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ORIGINAL ARTICLE
Year : 2016  |  Volume : 14  |  Issue : 2  |  Page : 171-174

Cross-cultural content validation of a modified service quality questionnaire in Kannada


Department of Public Health Dentistry, Bapuji Dental College and Hospital, Davangere, Karnataka, India

Date of Web Publication10-Jun-2016

Correspondence Address:
Akhil Pallepati
Department of Public Health Dentistry, Bapuji Dental College and Hospital, MCC B' B Block, Davangere - 577 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.183811

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  Abstract 


Introduction: Many variables of interest in healthcare research are abstract concepts. Reliable and valid instruments are required for the researchers to study complex constructs. Hence, measuring and reporting validity of instruments is incumbent where content validity shows to be a promising tool. Aim: To content validate the Kannada translated modified service quality (SERVQUAL) questionnaire. Materials and Methods: A modified SERVQUAL questionnaire consisting of 15 close-ended questions was prepared and translated to Kannada language. Content validity of the questionnaire was calculated by content validity ratio after distributing to a panel of five subject matter experts (SME's). SME scored the questionnaire according to relevance, clarity, simplicity, and ambiguity. It was later modified according to the inputs of SME's, and final content validity index of the questionnaire was obtained. Results: The content validity scores based on the relevance, clarity, simplicity, and ambiguity were 0.97, 0.97, 0.97, and 0.94, respectively for the translated and modified SERVQUAL Kannada questionnaire. Overall, CVI score was 0.96. Conclusion: The content of the present questionnaire is validated in respect to relevance, clarity, simplicity, and ambiguity. It can be utilized in future by the researchers for assessing the SERVQUAL of hospitals in Kannada language.

Keywords: Content validity index, service quality Kannada questionnaire, subject matter experts'


How to cite this article:
Prakash S, Pallepati A. Cross-cultural content validation of a modified service quality questionnaire in Kannada. J Indian Assoc Public Health Dent 2016;14:171-4

How to cite this URL:
Prakash S, Pallepati A. Cross-cultural content validation of a modified service quality questionnaire in Kannada. J Indian Assoc Public Health Dent [serial online] 2016 [cited 2019 Nov 15];14:171-4. Available from: http://www.jiaphd.org/text.asp?2016/14/2/171/183811




  Introduction Top


Measurement is assigning of numbers to observations to quantify phenomena. Key indicators of the quality of a measuring instrument are the reliability and validity of the measures.[1] Reliable and valid instruments are required for the researchers to study complex constructs.[2] The process of developing an instrument is in large part focused on reducing error in the measurement process.[1] Hence, the important goal for any instrument developer is the development of a valid instrument.[3]

Validity is often defined as the extent to which an instrument measures what it purports to measure.[1] It is classified as face, content, criterion, and construct validity. In which, content validity refers to the degree that the instrument covers all the domains, it is supposed to measure.[4] According to Burns and Grove,[5] content may be obtained from 3 sources: Literature, representatives of the relevant populations, and experts.

Abstract concepts are very common in healthcare research. Using instruments that are valid and reliable to measure constructs are a crucial component of research quality. Hence, measuring and reporting validity of instruments is mandatory. Zeithami, Parasuraman, and Berey developed a service quality (SERVQUAL) framework in 1980 which aimed at measuring the scale of quality in the service sectors.[6] This questionnaire tries to measure the level of importance as well as the performance of quality attributes.[7] Quality service is the need of the hour. It is assessed through questionnaire from patients. After a thorough literature search, most commonly used, simple SERVQUAL questionnaire was chosen and modified to suit the local situations. Available literature contains questionnaire in English, which may not be understood by many patients attending the hospital. Hence, there is a need to have the questionnaire in local language. There are no studies validating a questionnaire to assess patients' satisfaction in Kannada language; hence, a study was conducted with the objective of validating the tool using content validity index.


  Materials and Methods Top


A modified SERVQUAL questionnaire consisting of 15 close-ended questions was prepared to assess the patients' satisfaction regarding dental treatment in Dental College and Hospital. It was translated to local (Kannada) language. The questionnaire was divided into two sections. Section I dealt with demographic details and Section II contained questions pertaining to hospital service, lunch schedule, appointment schedule, drinking water facility, and behavior of doctor in the hospital.

To know the validity of the questionnaire, content validity was measured by content validity ratio (CVR): CVRi= neN/2/N/ 2.

CVRi= CVR value for the i th measurement item; ne= number of subject matter experts (SMEs) indicating a measurement item is “essential”; N = total number of SMEs in the panel; CVR equation takes on values between −1.00 (strong disagreement) and +1.00 (strong agreement).

Content validity index

The CVI is the mean of the CVR values of all the retained items.

The questionnaire was distributed to a panel of five SMEs to indicate whether or not a measurement item is “essential” for operationalization of the questionnaire. Two faculties from public health dentistry, two from periodontology, and one from oral medicine and radiology were invited as SMEs. They thoroughly scrutinized the questionnaire and scored for relevance, clarity, simplicity, and ambiguity individually, and the overall score was calculated. According to the inputs of SME's, the following questions were eliminated, and a few questions were added to the questionnaire.

The eliminated questions are:

  1. Charges for the services rendered by hospital are affordable
  2. The employees of the hospital are never busy to respond to your requests
  3. Employees of the hospital understand your specific needs.


Questions added according to the inputs put forth by the subject matter experts are:

  1. Fundamental facilities (drinking water, lift, toilets, and wheel chair) are available
  2. In hospital, importance is given to cleanliness
  3. Measures are taken to prevent the transfer of disease from person to person.



  Results Top


Content validity of the questionnaire was measured by CVR. It was calculated individually based on the SME's opinion on relevance, clarity, simplicity, and ambiguity of the questions. Three questions having a CVR score of −0.2 were eliminated, three new questions were added. Final CVI scores were 0.97, 0.97, 0.97, and 0.94 for relevance, clarity, simplicity, and ambiguity, respectively [Table 1]. Overall, CVI score for the modified SERVQUAL Kannada questionnaire was 0.96.
Table 1: Content validity ratio and content validity index scores based on relevance, clarity, simplicity, and ambiguity

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  Discussion Top


Content validity is a cardinal step in developing new device used in experiments because it represents an initiating mechanism for linking abstract concepts with observable and measurable indicators.[8] Content validation is a two-step process beginning with the development stage and ending with the judgment quantification process. The development stage requires an extensive review of the literature to identify the content for the instrument and constitute relevant domains.[9]

Adaptation may be made to the content, format, response options, or visual presentation of any part of an instrument. The purpose of adaptation is to better fit needs of a new population, location, language or mode, or any combination of these. Although the original SERVQUAL has been successfully used in many countries, no studies have been published on cross-cultural validity of the revised instrument. To ensure cross-cultural competent questionnaire, it was translated to local language.

Researchers should not simply consider translation as the answer to help the respondent understand the questionnaire better. Validated questionnaires are precision measurement instruments such as mechanical and electrical measurements. The only difference in that is earlier measures the subjective status and the later measures objective status. Thus, one should never think of changing the validated questionnaire. Even a very small change can distort its validity.

A study was conducted by Yaghmale in which the questionnaire was rated by the experts based on relevance, clarity, simplicity, and ambiguity on 4-point scale.[5] This study questionnaire was validated based on the above parameters, and we achieved CVI scores of 0.97, 0.97, 0.97, and 0.94, respectively. Taking all these into consideration, overall CVI score was 0.96.

A rubric was developed by Lynn et al.[9] which states a CVI of 0.70 represents average agreement; 0.80, adequate agreement; 0.9, good agreement, and CVI of 1.00 indicates 100% agreement between raters. Content validity of the current questionnaire was 0.96. This is similar to the results from the panel of experts in a study by Sirajudeen et al. where the experts' agreement was 0.98 or 98%.[4]

The ratings given by the experts are too subjective, and hence, they pose a serious threat to validity. In addition, it is very difficult to pinpoint a source of error in the ratings which would be a limitation of this study. Since it is not possible to generate feedback from experts in a consensus building meeting, errors may always be a matter of speculation. Content validity is an important factor which identifies the concept of measuring; however, it is not a sufficient indication that the instrument actually measures what is intended to measure.[5] Researchers should have a more comprehensive view of content validity. A single approach is insufficient, and a variety of approaches should be tested.


  Conclusion Top


The content of the present questionnaire is validated and can be utilized in future by the researchers for assessing the SERVQUAL of hospitals in Kannada language.

However, depending on the functioning pattern of the hospital, its use is warranted. It should be noted that content validity evidence is unitary and requires multiple evidence. Hence, additional research is needed to collect other validity evidence such as construct validity and criterion validity evidence.

Acknowledgment

Our heartfelt gratitude to all the SME's for their participation in the study. We would like to thank Dr. Ambika for helping in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Kimberlin CL, Winterstein AG. Validity and reliability of measurement instruments used in research. Am J Health Syst Pharm 2008;65:2276-84.  Back to cited text no. 1
    
2.
Rubio DM, Berg-Weber M, Tebb SS, Lee ES, Rauch S. Objectifying content validity: Conducting a content validity study in social work research. Soc Work Res 2003;27:94-104.  Back to cited text no. 2
    
3.
Aravamudhan NR, Krishnaveni R. Establishing and reporting content validity evidence of new training and development capacity building scale (TDCBS). Management 2015;20:131-58.  Back to cited text no. 3
    
4.
Sirajudeen MS, Pillai PS, Shah UN, Mohan N. Content validity and inter-rater reliability of a checklist to assess the ergonomic practice of computer professionals. Int J Ther Rehabil Res 2012;1:11-8.  Back to cited text no. 4
    
5.
Yaghmale F. Content validity and its estimation. J Med Educ 2009;3:25-7.  Back to cited text no. 5
    
6.
Parasuraman A, Zeithaml VA, Berry LL. SERVQUAL: A multiple-item scale for measuring customer perception quality. J Retailing 1988;64:12-40.  Back to cited text no. 6
    
7.
Dewi FD, Sudjana G, Oesman YM. Patient satisfaction analysis on service quality of dental health care based on empathy and responsiveness. Dent Res J (Isfahan) 2011;8:172-7.  Back to cited text no. 7
    
8.
Wynd CA, Schmidt B, Schaefer MA. Two quantitative approaches for estimating content validity. West J Nurs Res 2003;25:508-18.  Back to cited text no. 8
    
9.
Lynn MR. Determination and quantification of content validity. Nurs Res 1986;35:382-5.  Back to cited text no. 9
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