as the final Amharic version of AD8. Conclusion changes made, reasons for change, and a vote of consensus for each question item of AD8 was documented at every step of deliberations of the panel. The Amharic version of AD8 demonstrated a very good internal reliability with strong item correlation. The Amharic version of AD8 fulfills the perquisite for the development of mobile health based AD8 dementia screening at primary care settings of Ethiopia and aligns with the WHO task-shifting strategy of dementia screening.