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Table 2: Effect of health problems on work and daily activity French (N=30) Health problems past 7 days 63.3% Absenteeism (range) 10.3% (0-100%) Presenteeism (range) 18.3% (0-100%) Work productivity loss (range) 23.8% (0-100%) Activity impairment (range) 25.0% (0-80%) RESULTS • A total of 63.3% reported a health problem in the past 7 days. • The item comprehension rate was 97.2%. • Response revision rates were 0.0%. • 83.3% of subjects correctly excluded “sick days” for personal research from a hypothetical question about health-related absenteeism. Table 1: Demographic characteristics of the population by gender Characteristic Male (N=9) Female (N=21) Total (N=30) Mean years of age (range) 43.3 (30-64) 43.3 (27-66) 43.3 (27-66) 27-36, n (%) 2 (22%) 9 (43%) 11 (37%) 37-46, n (%) 4 (44%) 4 (19%) 8 (27%) 47-56, n (%) 2 (22%) 3 (14%) 5 (17%) 57-66, n (%) 1 (11%) 5 (24%) 6 (20%) Mean years of education (range) 14.3 (11-18) 13.4 (11-18) 13.7 (11-18) 11 years, n (%) 3 (33%) 7 (33%) 10 (33%) 12 years, n (%) 0 (0%) 3 (14%) 3 (10%) 13-14 years, n (%) 1 (11%) 2 (10%) 3 (10%) 15-16 years, n (%) 3 (33%) 8 (38%) 11 (37%) 17 or more years, n (%) 2 (22%) 1 (5%) 3 (10%) Employed, n (%) 9 (100%) 21 (100%) 30 (100%) White collar, n (%) 6 (67%) 10 (48%) 16 (53%) Blue collar, n (%) 3 (33%) 11 (52%) 14 (47%) DEMOGRAPHIC DATA • A total of 30 subjects, all of whom were currently employed at the time of the interview and indicated French as their primary language, were enrolled. • Overall, 33% of subjects had <12 years of education; years of education ranged from 11 to 18. • 30% of subjects were male; 70% were female. • The average age of subjects was 43.3; the range of ages was from 27 to 66 years. RESULTS • Blue collar workers reported higher rates for absenteeism and presenteeism, while both groups reported similar scores in the categories of work productivity loss and activity impairment. Table 3: Effect of health problems on work and daily activity (raw score) by occupation, by health problems in past 7 days Blue Collar (N=14) White Collar (N=16) Total (N=30) Health problems in past 7 days (n=10) All Health problems in past 7 days (n=9) All Health problems in past 7 days (n=19) All Hours missed- health reasons (range) 11.8 (0-40) 8.4 (0-40) 2.3 (0-10) 1.3 (0-10) 7.3 (0-40) 4.6 (0-40) Hours missed- other reasons (range) 2.4 (0-24) 1.7 (0-24) 1.1 (0-5) 1.1 (0-8) 1.8 (0-24) 1.4 (0-24) Work productivity loss raw score* (range) 2.8 (0-8) 2.0 (0-8) 3.0 (0-10) 1.7 (0-10) 2.9 (0-10) 1.8 (0-10) Activity impairment raw score* (range) 4.2 (1-8) 3.0 (0-8) 3.7 (0-8) 2.1 (0-8) 3.9 (0-8) 2.5 (0-8) *For the work productivity loss and activity impairment raw scores, 0 indicates “Health problems had no effect on my work/ daily activities” and 10 indicates “Health problems completely prevented me from working/doing my daily activities” Table 4: Results from previous validation of Spanish US WPAI:GH Demographics Spanish* (N=31) English (N=35) Age in years (range) 39.9 (21-64) 41.5 (21-75) Education in years (range) 10.9 (3-19) 12.4 (8-20) % Female 51.6 57.1 % White collar occupation 48.4 40.0 Results Health problem past 7 days 71.0% 62.9% Absenteeism (range) 11.3% (0-100%) 5.0% (0-100%) Work productivity loss (range) 32.9% (0-100%) 23.5% (0-70%) Activity impairment (range) 34.5% (0-100%) 24.0% (0-100%) Item comprehension rate 98.6% (0-100%) 99.6% (0-80%) Response revision rate 1.6% 0.5% Correct response to hypothetical item 86.2% 84.4% *Subjects came from 8 different countries of origin PREVIOUS RESEARCH • In 2004, Corporate Translations began performing linguistic validations of the WPAI:GH in various language-country pairs. • The first phase of this project was the validation of the Spanish US translation. • We also collected data on the English US WPAI:GH as a control. • Results mirror those for the validation of the French Canadian WPAI:GH. REFERENCES 1. The CIA World Factbook, https://www.cia.gov/library/publications/the-world-factbook/geos/ca.html, 12 Aug 2008. 2. http://www.reillyassociates.net/WPAI_GH.html 3. Gawlicki M. Procedures for Linguistic Validation of Health Status Questionnaires. Mansfield Center, CT: Corporate Translations, Inc. 2004. 4. Reilly MC, Zbrozek AS, Dukes EM. The validity and reproducibility of a work productivity and activity impairment instrument. PharmacoEconomics 1993;4:353-65. 5. Wahlqvist P, Carlsson J, Stålhammar N-O,Wiklund I.Validity of a Work Productivity and Activity Impairment Questionnaire for Patients with Symptoms of Gastro-Esophageal Reflux Disease (WPAI-GERD) -Results From a Cross-Sectional Study. Value in Health 2002;5:106-113. 6. Reilly MC, Lavin PT, Kahler KH, Pariser DM. Validation of the Dermatology Life Quality Index (DLQI) and the Work Productivity and Activity Impairment: Chronic Hand Dermatitis Questionnaire (WPAI-ChHD) in Chronic Hand Dermatitis (ChHD). J Am Academy Dermatol 2003;48:128-30. 7. Jacobs RJ, Davidson JR, Gupta S, Meyerhoff AS. The effects of clonazepam on quality of life and work productivity in panic disorder. Am J Man Care 1997;3:1187-1196. 8. Tanner LA, Reilly M, Meltzer EO, Bradford JE, Mason J. Effect of fexofenadine HCI on quality of life and work, classroom and daily activity impairment in patients with seasonal allergic rhinitis. Am J Man Care 1999;5(suppl):S235-S247. 9. Perrillo RP, Rothstein KD, Imperial JC et al. Comparison of quality of life, work productivity and medical resource utilization of peginterferon alfa 2a vs the combination of interferon alfa 2b plus ribavirin as initial treatment in patients with chronic hepatitis C. J Viral Hepatitis 2004:11:157-165. 10. Reilly MC, Barghout V, Ruegg P, Pecher E, Ricci J-F. Tegaserod significantly reduces work productivity loss and daily activity impairment in patients with IBS with constipation. Am J Gastroenterol 2004;99(10):S241. Linguistic Validation of the French Canadian Work Productivity and Activity Impairment Questionnaire General Health Version (WPAI:GH) Mary C. Gawlicki, MBA; Melissa Handa, BA; Shawn McKown, MA —— Corporate Translations, Inc. —— OBJECTIVE To establish the linguistic validity of the French Canadian translation of the Work Productivity and Activity Impairment Questionnaire, General Health Version (WPAI:GH) as part of an ongoing series of validations. BACKGROUND • The French language, which shares official status with English in Canada, is spoken by about 23.2% of the country; this is roughly 7.7 million people [1]. • The WPAI:GH, a leading measure of the work productivity indicators absenteeism and presenteeism, has not yet been tested in French Canada for both clarity of translation and item comprehension. LINGUISTIC VALIDATION Linguistic Validation is a process that is conducted to confirm that a Patient Reported Outcome (PRO) questionnaire is acceptable for use in different languages and in different cultural contexts. Without this careful development of a translation and subsequent cognitive debriefing, one could not be reasonably certain that the adapted instrument is equivalent to the original and that it can also be clearly understood by the average individual. The process begins with two independently created translations, which are then reconciled by the translation team to create a harmonized translation. After that, the harmonized translation is provided to a third translator who translates the text back into English. Both the harmonized translation and the English back translation are reviewed by project managers, a survey research expert and an in-country clinician; adaptations to the translation are made as needed. Once the final translation has been approved, it is debriefed among in- country native speakers of the language, with varying demographic and educational backgrounds, to check for conceptual equivalence and clarity. WORK PRODUCTIVITY AND ACTIVITY IMPAIRMENT (WPAI) QUESTIONNAIRE The WPAI questionnaire measures work time missed (absenteeism), impaired productivity at work (presenteeism), and work productivity loss (absenteeism + presenteeism) due to general health or to a specified health problem in the past 7 days. Impairment in performing daily activities, such as work around the house, shopping, child care, exercising, studying, etc. is also assessed. Scores are expressed as percentages, with higher scores indicating greater impairment. The WPAI has been validated for general health [4] and a number of chronic diseases, including gastroesophageal reflux disease [5] and dermatitis [6]; it has been useful for assessing treatment effects in clinical trials [7, 8, 9, 10]. METHODS • A convenience sample of currently employed persons living in Canada and at least 21 years of age was enrolled. • Subjects were stratified by education (<12 years vs. >12 years of academic education). • Subjects were selected to be diverse with regard to age, gender, occupation, having/ not having a health problem, and for geographical location within Canada. • Subjects completed the self-administered WPAI:GH [2] and were then debriefed by a trained bilingual interviewer via the telephone. The French Canadian WPAI:GH was created using standard translation procedures for questionnaires [3]. • One hypothetical question was asked during debriefing to test understanding of the need to exclude sick-day absences for personal reasons from health-related absenteeism, and to exclude absenteeism in responding to the question on impaired productivity at work (presenteeism). VOCABULARY • Absenteeism: when an employee takes a sick day from work for health reasons • Presenteeism: when an employee attends work while ill and experiences reduced work efficiency • White collar: includes positions such as executive, professional, technical support, or sales • Blue collar: includes positions such as clerical and administrative support, service occupations, precision production and crafts workers, and operators or laborers • Item comprehension rate: the number of correctly understood items divided by the total number of items (both questions and directions) • Response revision rate: the number of revised responses divided by the total number of items • Hypothetical question: the hypothetical question used for this study was “Let me ask you a hypothetical question: If you took a sick day, that is, called in sick, but weren’t really sick, how would you have answered this question about hours missed due to health?” CONCLUSIONS • The linguistic validity of the French Canadian WPAI:GH was established among a diverse French Canadian-speaking population, including those with minimal education. • The WPAI:GH is a more accurate method of assessing health-related absenteeism than counts of “sick days” among French Canadian speaking workers as well as speakers of other previously tested languages. • The hypothetical item helped to better assess subjects’ ability to differentiate between sick time taken for health and non-health reasons and between absenteeism and presenteeism.
