Validation of the Arabic Version of the European Community Respiratory Health Survey Screening Questionnaire

Abstract

Purpose

The European Community Respiratory Health Survey (ECRHS) questionnaire has been widely used in epidemiological studies to quantify respiratory symptoms and screen for asthma, but there is no formally validated Arabic version. This study developed an Arabic ECRHS screening questionnaire, comprehensively evaluated its reliability and validity, and used it to estimate the population prevalence of respiratory symptoms and asthma in Saudi Arabia.

Methods

The ECRHS screening questionnaire was adapted to Arabic through translation and back-translation by bilinguals with consultation to a professional committee and lay panel. Reliability and validity were evaluated in a prospective, cross-sectional convenience sample of adults (>18 years) between January and July 2022 in Riyadh, Saudi Arabia. A subgroup completed the questionnaire again three weeks later to assess test–retest reliability. All respiratory symptom-positive participants were invited for spirometry to diagnose asthma according to GINA criteria. Internal consistency was assessed using Cronbach’s α coefficient, test–retest reliability with Cohen κ coefficients, and reliability by calculating the sensitivity and specificity for diagnosing asthma.

Results

Of 2500 invited individuals, 1881 participated (75.2%). A total of 668 (35.5%) participants reported respiratory symptoms according to the ECRHS questionnaire, and 157/1881 (8.3%) had a current diagnosis of asthma on ECRHS questions. Cronbach’s α coefficient for internal consistency was 0.831, “good” internal consistency. The test–retest reliability (n = 303) was “excellent” for all questions (Cohen’s κ≥0.75). A total of 543 (81.3%) screening-positive participants underwent spirometry, of whom 278 (52%) were diagnosed with asthma according to GINA guidelines, an overall estimated prevalence of 14.8%. Most questions showed good-to-fair specificity and variable sensitivity for physician-diagnosed asthma.

Conclusion

This Arabic version of the ECRHS screening questionnaire is conceptually similar to the English version, comprehensible, and reliable. Many asthma cases remain hidden and undiagnosed. In addition to utility in epidemiological studies, the ECRHS screening questionnaire might be a simple, quick, and useful tool for asthma case finding.

Keywords:

• Arabic
• asthma
• European Community Respiratory Health Survey
• reliability
• validity

Data Sharing Statement

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

Ethics Approval and Consent to Participate

The ethical approval of this study was granted from Imam Mohammad Ibn Saud Islamic University, (HAPO-01-R-011). The consent was obtained from each participant.

Acknowledgments

The author extends his appreciation to the Deanship of Scientific Research, Imam Mohammad Ibn Saud Islamic University (IMSIU), Saudi Arabia, for funding this research work through Grant No. (221413002).

Author Contributions

Saad Mohammed AlShareef made significant contributions to the work reported and was involved in the conception, study design, execution, acquisition of data, and analysis and interpretation; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; he agreed on the journal to which the article has been submitted and agreed to be accountable for all aspects of the work.

Disclosure

The author declares that they have no competing interests.

Additional information

Funding

This study was funded by Imam Mohammad Ibn Saud Islamic University (IMSIU) with grant No. (221413002).