Translation and socio-linguistic adaptation of the Maltese version of the decision regret scale

Alice Silvia Brera; Justin Lee  Mifsud; Josef Trapani; Maria Cassar; Gianluca Conte; Arianna Magon; Silvia  Belloni; Pier Mario Perrone; Silvana Castaldi; Cristina Arrigoni; Rosario Caruso

doi:10.23750/abm.v96i5.17213

Translation and socio-linguistic adaptation of the Maltese version of the decision regret scale

Authors

Alice Silvia Brera Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy https://orcid.org/0000-0003-1107-768X
Justin Lee Mifsud Faculty of Health Sciences, Mater Dei Hospital, Msida, Malta https://orcid.org/0000-0001-5380-9418
Josef Trapani Faculty of Health Sciences, Mater Dei Hospital, Msida, Malta https://orcid.org/0000-0003-0888-5045
Maria Cassar Faculty of Health Sciences, Mater Dei Hospital, Msida, Malta https://orcid.org/0000-0002-1716-3207
Gianluca Conte Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy https://orcid.org/0000-0002-8171-8203
Arianna Magon Health Professions Research and Development Unit, IRCCS Policlinico San Donato, San Donato Milanese, Italy https://orcid.org/0000-0003-0440-6940
Silvia Belloni Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy https://orcid.org/0000-0002-5187-2410
Pier Mario Perrone Department of Biomedical Sciences for Health, University of Milan, Milan, Italy https://orcid.org/0000-0002-2437-1696
Silvana Castaldi Department of Biomedical Sciences for Health, University of Milan, Milan, Italy; Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy https://orcid.org/0000-0003-1716-6624
Cristina Arrigoni Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
Rosario Caruso Department of Biomedical Sciences for Health, University of Milan, Milan, Italy https://orcid.org/0000-0002-7736-6209

Keywords:

decision regret, patient-reported outcome measures, content validity, cross-cultural adaptation, non-communicable diseases, Maltese version

Abstract

Background and aim: Decision regret (DR) is critical in patient-centred care, especially among individuals with chronic diseases who face complex healthcare decisions. Despite growing interest in DR as a measurable construct, no validated instrument exists in the Maltese language. This study aimed to translate the 5-item Decision Regret Scale (DRS) into Maltese and to evaluate its content validity, following a structured methodological approach.

Methods: The study adopted a two-phase methodological design. In Phase One, the DRS was translated into Maltese using a collaborative and iterative model, as described by Douglas and Craig, which involved forward translation, synthesis, expert adjudication, and back-translation. Phase Two evaluated both quantitative and qualitative content validity. A panel of eight experts assessed the relevance and clarity of each item using the Content Validity Ratio (CVR), Item- and Scale-level Content Validity Indexes (I-CVI and S-CVI). Qualitative feedback was also collected to explore face validity and semantic nuances.

Results: All items demonstrated acceptable CVR, I-CVI, and S-CVI values after two rounds of expert review. Items 3 and 5 required further discussion due to initial concerns about semantic overlap, resulting in the revision of item 3. Additionally, minor changes were introduced to enhance conceptual clarity. Final indices confirmed the content validity of all five items.

Conclusions: The Maltese version of the DRS was found to be culturally appropriate, linguistically accurate, and content-valid. Further psychometric studies are recommended to assess construct validity, reliability, and responsiveness in clinical populations.

Author Biography

Rosario Caruso, Department of Biomedical Sciences for Health, University of Milan, Milan, Italy

Associate Professor of Nursing Science, Department of Biomedical Sciences for Health, University of Milan.

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