Assessment of the face validity of two pain scales in Kenya: a validation study using cognitive interviewing

Kristin Tl Huang, Claudio Owino, Rachel C Vreeman, Mildred Hagembe, Festus Njuguna, R Matthew Strother, Gregory P Gramelspacher, Kristin Tl Huang, Claudio Owino, Rachel C Vreeman, Mildred Hagembe, Festus Njuguna, R Matthew Strother, Gregory P Gramelspacher

Abstract

Background: Patients in sub-Saharan Africa commonly experience pain, which often is un-assessed and undertreated. One hindrance to routine pain assessment in these settings is the lack of a single-item pain rating scale validated for the particular context. The goal of this study was to examine the face validity and cultural acceptability of two single-item pain scales, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised (FPS-R), in a population of patients on the medical, surgical, and pediatric wards of Moi Teaching and Referral Hospital in Kenya.

Methods: Swahili versions of the NRS and FPS-R were developed by standard translation and back-translation. Cognitive interviews were performed with 15 patients at Moi Teaching and Referral Hospital in Eldoret, Kenya. Interview transcripts were analyzed on a question-by-question basis to identify major themes revealed through the cognitive interviewing process and to uncover any significant problems participants encountered with understanding and using the pain scales.

Results: Cognitive interview analysis demonstrated that participants had good comprehension of both the NRS and the FPS-R and showed rational decision-making processes in choosing their responses. Participants felt that both scales were easy to use. The FPS-R was preferred almost unanimously to the NRS.

Conclusions: The face validity and acceptability of the Swahili versions of the NRS and FPS-R has been demonstrated for use in Kenyan patients. The broader application of these scales should be evaluated and may benefit patients who currently suffer from pain.

Figures

Figure 1
Figure 1
Numerical Rating Scale. Instructions for patients: “If 0 means ‘no pain,’ and 10 means ‘the worst pain that you can imagine,’ on this scale from 0 to 10, what is your current level of pain?”
Figure 2
Figure 2
Faces Pain Scale-Revised. Instructions for patients: “These faces show how much something can hurt. The face on the left shows no pain. The faces show more and more pain proceeding from left to right, up to the face on the right – it shows the most pain. Point to the face that shows how much you hurt right now.” Scored 0-2-4-6-8-10 This figure has been reproduced with permission of the International Association for the Study of Pain® (IASP®). The figure may not be reproduced for any other purpose without permission.
Figure 3
Figure 3
Faces Pain Scale-Revised – Swahili. Instructions for patients: “Hizi nyuso zaonyesha jinsi kitu kinaweza umiza. Uso ulio kushoto hauonyeshi uchungu. Nyuso hizo zaonyesha uchungu zaidi na zaidi kuanzia kushoto kuelekea kulia hadi uso ulio kulia – inaonyesha uchungu ulio mwingi zaidi. Lenga uso unaoonyesha jinsi unavyoumia sasa hivi.” This figure has been reproduced with permission of the International Association for the Study of Pain® (IASP®). The figure may not be reproduced for any other purpose without permission.
Figure 4
Figure 4
Numerical Rating Scale – Swahili. Instructions for patients: “Ikiwa 0 inamaanisha ‘hakuna uchungu,’ na 10 inamaanisha ‘uchungu mbaya zaidi wenye unaweza kufikiria,’ katika mizani hii ya 0 mpaka 10, ni kipi kiwango chako cha sasa cha uchungu?”
Figure 5
Figure 5
FPS-R Responses. The y-axis depicts the number of participants who chose each face to represent their pain
Figure 6
Figure 6
Numerical Rating Scale Responses. The y-axis represents the number of participants who chose each number to represent their pain

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