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Enabling Cross-cultural Data Pooling in Trials: Linguistic Validation of the Head
and Neck Body Image Measurement Assessment Inventory for Chinese Patients

W. Xu and H. Wan 2
1

1 2
School of Nursing, Fudan University, China, and Department of Nursing, Shanghai Proton and Heavy
Ion Center, Fudan University, China

Background: Head and neck cancer (HNC) and its treatments cause notable distress associated with
body image. Ongoing psychological assessments using disease-specific patient-reported measures
(PROMs) may optimize clinical decision-making and facilitate interventions that reduce the patient’s
psychosocial burden. The Inventory to Measure and Assess imaGe disturbencE-Head and Neck
(IMAGE-HN) is a psychometrically sound, multidomain PROM for HNC-related body image distress
(BID). However, there PROMs of HNC-related BID for use in China are lacking.

Objective: The search for a reliable measurement that can effectively identify Chinese HNC patients with
BID and provide solid reference for subsequent precise interventions is well worth our consideration.

Methods: Following established guidelines for translation and linguistic validation of PROMs, IMAGE-HN
underwent forward translation by two independent reviewers, reconciliation, independent backward
translation, creation of translation reports, and expert review to create a preliminary Chinese version
of the IMAGE-HN which subsequently underwent cognitive debriefing interviews with 18 patients with
HNC and 4 healthcare professionals. The semantic, cultural, and conceptual equivalence of the
Chinese version of IMAGE-HN was evaluated.

Results: The Chinese-IMAGE underwent cognitive debriefing with 18 patients with HNC. Among these
patients, the median (range) age was 39 (20-52) years, and 7 patients (39%) were female. The cancer
Oral Presentation Abstracts
subsites were 38.9% nasopharyngeal, 16.7% oral cavity, 11.1% laryngeal, 11.1% salivary gland, and 22.2% other
HNC. Semantic issues were identified with 6 Chinese items and resolved to achieve equivalence with the
original IMAGE-HN items. The items’ ease of comprehension, ambiguity, level of difficulty to understand, and
perceived offensiveness of the Chinese version of IMAGE-HN were 99.48%, 0.78%, 0% and 0%, respectively.
Interviews with healthcare professionals indicated that all items were equivalent to the original versions.

Conclusion: We have culturally adapted and linguistically validated a Chinese version of IMAGE-HN as the
first Chinese language PROM of HNC-related BID for clinical and research use in this patient population.

Keywords: IMAGE-HN, body image distress, head and neck cancer, translation, cultural adaptation,
linguistic validation

_____________________________________________________________________________________________________
Correspondence: Hongwei Wan, Department of Nursing, Shanghai Proton and Heavy Ion Center,
Fudan University, China
E-mail: 1341074403@qq.com

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