Adaptation of the barriers to help-seeking for trauma (BHS-TR) scale: a cross-cultural cognitive interview study with female intimate partner violence survivors in Iceland

• Published in: Journal of Patient-Reported Outcomes
• Main Authors: Karen Birna Thorvaldsdottir, Sigridur Halldorsdottir, Rhonda M. Johnson, Sigrun Sigurdardottir, Denise Saint Arnault
• Format: Article in Journal/Newspaper
• Language: English
• Published: SpringerOpen 2021
• Subjects: Translation; Cross-cultural adaptation; Cognitive interviews; Self-reported measures; Trauma; Help-seeking; Public aspects of medicine; RA1-1270; Iceland
• Online Access: https://doi.org/10.1186/s41687-021-00295-0; https://doaj.org/article/f5331b0a146445c5bd1c52e26aff3a15

Abstract Background Even though traumatization is linked to substantially reduced health-related quality of life, help-seeking and service utilization among trauma survivors are very low. To date, there has not been available in Iceland a culturally attuned, self-reported measure on help-seeking barriers after trauma. This study aimed to translate and cross-culturally adapt the English version of Barriers to Help-Seeking for Trauma (BHS-TR) scale into the Icelandic language and context. Methods The BHS-TR was culturally adapted following well-established and rigorous guidelines, including forward-backward translation, expert committee review, and pretesting through cognitive interviews. Two rounds of interviews with 17 female survivors of intimate partner violence were conducted using a think-aloud technique and verbal probing. Data were analyzed using qualitative content analysis, a combination of deductive and inductive approaches. Results Issues with the BHS-TR that were uncovered in the study were classified into four categories related to general design, translation, cultural aspects, and post-trauma context. The trauma-specific issues emerged as a new category identified in this study and included concepts specific to trauma experiences. Therefore, modifications were of great importance—resulting in the scale becoming more trauma-informed. Revisions made to address identified issues improved the scale, and the process led to an Icelandic version, which appears to be semantically and conceptually equivalent to the original version; additionally, the results provided evidence of content validity. Conclusions As a cognitive interview study, it adds to the growing cognitive interviewing methodology literature. Furthermore, the results provide essential insights into the self-report response process of trauma survivors, highlighting the significance of making health-related research instruments trauma-informed.