Browsing by Author "Steiner, TJ"
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Publication Measuring Neuroticism in Nepali: Reliability and Validity of the Neuroticism Subscale of the Eysenck Personality Questionnaire(Kathmandu University, 2015) Manandhar, K; Risal, A; Linde, M; Koju, R; Steiner, TJ; Holen, AABSTRACT Background The Neuroticism subscale of the Eysenck Personality Questionnaire Revised Short Form (12 items) (EPQRS-N) has proven to be a reliable and valid measure in multiple languages. Objective To develop a single-factor Nepali-language version of the EPQRS-N for use in the adult population of Nepal. Method The original English version of EPQRS-N was translated into Nepali using a forward- backward translation protocol. The first set of translated items was modified after testing by factor analysis with principal component extraction in an outpatient sample. Items with low factor correlations or poor semantic consistencies were reworded to fit the gist of the original items in a Nepali cultural context; the revised version was then tested in a representative random sample from the general population. Again, the same statistical procedures were applied. Results The first trial gave three factors. Based on the factor distribution of the items or their semantic quality, five were reworded. In the second trial, a two-factor solution emerged; the second factor had only one item with high correlation, which also had modest correlation with the first factor. Accordingly, a forced one-factor solution was chosen. This gave an internal consistency (Cronbach’s alpha) of 0.80, with item-to- factor correlations from 0.40 to 0.73, and item-to-sum correlations from 0.31 to 0.61. Conclusion The final Nepali version of EPQRS-N achieved satisfactory internal consistency. The item distribution coincided with the original English version, providing acceptable construct validity. It is psychometrically adequate for use in capturing the personality trait of neuroticism, and has broad applicability to the adult population of Nepal because of the diversity of the participant samples in which it was developed. KEY WORDS Eysenck personality questionnaire, global campaign against headache, item translation, Nepal, neuroticism, personality traits, trans-cultural psychiatryPublication Reliability and Validity of a Nepali-language Version of the Hospital Anxiety and Depression Scale (HADS)(Kathmandu University, 2015) Risal, A; Manandhar, K; Linde, M; Koju, R; Steiner, TJ; Holen, AABSTRACT Background In several languages and settings, the Hospital Anxiety and Depression Scale (HADS) has demonstrated reliable and valid screening properties in psychiatry. Objective To develop a Nepali version of HADS with acceptable reliability and construct validity for use among hospital patients and in the general population. Method The original English version was translated into Nepali using a forward-backward translation protocol. Psychometric properties were tested by factor analysis and Cronbach’s alpha. The translated scale was administered to three groups of adult in-patients in a university hospital in three trials, and to a sample of adults from the community in a fourth trial. Some of the 14 items were reworded reiteratively to achieve viable semantic and statistical solutions. Results The two-factor solution with anxiety and depression subscales eventually explained 40.3% of the total variance. Cronbach’s alpha was 0.76 for anxiety (HADS-A) and 0.68 for depression (HADS-D). All seven HADS-A items showed at least acceptable item-to-factor correlations (range 0.44-0.74), and full construct validity was achieved for this subscale. Item-to-factor correlations for six HADS-D items were also at least acceptable (range 0.42-0.70); one item (D4) had persistently low correlations throughout all trials, although construct validity was still satisfactory. Conclusion Reiterated rewording of items guided by statistical testing resulted in a Nepali version of HADS with satisfactory psychometric properties. KEY WORDS Item translation, psychometrics, psychopathology, screening, transcultural psychiatry.Publication Undertreated Hypertension and its Implications for Public Health in Nepal: Nationwide Population-Based Survey(Kathmandu University, 2015) Koju, R; Manandhar, K; Risal, A; Steiner, TJ; Holen, A; Linde, MABSTRACT Background Hypertension (HTN), a major risk factor for cardiovascular diseases (CVDs), is a substantial global public health problem. Occasional studies indicate a high prevalence of HTN in the Nepalese population, but no nationwide population-based data exist so far. We opportunistically used a survey of major disorders of the brain in Nepal to measure blood pressure (BP) in participants selected randomly from the adult general population. Objective To establish the prevalence of elevated BP (eBP), and factors associated with it, regardless of any antihypertensive therapy being taken. We took this to be indicative of unmet health-care need. Method This was a cross-sectional study, conducted by unannounced household visits, employing multistage random cluster sampling. To achieve representativeness, 15 districts out of 75 in the country were investigated: one district from each of the three physiographic divisions in each of the five development regions of Nepal. One adult aged 18-65 years was selected from each household and interviewed by structured questionnaire. BP was recorded in a standardised manner by digital device (Microlife 3BM1-3®). Result From 2,109 eligible households, 2,100 adults (99.6%) participated. The prevalence of eBP (>140/90 mmHg on ≥2 readings) was found to be 15.1%. Multivariate logistic regression showed significant and independent associations with demographic variables (higher age, male gender), with life-style factors (daily alcohol consumption, BMI ≥25), and with living at high altitude (≥2000 m). Conclusion In the context of the survey we could not collect data on antihypertensive therapy being taken but, clearly, whatever this might have been, it was failing to meet treatment needs. Almost one in six adults met criteria for hypertension, carrying risk implications for CVDs and their substantial public-health consequences. Two remediable associated factors were identified, although in a cross-sectional survey we could not prove causation. KEY WORDS Cardiovascular disease, coronary artery disease, hypertension