Validation and Cultural Adaptation of the Sinhala Translation of the Cardiff Acne Disability Index (CADI)

Abstract

Introduction

Quality of life (QoL) is impaired in patients with acne vulgaris. The Cardiff Acne Disability Index (CADI) that assesses QoL of acne patients was initially developed in English and is being currently used widely after being validated in different languages. This study was conducted to validate the CADI in Sinhala, a language used by the majority of Sri Lanka.

Materials and Methods

The CADI was translated into Sinhala, and lingually validated as per published guidelines. This CADI-Sinhala version and the Sinhala version of the Dermatology Life Quality Index (DLQI) were simultaneously administered to 150 Sinhala-speaking young adults with acne. The clinical severity of acne was assessed using the Global Acne Grading System (GAGS). The Cronbach’s alpha and Spearman correlation coefficients were used to determine the internal consistency, reliability, and validity of the CADI-Sinhala. Construct validity was examined using a factor analysis.

Results

The study included 90% females and their mean age was 23 (SD, 2.5) years. The majority (97.3%) had acne of mild to moderate severity when measured by the GAGS. The CADI-Sinhala Scale showed a Cronbach’s alpha coefficient of 0.819 indicating high internal consistency and reliability. The mean item-total correlation coefficient was 0.74 (range, 0.42–0.87) with CADI Q3 having the lowest correlation. CADI Sinhala showed a strong and highly significant correlation with the Sinhala DLQI (Spearman’s rho = 0.66; P< 0.001) indicating concurrent validity. The correlation with GAGS was of low intensity, although it was statistically significant (p < 0.01).

Conclusion

The CADI-Sinhala is a reliable and valid tool for assessing the QoL of Sinhala-speaking acne patients. This five-item tool will help clinicians to provide holistic treatment through improved understanding of patient’s perspectives.

Keywords:

• acne vulgaris
• Cardiff acne disability index-Sinhala
• validation
• quality of life

Abbreviations

CADI, Cardiff Acne Disability Index; DLQI, Dermatology life quality index; GAGS, Global acne grading system; QoL, Quality of life; SD, Standard deviation; SPSS, Statistical Package for Social Sciences.

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.

Ethics Approval and Consent to Participate

The study was performed in accordance with the principles of the Declaration of Helsinki and was approved by the Ethics Review Committee of the Faculty of Medical Sciences, Sri Jayewardenepura University, Nugegoda, Sri Lanka (ERC 45/22, 30.1.23).

Acknowledgments

We thank Professor Andrew Finlay and Dr. Faraz Mahmood Ali of Medical School at Cardiff University, United Kingdom, for permission to use CADI and for assistance in revising the back-translation respectively.

Author Contributions

All authors made a significant contribution to all areas of the study, including conception, study design, execution, acquisition of data, analysis and interpretation; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was financially supported by a grant received by Jennifer Perera from the Research & Development Centre, Link Natural Products (Pvt.) Limited, Dompe, Sri Lanka. (Grant No. 22/02).