CULTURAL ADAPTATION OF THE COMMUNITY COHESION AND HEALTH INSTRUMENT

Aims: To develop and determine the qualitative cultural validity of the Community Cohesion and Health Instrument for Vietnamese Americans.  Rationales: Evidence is growing on the protective nature of community cohesion on the health of individuals and populations.  Many health promotion studies focus on refugee and immigrant communities, including Vietnamese Americans, among whom many health disparities exist.  Yet there is no culturally appropriate instrument to measure community cohesion and health for Vietnamese Americans.  Methods: This study adapted existing validated instruments to measure the identity-based community cohesion and health of Vietnamese Americans.  Three measures were selected and combined to create two language versions of the Community Cohesion and Health Instrument (CCHI) for the Vietnamese American communities: the place-based Neighborhood Cohesion Instrument, 3-item social isolation questionnaire, and self-rated general health question. The first step was a modification of the Neighborhood Cohesion Instrument to an ethnic-based Community Cohesion Instrument.  The Community Cohesion Instrument was then combined with measures of social isolation and self-rated general health to create the Community Cohesion and Health Instrument.  Second, using content validity index, two expert panels in community work and community health reviewed the contents of the English version of CCHI.  One panel consisted of English speakers only.  To get Vietnamese American experts’ perspectives, the other panel consisted of bi-cultural, bi-lingual experts in community work.  Each panel gave CCHI a 0.80 validation, an acceptable validation score.  Third, a revision was made to the English version based on comments by the expert panels.  This revision was translated by a certified translator into Vietnamese.  A committee of qualified translators reviewed the Vietnamese version and provided their feedback.  Fourth, both language versions were revised based on input from the review committee of translators.  Fifth, both language versions underwent cognitive interviews with selected members of the community.  The feedback from cognitive reviews resulted in further revision.  Finally, the latest versions of the CCHI in both languages were field tested in focus group discussions with community members at large to establish linguistic and cultural validity of the CCHI.  Results:  In general, community members of different genders and age groups rated the CCHI as linguistically and culturally appropriate to measure the sense of community cohesion, social isolation, and general self-rated health.  They provided further input to improve the meaning, clarity, relevance, and simplicity of the instrument for Vietnamese Americans.  Implications:  The process followed by this project is appropriate in producing a culturally relevant Community Cohesion and Health Instrument for Vietnamese Americans.  Although time-consuming, the process may be cost-effective in the long run because the instruments that result are likely to capture the true essence of the phenomena they intend to measure.  Hence, the process can be helpful to adapt for other language pairs as well.  A quantitative reliability test is underway to ascertain the reliability of the instrument.