How to adapt a measure for use in a different population?
Background
Nutrition and dietary behaviors play an important role in the development of chronic diseases for Asian American adults, including those who are caregivers of Asian American children. However, food preferences and patterns are often different for Asian American sub-groups and thus require tailored instruments to capture nutrition and dietary behaviors. Developing high quality tools that capture culturally-specific and culturally-preferred foods among ethnic minority groups is important to reduce health inequities in the United States.
Glossary
Adaptation refers to the process of making thoughtful and planned alterations to the design or delivery of an evidence-based intervention or tool, with the explicit goal of improving fit or effectiveness in a specific context. Cultural adaptation, more specifically, refers to adaptations that pay attention to the importance of cultural factors and accounts for cultural patterns, meanings, and values within that context.
This case study describes how one team approached the process of adapting the 26-item Dietary Screener Questionnaire (DSQ) from the 2009–2010 National Health and Nutrition Examination Survey (NHANES) to be both relevant and culturally appropriate for English-speaking Asian American families. Specifically, the research team adapted the DSQ to better reflect the diets of Chinese, South Asian, Filipino, Korean, Vietnamese, and Japanese Americans, which represent 85% of Asian Americans. The research team planned to adapt the DSQ after searching the peer-reviewed literature and “grey” literature on Google Scholar and identified that currently, no dietary screeners exist that capture the variety of food preferences and patterns specific to Asian American sub-groups.
Considerations and challenges
Why is it important to develop and culturally adapt measures to be relevant to Asian American adults and children?
Asian Americans are an underserved yet understudied population. Applications of culturally adapted tools can help ensure more accurate data collection by providing specific examples of foods that are consumed by first-, second- and/or third- generation Asian ethnic subgroups. The overarching goal is to advance population health equity by filling gaps in knowledge about different Asian households and families.
What are the parameters for how the tool will be used?
In this case study, the selection of a specific tool is guided by 1) length—the tool must be short and validated, 2) delivery options—can it be delivered online, and 3) adaptability—does it allow for conversion of screener responses to dietary factors of interest. After examining the evidence-based tools listed in the National Cancer Institute’s Register of Validated Short Dietary Assessment Instruments, the research team makes the decision to adapt the DSQ. They recognize that the original DSQ did not capture foods typically consumed by Asian American families, including expectations of what a typical “plate” looks like in Asian American households—a lesson the research team learned from prior work to culturally adapt plate planning tools for multiple Asian subgroups. For example, among the many food options listed in the prompts/probes under each item in the DSQ, the majority 1) are not commonly found in Asian ethnic grocery stores, bakeries, coffeeshops, and household pantries, and 2) did not include traditional and popular items that are commonly found in Asian ethnic grocery stores, bakeries, coffeeshops, or household pantries.
Who is the target population, and what degree of adaptation is needed?
Practitioners and researchers should be specific in understanding who their target population is by age, ethnic subgroup, language preference, and acculturation level (i.e., adaptation to U.S. norms and values). These factors help determine the degree of cultural adaptation that is necessary and would be acceptable to the target population. For example, is a larger-scale “macro” adaptation required or would smaller-scale “micro” adaptation be more appropriate. For this case study, it is important to note that because the planned survey would be administered online and in English, the research team knows that they would likely be reaching Asian Americans with higher lev