Development of the Cantonese Version of Speech Handicap Index (S.H.I.) and Its Application to Patients after Total Laryngectomy

Abstract

Background: Speech Handicap Index (SHI) is a psychometrically robust assessment inventory originally developed in Dutch to evaluate the speech-specific QOL in patients with oral and oropharyngeal cancer in 2008 (Rinkel et al., 2008). SHI is different from Voice Handicap Index (Jacobson et al., 1997) and Voice-Related Quality of Life questionnaire (Hogikyan & Sethuraman, 1999) which mainly focus on the aspect of voice, rather than speech. As speech reflects the interplay of the entire speech production mechanism including respiration, phonation, articulation (resonance), and the neural control, it can provide a more comprehensive picture of one’s communication ability (Dwivedi et al., 2009). SHI has been translated from Dutch into many different languages including Lithuanian, English, French, Korean, and Mandarin Chinese. Despite the Mandarin version of SHI (Li, Ma, & Mao, 2016), due to obvious cultural and language differences between Hong Kong and the mainland China, the Mandarin SHI cannot be used directly on the Cantonese-speaking population in Hong Kong. In addition, anecdotally, some of the items in the Mandarin SHI appear to be inappropriately translated and may need to be revisited. As such, the present study aims to develop and validate the first Cantonese SHI (CanSHI) based on English SHI. Evidence on the psychometric properties of the adapted CanSHI will be obtained to confirm its validity which will be assessed using Cantonese-speaking patients of different types of alaryngeal speech after total laryngectomy. Although total laryngectomy for removing a cancerous larynx affects one’s voice the most, assessing alaryngeal speakers’ speech production and speech-related quality of life apparently better depicts how the loss of one’s larynx affect his/her living quality. Methods: The study will involve two phases: (1) translation of questionnaire items, and (2) validation of draft CanSHI with laryngectomees. All 30 items of the English SHI will be translated into Cantonese (Dwivedi et al., 2011). This will involve translation by experts and backward translation. Upon completion of the translation phase, reliability and validity of the draft CanSHI will be assessed. Internal consistency, test-retest reliability, inter-rater reliability, content validity and construct validity will be assessed. It will be evaluated with inputs from 40 local laryngectomees who will represent all types of alaryngeal speech used in Hong Kong. Results: While the study is on-going, preliminary findings indicated that CanSHI is feasible and can be used to reveal the speech-related QoL of laryngectomees. Strong test-retest reliability and internal consistency for both Cantonese SHI and original SHI developed by Rinkel et.al are seen, suggesting that CanSHI is cross-culturally robust. Conclusion: This study is significant in that it shows the Cantonese version of SHI can be a useful tool for evaluating a patient’s self-perception of his or her speech, psychosocial function, and degree of speech problems. Learning Outcome: Development of the Cantonese Speech Handicap Index (CanSHI) ; Validation of CanSHI ; Evaluation of speech-related Quality of Life of laryngectomees