Cross-Cultural Adaptation and Reliability Testing of Chinese Version of the Living with Medicines Questionnaire in Elderly Patients with Chronic Diseases

Abstract

Background

The Living with Medicines Questionnaire (LMQ-3) is a reliable, valid instrument used to assess the medication-related burden of patients with chronic disease using long-term medication, but it has not been used in China.

Purpose

To translate and cross-culturally adapt the LMQ-3 into Chinese and assess its reliability and validity among elderly patients with chronic disease.

Methods

After translation and back-translation, views from an expert group and cognitive interviews with elderly persons using multiple medicines were used to ensure the cultural relevance of the LMQ-3. Then, 412 participants aged 60–92 years were recruited from three communities in Zhengzhou to complete the instrument. Item analysis, internal consistency, content validity, exploratory factor analysis (EFA) and reliability testing were performed.

Results

Item analysis identified nine items for possible removal, which were discussed with the originating team. Internal consistency testing confirmed the suitability of removing two of these items, which concurred with the views of the expert group and cognitive interviews. All other items were retained, but four were modified for clarification without changing their meaning, resulting in a 39-item instrument. EFA of this 39-item measure yielded an eight-factor model, similar to the English version. Cronbach’s alpha of the Chinese version of LMQ-3 (C-LMQ-3) for elderly patients with chronic diseases was 0.855, and alpha values for the eight domains ranged from 0.822 to 0.932. Test–retest reliability was satisfactory, with ICC values for the eight domain scores ranging from 0.751 to 0.881.

Conclusion

With only minor modifications compared to the English version, the 39-item C-LMQ-3 is a valid tool, with adequate reliability, which can be used to assess the medication-related burden of long-term use of multiple medicines in elderly patients in China.

Keywords:

• reliability
• cultural adaptation
• medicine burden
• patient-reported outcome
• multi-morbidity
• Living with Medicines Questionnaire

Acknowledgments

We would like to thank all participants, researchers, experts and community workers for their contributions to this work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This study was funded by Science and Technology Department of Henan Province (no. 182102310198), and the General Research Project of Humanities and Social Sciences of Henan Provincial Department of Education (no. 2018-ZZJH-547).