Psychometric properties of the Kannada version of the International Outcome Inventory for Hearing Aids (IOI-HA)

Figures & data

Table 1. Demographic and audiological details of the study participants.

N	105
Age in years (Mean ± SD)	59.1 ± 16.9
Gender (in %)
Male	70.5
Female	29.5
Education (in %)
Primary	5.7
Secondary	30.5
Tertiary	63.8
Socio-economic status (in %)
Low income (<₹20,000/month)	39.0
Lower-middle (between ₹20,000 and 40,000/month)	41.0
Upper-middle income (₹40,000 and ₹80,000/month)	14.3
High income (>₹80,000/month)	5.7
Hearing status in right/left ear (in %)
Normal	1.9 / 2.9
Conductive hearing loss	3.8 / 3.8
Sensorineural hearing loss	55.2 / 54.3
Mixed hearing loss	39.1 / 39
Pure tone average (Mean ± SD in dB HL)
Right ear	63.1 ± 22.7
Left ear	61.3 ± 22.2
Duration of hearing loss in years (Mean ± SD in years)	8.9 ± 8.5
Hearing loss (in %)
Unilateral	3.8
Bilateral	96.2
Hearing aid usage (in %)
Unilateral	64.8
Bilateral	35.2

₹ = Indian Rupees, $1 USD = 75 Indian Rupee.

Table 2. Recommended quality criteria for acceptance of different psychometric properties analysed in the study.

Psychometric property	Recommended quality criteria for acceptance
Factor structure is the correlational relationship between several variables that are said to measure a particular construct.	Exploratory factor analysis was performed using Principal Component Analysis (PCA) with Varimax rotation. Factors were extracted based on eigenvalues identified in the Scree Plot, item factor loading (r > 0.40).
Internal consistency (reliability) refers to the extent to which questions in a (sub)scale are inter-correlated. This measure helps in identifying whether all the questions of a questionnaire are measuring the same construct.	Cronbach’s Alpha between ≥0.70 and ≤0.95 (Terwee et al. 2007).
Test-retest reliability (stability) refers to the extent to which the scores on repeated measures are close to each other (absolute measurement error). In the paper, test-retest reliability was assessed for two conditions, one is between original and translated questionnaire and the other is for the repeated measurement of the translated questionnaire with a time gap.	Intra-Class Correlation Coefficient (ICC) ≥ 0.70 for absolute agreement (Terwee et al. 2007).
Discriminant validity refers to the extent to which scores of questions on a particular questionnaire are related to the main construct but unrelated to each other. Inter-question correlations are used during this analysis.	Inter-question correlation (Spearman’s correlation coefficient) of 0.3–0.7 (Anastasi 1976).
Convergent (or construct) validity refers to the extent to which scores on a particular questionnaire relate to other questionnaires in a manner that is consistent with theoretically derived hypotheses concerning the concepts that are being measured. Another self-report questionnaire (i.e. the SAC) was applied in this study to assess convergent validity.	At least 75% of the priori hypotheses to be confirmed (Terwee et al. 2007). Hypothesis: A moderate negative correlation, i.e. Spearman’s correlation coefficients between −0.8 and 0.4, between IOI-HA and SAC. This suggests that higher hearing aid benefit results in fewer communication problems.
Floor and ceiling effects refer to the total number of respondents who achieved the lowest or highest possible score. Having a floor/ceiling effect reduces the sensitivity of any questionnaire and hence it is important to measure this effect.	≤15% of the respondents should achieve the highest or lowest possible scores (Terwee et al. 2007).

Figure 1. Distribution of responses for each IOI-HA item.

Table 3. Mean, median, standard deviation (SD), and interquartile range (IRQ) for IOI-HA questionnaire in Kannada along with norms from the western population reported by Cox, Alexander, and Beyer (2003).

IOI-HA Items	Norms for mild-mod hearing loss (Cox, Alexander, and Beyer 2003)	Current Study: Kannada 1st administration
	Mean ± SD	Mean ± SD	Median	IRQ
Daily use	4.5 ± 0.96	4.09 ± 0.91	4	2
Benefit	3.52 ± 1.08	3.13 ± 1.05	3	2
Residual activity limitation	3.19 ± 1.05	3.37 ± 0.87	3.5	1
Satisfaction	3.83 ± 1.17	3.23 ± 1.0	3	1.75
Residual participation restriction	3.38 ± 1.11	3.18 ± 1.09	3	2
Impact on others	3.38 ± 1.1	3.53 ± 1.03	4	1
Quality of life	3.68 ± 1.02	3.30 ± 0.87	3	1

Table 4. Results of principal components analysis for questionnaire.

Questions	Factor 1	Factor 2
1. Daily use	0.837	–0.275
2. Benefit	0.822	–0.210
3. Residual activity limitation	0.714	0.026
4. Satisfaction	0.700	0.166
5. Residual participation restriction	0.660	–0.231
6. Impact on others	0.582	0.472
7. Quality of life	–0.189	0.847
Percentage variance explained (61.8% in total)	46.14%	15.66%

Table 5. Spearman’s Correlation between IOI-HA items.

IOI-HA items	Use	Ben	RAL	Sat	RPR	Ioth	QoL
Use	1.0
Ben	0.54**	1.0
RAL	0.45**	0.47**	1.0
Sat	0.43**	0.77**	0.49**	1.0
RPR	−0.21*	−0.24*	−0.08	−0.2*	1.0
Ioth	0.28**	0.26*	0.37**	0.31**	0.041	1.0
QoL	0.29**	0.56**	0.28**	0.51**	−0.036	0.33**	10.0

Note: ** Indicates p-value ≤0.01; * indicates p-value ≤0.05; significance values adjusted for False Discovery Rate with alpha 0.05.

Figure 2. Frequency distribution of the Kannada IOI-HA total scores.

Table

No.	Question	Question content
1.	Think about how much you used your present hearing aid(s) over the past two weeks. On an average day, how many hours did you use the hearing aid(s)?	Daily Use (Use)
2.	Think about the situation where you most wanted to hear better, before you got your present hearing aid(s). Over the past two weeks, how much has the hearing aid helped in those situations?	Benefit (Ben)
3	Think again about the situation where you most wanted to hear better. When you use your present hearing aid(s), how much difficulty do you STILL have in that situation?	Residual Activity Limitation (RAL)
4	Considering everything, do you think your present hearing aid(s) is worth the trouble?	Satisfaction (Sat)
5	Over the past two weeks, with your present hearing aid(s), how much have your hearing difficulties affected the things you can do?	Residual Participation Restriction (RPR)
6	Over the past two weeks, with your present hearing aid(s), how much do you think other people were bothered by your hearing difficulties?	Impact on Others (Ioth)
7	Considering everything, how much has your present hearing aid(s) changed your enjoyment of life?	Quality of Life (QoL)

Terwee, C. B., S. D. Bot, M. R. de Boer, D. A. van der Windt, D. L. Knol, J. Dekker, L. M. Bouter, and H. C. de Vet. 2007. “Quality Criteria Were Proposed for Measurement Properties of Health Status Questionnaires.” Journal of Clinical Epidemiology 60 (1): 34–42. doi:https://doi.org/10.1016/j.jclinepi.2006.03.012.

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Anastasi, A. 1976. Psychological Testing (4th ed). New York: Macmillan Publishing.

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Cox, R. M., G. C. Alexander, and C. M. Beyer. 2003. “Norms for the International Outcome Inventory for Hearing Aids.” Journal of the American Academy of Audiology 14 (8): 403–413.

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