Cultural adaptation of the EQ-5D-Y-5L into Amharic and Tigrinya languages in Ethiopia

Abstract Background The EQ-5D-Y-5L is available in both digital and paper formats for self-complete (SC), interviewer-administered (IA), and proxy-reports. This study aimed to report the process of translation and cultural adaptation of the EQ-5D-Y-5L into Amharic and Tigrinya in Ethiopia. Method An iterative process of forward and backward translations followed by independent review of conceptual equivalence and cultural relevance using cognitive interviews, was conducted for both the Amharic and Tigrinya languages. Card-ranking was conducted to assess children’s understanding of the hierarchical ordering of severity levels of EQ-5D-Y-5L response options. The final translations were subsequently proofread. Results The first Amharic and Tigrinya versions of the paper and digital versions for SC, IA, and proxy-report questionnaires were developed following the forward translation. Backward translation identified some linguistic and conceptual issues requiring refinement, including qualifiers and non-child-friendly words. The iterative card ranking exercise showed that children were able to differentiate between severity levels of response options in both the Amharic and Tigrinya versions of the EQ-5D-Y-5L dimensions. Cognitive interviews identified further conceptual issues, specifically with the “pain/discomfort” dimension. Pain/discomfort was considered internal discomfort/pain and emotional distress, which was refined to emphasize physical pain. Conclusions The paper and digital formats for SC, IA, and proxy-report of the Tigrinya and Amharic EQ-5D-Y-5L versions were translated and culturally adapted for use in Ethiopia. Both versions demonstrated good conceptual equivalence, comprehensibility, and cultural relevance and acceptability among children and adolescents.