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Validation of a culturally adapted Swedish-language version of the Death Literacy Index

Johansson, Therese ; Olsson, Åsa LU ; Tishelman, Carol ; Noonan, Kerrie ; Leonard, Rosemary ; Eriksson, Lars E. ; Goliath, Ida and Cohen, Joachim (2023) In PLoS ONE 18(11 November).
Abstract

The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional... (More)

The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional survey (n = 503). The psychometric evaluation involved analysis of descriptive statistics on item and scale-level, internal consistency and test-retest reliability, and confirmatory factor analysis. During translation and adaptation, changes were made to adjust items to the Swedish context. Additional adjustments were made following findings from the expert review and cognitive interviews. The content validity index exceeded recommended thresholds (S-CVIAve = 0.926). The psychometric evaluation provided support for DLI-S’ validity. The hypothesized six-factor model showed good fit (χ2 = 1107.631 p<0.001, CFI = 0.993, TLI = 0.993, RMSEA = 0.064, SRMR = 0.054). High internal consistency reliability was demonstrated for the overall scale (Cronbach’s α = 0.94) and each sub-scale (α 0.81–0.92). Test-retest reliability was acceptable, ICC ranging between 0.66–0.85. Through a comprehensive assessment of several sources of evidence, we show that the DLI-S demonstrates satisfactory validity and acceptability to measure death literacy in the Swedish context. There are, however, indications that the sub-scales measuring community capacity perform worse in comparison to other sca and may function differently in Sweden than in the original context. The DLI-S has potential to contribute to research on community-based EOL interventions.

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organization
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Contribution to journal
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published
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in
PLoS ONE
volume
18
issue
11 November
article number
e0295141
publisher
Public Library of Science (PLoS)
external identifiers
  • pmid:38033042
  • scopus:85178510938
ISSN
1932-6203
DOI
10.1371/journal.pone.0295141
language
English
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yes
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11545f38-9a5c-4270-8536-45451ccc97f8
date added to LUP
2024-01-08 10:54:05
date last changed
2024-04-23 06:30:14
@article{11545f38-9a5c-4270-8536-45451ccc97f8,
  abstract     = {{<p>The death literacy index (DLI) was developed in Australia to measure death literacy, a set of experience-based knowledge needed to understand and act on end-of-life (EOL) care options but has not yet been validated outside its original context. The aim of this study was to develop a culturally adapted Swedish-language version of the DLI, the DLI-S, and assess sources of evidence for its validity in a Swedish context. The study involved a multi-step process of translation and cultural adaptation and two validation phases: examining first content and response process validity through expert review (n = 10) and cognitive interviews (n = 10); and second, internal structure validity of DLI-S data collected from an online cross-sectional survey (n = 503). The psychometric evaluation involved analysis of descriptive statistics on item and scale-level, internal consistency and test-retest reliability, and confirmatory factor analysis. During translation and adaptation, changes were made to adjust items to the Swedish context. Additional adjustments were made following findings from the expert review and cognitive interviews. The content validity index exceeded recommended thresholds (S-CVI<sub>Ave</sub> = 0.926). The psychometric evaluation provided support for DLI-S’ validity. The hypothesized six-factor model showed good fit (χ<sup>2</sup> = 1107.631 p&lt;0.001, CFI = 0.993, TLI = 0.993, RMSEA = 0.064, SRMR = 0.054). High internal consistency reliability was demonstrated for the overall scale (Cronbach’s α = 0.94) and each sub-scale (α 0.81–0.92). Test-retest reliability was acceptable, ICC ranging between 0.66–0.85. Through a comprehensive assessment of several sources of evidence, we show that the DLI-S demonstrates satisfactory validity and acceptability to measure death literacy in the Swedish context. There are, however, indications that the sub-scales measuring community capacity perform worse in comparison to other sca and may function differently in Sweden than in the original context. The DLI-S has potential to contribute to research on community-based EOL interventions.</p>}},
  author       = {{Johansson, Therese and Olsson, Åsa and Tishelman, Carol and Noonan, Kerrie and Leonard, Rosemary and Eriksson, Lars E. and Goliath, Ida and Cohen, Joachim}},
  issn         = {{1932-6203}},
  language     = {{eng}},
  number       = {{11 November}},
  publisher    = {{Public Library of Science (PLoS)}},
  series       = {{PLoS ONE}},
  title        = {{Validation of a culturally adapted Swedish-language version of the Death Literacy Index}},
  url          = {{http://dx.doi.org/10.1371/journal.pone.0295141}},
  doi          = {{10.1371/journal.pone.0295141}},
  volume       = {{18}},
  year         = {{2023}},
}