Translation, cross-cultural adaptation and validation of questionnaires for Turkish and Moroccan Dutch patients with mood, anxiety and/or somatoform disorders and a comparison between native Dutch and Turkish and Moroccan immigrant patients

Many Turkish and Moroccan immigrants moved to the Netherlands in the 1960s and
1970s. They are currently forming the two largest ethnic groups in the
Netherlands. A growing number of Turkish and Moroccan immigrants find their way
to the mental health institutions, including Rivierduinen. However, these
mental health institutions cannot offer accurate mental health care for the
majority of the first generation Turkish and Moroccan immigrants, because the
first generation immigrants often do not master the Dutch language.
Even for Turkish and Moroccan immigrants who do speak Dutch sufficiently it is
difficult to complete a questionnaire, because current questionnaires are
designed to measure symptoms of patients of Dutch ethnicity. This is not only
due to the language barrier, but also due to cultural barriers. **
Mental health care institutions have the obligation to ensure high quality care
for all patients. It starts with identifying the exact nature and severity of
the symptoms. To offer high quality care it is essential to both translate and
culturally adapt questionnaires to the Moroccan Arabic, Tarifit and Turkish
language. Furthermore, translated and cross cultural adapted questionnaires are
essential to adequately compare immigrants with the native population.

Our aim is to make ROM suitable for patients of Moroccan or Turkish origin. In
order to achieve this, necessary steps need to be taken: (1) translate and
cross cultural adapt ROM questionnaires; (2) validate the translated
questionnaires; and (3) compare the results of the questionnaires obtained from
patients with different ethnic backgrounds (native Dutch, Moroccan, Turkish).

The process of translation and cross-cultural adaptation will follow
internationally accepted guidelines and consists of six steps: (1) translation;
(2) synthesis of translations; (3) backwards translation; (4) Review Committee;
(5) pilot study; and (6) evaluation of psychometric properties of the adapted
questionnaire. **
A pilot study will ensure the questionnaires are properly translated and
culturally adapted. Interviews with a small number of patients and focus groups
with healthy patients will take place to evaluate the comprehension and
cultural relevance of the translated versions of the questionnaires. After
this evaluation the psychometric properties of the translated instruments will
be tested by assessing the results of Moroccan and Turkish patients with MAS
disorders and healthy Moroccan and Turkish participants. Internal consistency
and several aspects of validity (concurrent, discriminant, cross-cultural) will
be investigated. In addition, the cut-off scores of the translated instruments
for both the Moroccan and Turkish patients will be established.
**As part of sub-projects II and III, the participants will complete the
standard ROM procedure, supplemented by additional instruments. The ROM data of
native Dutch patients will be compared with ROM data from patients of Moroccan
or Turkish origin throughout sub-projects II and III.

There are no burdens or risks for participants during this study. ROM
measurements are part of the standard diagnosis and treatment procedure of
participating institutions and therefore the burden for patients participating
in this study is minimal. Obtained data will be encrypted to protect the
privacy of participants.**
Patients will be informed about the study and asked to sign an informed consent
before participating. They will be given one or two weeks to consider
participating in this study. Participants are also informed that they can
withdraw from participation any time and for any reason during the study
without affect on future treatment at Rivierduinen, RIAGG Rijnmond or i-psy
Amsterdam.