Translation, adaptation and validation of "Community Integration Questionnaire"

Fraga-Maia, Helena Maria Silveira; Werneck, Guilherme; Dourado, Inês; Fernandes, Rita de Cássia Pereira; Brito, Luciara Leite

doi:10.1590/1413-81232015205.08312014

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Article • Ciênc. saúde coletiva 20 (5) • May 2015 • https://doi.org/10.1590/1413-81232015205.08312014 copy

Translation, adaptation and validation of "Community Integration Questionnaire"

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective:

To translate, adapt, and validate the "Community Integration Questionnaire (CIQ)," a tool that evaluates community integration after traumatic brain injury (TBI).

Methods:

A study of 61 TBI survivors was carried out. The appraisal of the measurement equivalence was based on a reliability assessment by estimating inter-rater agreement, item-scale correlation and internal consistency of CIQ scales, concurrent validity, and construct validity.

Results:

Inter-rater agreement ranged from substantial to almost perfect. The item-scale correlations were generally higher between the items and their respective domains, whereas the intra-class correlation coefficients were high for both the overall scale and the CIQ domains. The correlation between the CIQ and Disability Rating Scale (DRS), the Extended Glasgow Outcome Scale (GOSE), and the Rancho Los Amigos Level of Cognitive Functioning Scale (RLA) reached values considered satisfactory. However, the factor analysis generated four factors (dimensions) that did not correspond with the dimensional structure of the original tool.

Conclusion:

The resulting tool herein may be useful in globally assessing community integration after TBI in the Brazilian context, at least until new CIQ psychometric assessment studies are developed with larger samples.

Traumatic brain injury; Community integration; Questionnaires; Validity

		Glasgow Coma Scale (GCS)
Variables	Severe injury		Moderate injury		Mild injury		Total
	(GCS 3- 8)		(GCS 9- 13)		(GCS 14- 15)		Mean (SD)
	Mean (SD)		Mean (SD)		Mean (SD)

Sociodemographic characteristics
Age ^***	26.2 (7.4)		33.6 (11.6)		34.3 (11.8)		31.7 (11.1)
Monthly family income	963.1 (857.6)		776.5 (512.9)		906.0 (625.9)		886.7 (668.7)
Number of persons residing in the home	2.7 (1.6)		3.4 (2.3)		2.5 (1.9)		2.8 (1.9)
	n (%)		n (%)		n (%)		n (%)
Skin Color
Black	18	(100.0)	16	(94.1)	25	(96.2)	59	(96.7)
Not Black	0	(0.0)	1	(5.9)	1	(3.8)	2	(3.3)
Marital Status
Single/Separate/Divorced	12	(66.7)	9	(52.9)	16	(61.5)	37	(60.7)
Married/Stable relationship	6	(33.3)	8	(47.1)	10	(38.5)	24	(39.3)
Education Level
Low	13	(72.2)	12	(70.6)	16	(61.5)	41	(67.2)
Moderate	4	(22.2)	5	(29.4)	10	(38.5)	19	(31.2)
High	1	(5.6)	0	(0.0)	0	(0.0)	1	(1.6)
Clinical Characteristics
Somatic symptoms
Headaches
No	8	(44.4)	8	(47.1)	12	(46.1)	28	(45.9)
Yes	10 (55.6)		9	(52.9)	14	(53.9)	33	(54.1)
Dizziness
No	12	(66.7)	10	(58.8)	11	(42.3)	33	(54.1)
Yes	6	(33.6)	7	(41.2)	15	(57.7)	28	(45.9)
Cognitive symptoms
Memory difficulties^**
No	4	(22.2)	10	(58.8)	15	(57.7)	29	(47.5)
Yes	14	(77.8)	7	(41.2)	11	(42.3)	32	(52.5)
Impaired concentration
No	8	(50.0)	13	(76.5)	18	(69.2)	40	(65.6)
Yes	9	(50.0)	4	(23.5)	8	(30.8)	21	(34.4)
Emotional symptoms^**
Irritability
No	3	(16.7)	11	(64.7)	13	(50.0)	27	(44.3)
Yes	15	(83.3)	6	(35.3)	13	(50.0)	34	(55.7)
Changes in balance^**
No	6	(33.3)	11	(64.7)	18	(69.2)	35	(57.4)
Yes	12	(66.7)	6	(35.3)	8	(30.8)	26	(42.6)
Cognitive Levels Rancho Los Amigos (RLA)^*
Good recovery	9	(50.0)	15	(88.2)	24	(92.3)	48	(78.7)
Moderate disability	7	(38.9)	2	(11.8)	2	(7.7)	11	(18.0)
Severe disability	2	(11.1)	0	(0.0)	0	(0.0)	2	(3.3)
Functional capacity (DRS)^*
Absent functional impairment	9	(50.0)	15	(88.2)	23	(88.5)	47	(77.1)
Moderate functional impairment	6	(33.3)	2	(11.8)	2	(11.5)	11	(18.0)
Severe functional impairment	3	(16.7)	0	(0.0)	0	(0.0)	3	(4.9)
Functional capacity (GCS)^*
Good recovery	7	(38.9)	14	(82.4)	22	(84.6)	43	(70.5)
Moderate disability	8	(44.4)	3	(17.6)	4	(15.4)	15	(24.6)
Severe disability	3	(16.7)	0	(0.0)	0	(0.0)	3	(4.9)

	Item		Interviewer 1			Interviewer 2		Inter-interviewer
	Item		(n = 61)			(n = 61)		Inter-interviewer
			(n = 61)			(n = 61)		agreement/(n = 61)
								agreement/(n = 61)
			n	%		n	%	Kappa (CI95%)

Home Integration Domain
Shopping for food and other necessities in your household
2	– Yourself alone		5	8.2	11		18.0
1	– Yourself and someone else		40	65.6	30		49.2	0.630 (0.451 - 0.776)
0	– Someone else		16	26.2	20		32.8
Prepares (cooks) or warms up or serves food in your
household
2	– Yourself alone		4	6.5	8		13.1
1	– Yourself and someone else		32	52.5	24		39.3	0.722 (0.560 - 0.861)
0	– Someone else		25	41.0	29		47.6
Does the everyday housework in your household
2	– Yourself alone		3	4.9	5		8.2
1	– Yourself and someone else		25	50.0	19		31.1	0.785 (0.647 - 0.897)
0	– Someone else		33	54.1	37		60.7
Cares for the children in your home
2	– Yourself alone		1	1.6	1		1.6
1	– Yourself and someone else		17	27.9	18		29.5	0.810 (0.640 - 0.931)
0	– Someone else		43	70.5	42		68.9
Initiates or organizes social arrangements such as get-
togethers with family and friends
2	– Yourself alone		3	4.9	4		6.5
1	– Yourself and someone else		28	45.9	17		27.9	0.610 (0.487 - 0.841)
0	– Someone else^*		30	49.2	40		65.6
			n	%		n	%	Kappa (CI95%)
Social Integration Domain
Looks after personal finances such as banking or paying bills
2	– Yourself alone		10	16.4	15		24.6
1	– Yourself and someone else		27	44.3	21		34.4	0.827 (0.637 - 0.922)
0	– Someone else		24	39.3	25		41.0
Number of times per month you go out shopping
2	– 5 or more times		5	8.2	7		11.5
1	– 4 times		26	42.6	30		49.2	0.581 (0.432 - 0.767)
Never			30	49.2	24		39.3
Number of times per month you participate in leisure
activities outside your home
2	– 5 or more times		34	55.7	30		49.2
1	– 4 times		17	27.9	21		34.4	0.755 (0.591 - 0.897)
Never			10	16.4	10		16.4
Number of times per month you visit friends or relatives
2	– 5 or more times		28	45.9	21		34.4
1	– 4 times		19	31.2	25		50.0	0.651 (0.420 - 0.777)
Never			14	22.9	15		24.6
Leisure activities alone or with others
2	– Mostly with friends who do not have head injuries /		27	44.3	25		41.0
both family and friends
1	– Mostly with friends who have head injuries / family		23	37.7	26		42.6	0.635 (0.489 - 0.783)
members
0	– Mostly alone		11	18.0	10		16.4
Have a best friend with whom you confide
2	– Yes		31	50.8	29		47.5
0	– No		30	49.2	32		52.5	0.803 (0.654 - 0.952)

Productive Activities Integration Domain
How often do you travel outside the home
2	– Almost every day	2	3.3	4		6.6
1	– Almost every week	-	-	-		-	0.651 (0.206 - 1.000)
0	– Seldom/Never. Less than once per week	59	96.7	57		93.4
Work – School – Volunteer Activities		27	44.3	31		50.8
0		2	3.3	2		3.3
1		6	9.8	8		13.1	0.673 (0.554 - 0.825)
2		9	14.7	5		8.2
3		15	24.6	11		18.0
4		2	3.3	4		6.6
5		Mean	SD		Mean	SD	Intra-class correlation
Subscales and Total CIQ							coefficient (CI95%)
Integration Dimension in the Home		2.85	1.92	2.72		2.20	0.887 (0.824-0.932)
Integration Dimension in the Social Environment		6.26	2.89	6.18		2.73	0.878 (0.812-0.926)
Integration Dimension in Productive Activities		1.89	1.86	1.72		1.94	0.816 (0.721-0.888)
CIQ		11	5.34	10.62		5.32	0.942 (0.908-0.965)

				Cronbach’s Alpha
	Home	Social	Productive	Domain	Domain
Domain Items	Integration	Integration	Activities	if item
	Domain	Domain	Domain	deleted

Home Integration Domain
Shopping for food and other necessities in	0.527	0.326	0.086	0.665
your household	0.527
your household	0.708
Prepares (cooks) or warms up or serves	0.708	0.377	0.111	0.559
Prepares (cooks) or warms up or serves	0.651	0.377	0.111	0.559
food in your household	0.651				0.696
food in your household	0.444				0.696
Does the everyday housework in your	0.444	0.424	0.077	0.599
Does the everyday housework in your	0.586	0.424	0.077	0.599
household	0.586	0.222	0.138	0.728
household		0.222	0.138	0.728
Cares for the children in your home	0.439
Initiates or organizes social arrangements	0.439	0.418	0.269	0.651
Initiates or organizes social arrangements		0.418	0.269	0.651
such as get-togethers with family and
friends	0.394
Social Integration Domain	0.394
Social Integration Domain
Looks after personal finances such as	0.274	0.410	0.233	0.658
banking or paying bills	0.274
banking or paying bills
Number of times per month you go out	0.371	0.484	0.187	0.630
shopping	0.371
shopping
Number of times per month you	0.318	0.587	0.195	0.572
participate in leisure activities outside your	0.318				0.665
participate in leisure activities outside your	0.226				0.665
home	0.226	0.614	0.195	0.562
home		0.614	0.195	0.562
Number of times per month you visit
friends or relatives	0.062	0.448	0.191	0.635
Leisure activities alone or with others	0.062	0.529	0.183
Leisure activities alone or with others	0.170	0.529	0.183
Have a best friend with whom you confide	0.170			0.671
Have a best friend with whom you confide				0.671
Productive Activities Integration Domain
How often do you travel outside the home		0.135	0.194	--	0.052
Work – School – Volunteer Activities		0.261	0.978	--

	RLA^*	GOSE^**	_DRS***
CIQ (Scale)
r	0.614	0.619	-0.588
p value	< 0.001	< 0.001	< 0.001
CIQ (Dimension)
Home Integration
r	0.409	0.384	-0.399
p value	0.001	0.002	0.001
Social Integration
r	0.640	0.615	-0.601
p value	< 0.001	< 0.001	< 0.001
Productive Activities
r	0.347	0.426	-0.344
p value	0.006	< 0.001	0.006

Domains and Items	Factor 1	Factor 2	Factor 3	Factor 4

Home Integration Domain
Shopping for food and other necessities in your household	0.341	0.723	0.005	-0.150
Prepares (cooks) or warms up or serves food in your household	0.695	0.474	0.090	-0.053
Does the everyday housework in your household	0.803	0.404	-0.009	-0.136
Cares for the children in your home	0.277	0.281	-0.735	0.213
Initiates or organizes social arrangements such as get-togethers	0.339	0.585	0.047	0.390
with family and friends
Social Integration Domain
Looks after personal finances such as banking or paying bills	0.078	0.883	0.042	0.179
Number of times per month you go out shopping	0.152	0.814	0.278	0.157
Number of times per month you participate in leisure activities	0.637	0.070	-0.053	0.538
outside your home
Number of times per month you visit friends or relatives	0.794	0.064	-0.100	0.330
Leisure activities alone or with others	0.550	-0.009	-0.282	0.505
Have a best friend with whom you confide	0.562	0.071	0.616	0.118
Productive Activities Integration Domain
How often do you travel outside the home	0.000	0.315	0.933	0.104
Work – School – Volunteer Activities	0.011	0.186	0.114	0.850
Eigenvalues before rotation	4.978	2.210	1.386	1.162
Percentage of explained variance	38	17	11	9

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[TFN01] SD = Standard Deviation; n = Absolute frequency. * P-value < 0.05 (Fisher's exact test); ** P-value < 0.05 (Pearson's chi-squared test); *** P-value < 0.05 (Analysis of variance)