Cultural adaptation and validation of the Burden of Treatment Questionnaire in Chinese Primary Care Patients with Multimorbidity

Abstract

Introduction The Burden of Treatment Questionnaire (TBQ) assesses the impact of a patient’s treatment workload on their quality of life. The aim of this study was to culturally adapt and validate the TBQ on Chinese primary care patients with multi-morbidity. Methodology The original English TBQ was translated and back translated using professional translators, and modifications made following cognitive debriefing interviews on 15 patients. The developed Chinese TBQ was administered to 200 primary care patients with multi-morbidity (>1 chronic disease) to examine its psychometric performance. The EQ-5D-5L, SF-6D, WONCA COOP and the global health rating were administered to assess convergent and divergent validity. Results The mean age of respondents = 61.6 years; mean number of conditions = 3.7; and mean TBQ total score = 21.8 (maximum 150). A significant floor effect (>15%) was found for all items. Spearman’s correlations was >0.4 for all items demonstrating adequate internal construct validity. TBQ global score correlated with the number of chronic conditions, the EQ-5D-5L, SF-6D and several domains of the WONCA COOP but no significant correlation between TBQ global score and global health rating was observed. Cronbach’s alpha = 0.842 showing good internal consistency and ICC = 0.830 showing good test-retest reliability. Discussion Our cultural adaptation of the TBQ appears to be valid for use in Chinese primary care patients with multi-morbidity in Hong Kong. As the instrument has a significant floor effect, the TBQ may be better for monitoring deterioration in treatment burden rather than capturing improvements following interventions to reduce burden.