The use of tobacco and related substances by ethnic minorities: the development of a culturally vali

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The use of tobacco and related substances by
ethnic minorities the development of a
culturally valid measure.

• Raj Bhopal, Sonja Hunt and Lisa Hanna
• Division of Community Health Sciences
• The Medical School
• University of Edinburgh

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• AIM

• The development of a cross-culturally valid
  method to measure the prevalence of smoking and
  related behaviours in Punjabi, Urdu, Bengali and
  Cantonese speaking populations living in
  Scotland.

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• WHY?

• Barriers to the accumulation of reliable
  information on ethnic minorities, particularly
  newer and older immigrants and refugees who may
  have little or no competency in the English
  language.
• Approximately 23 of immigrants to Britain born
  in China, Bangladesh, India and Pakistan have no
  functional skill in English.
• 70 have insufficient English to function in an
  English-speaking social environment.
• A proportion of older people may not be able to
  read or write their native language.
• Serious flaws exist in questions pertaining to
  health-related behaviours asked of ethnic
  minorities in health surveys.

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PROBLEMS WITH TRANSLATION/ADAPTATION

• Based on questions designed for native English
  population
• Direct translation by professional translators
  results in inappropriate expressions
• Inclusion of non-salient items
• Omission of culturally specific items

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COMMENTS FROM BENGALI/SYLHETI SPEAKERS

• Expressions too complex
• Literal and inappropriate translation
• Use of concepts which do not have a direct
  translation
• Use of culturally inappropriate concepts
• Offensive questions
• Omissions from or additions to the English
• Spelling mistakes.

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OBJECTIVES (1 - 3)

• to ascertain which are the key questions in
  existing survey instruments concerning the range
  of tobacco and related substances consumed in the
  four language groups.
• to assess cultural acceptability and sensitivity
  of the questions.
• to test the conceptual equivalence of the
  questions in each of the selected languages.

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OBJECTIVES (4 - 7)

• to modify the questions in each language as
  necessary.
• to develop supplementary questions as required.
• to ascertain the optimal mode of administration
  of questions.
• to deduce general principles concerning modes of
  enquiry into lifestyle factors with ethnic
  minorities.

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• METHODS 1

• Recruitment of 4 bi-lingual co-workers
• Recruitment of 10 monolingual representatives
  from each of the 4 groups to form 4 advisory
  panels.

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METHODS 2

• Individual interviews
• relevant questions and expressions
• Wording of instructions
• Form of response systems

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METHODS 3

• Extraction of relevant material
• Discussion with panels
• Selection of possible content
• Comparison of content across languages

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METHODS 4

• Selection of items and response systems
• emic and etic items
• Testing for face and content validity
• a) presentation of items to panels for comments
  on comprehensiveness, salience,
  understandability, cultural appropriateness and
  cultural acceptability
• b) administration to 20 representatives from each
  language group.

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BENEFITS

• Facilitation of collection of high quality,
  reliable data across language groups
• Enhancement of the effectiveness of prevention
  and control initiatives
• Raising of awareness of smoking issues in the
  four communities
• Implications for data collection on a variety of
  health-related issues