Cultural Adaptation and Psychometric Validation of the Sinhala Version of the Osteoporosis Knowledge Assessment Tool

Abstract

Background: Osteoporosis is a global health problem and it is a prevalent disease among postmenopausal women in Asian countries. It is considered as a silent disease as it does not give any clue until person suffer a fracture which is a major cause of long-term disability. Assessing osteoporosis-related knowledge is crucial for promoting prevention and management strategies. A validated tool for assessing knowledge on osteoporosis is therefore much needed. Osteoporosis Knowledge Assessment Tool (OKAT) is a reliable and standardised measure to assess individual knowledge of osteoporosis and it has been used across various countries, with no categorisation of any domains. Objectives: To adapt the OKAT in Sinhala language and assess its psychometric properties among peri-menopausal and postmenopausal women Methods: This validation study comprised of two phases; cultural adaptation and psychometric properties evaluation. Cultural adaptation includes forward translation, synthesizing a common version, backward translation, expert review and testing pre-final version. The final Sinhala version of OKAT was administered among 179 peri-menopausal and postmenopausal women selected using multi-stage random sampling from the Hikkaduwa Medical Officer of Health division. The tool was re-administered among the same group of women after two weeks of first administration. Content validity was evaluated using the expert review. Reliability was determined by measuring internal consistency (Cronbach’s alpha) and test-retest reliability (interclass correlation coefficient, ICC). Construct validity was examined using exploratory factor analysis. Results: The content validity index (CVI) was 0.97, indicating strong agreement among experts on the relevance and clarity of the questionnaire items. The OKAT demonstrated good internal consistency measures with Cronbach’s alpha of 0.91 and high test-retest reliability measured with ICC of 0.91. Factor analysis using the Principle Component Analysis revealed four factor structure with eigen value >1, explaining 59.81% of variance with KMO value of 0.89 and Bartlert Test of Spericity <0.001. The factor structure showed four main factors that can be explained as ‘General Knowledge about Osteoporosis’, ‘Knowledge on Risk Factors’, ‘Knowldge on Preventive Measures’ and ‘Knowledge on Consequences and Management’. Conclusions: The Sinhala version of OKAT demonstrated excellent validity and reliability in assessing osteoporosis related knowledge among peri-menopausal and postmenopausal women. Further, this is a psychometrically sound tool and its alidity and reliability make it a valuable instrument for both research and educational interventions focusing osteoporosis awareness and prevention. Further studies are recommended to explore its applicability in diverse populations with confirmatory factor analysis.