CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE MALEKA STROKE COMMUNITY REINTEGRATION MEASURE FOR YORUBA-SPEAKING STROKE SURVIVORS

ABSTRACT

Successful community reintegration is widely recognized as one of the primary goals of stroke rehabilitation because it reflects an individual's ability to resume meaningful social, family, occupational, and community roles following a stroke. Accurate assessment of community reintegration is therefore essential for evaluating rehabilitation outcomes and planning patient-centered interventions. Although several assessment instruments have been developed for this purpose, the Maleka Stroke Community Re-Integration Measure (MSCRIM), originally developed in South Africa, demonstrates strong cultural relevance to many African populations due to its consideration of social beliefs, environmental factors, and community participation. However, differences in language and cultural practices among African populations necessitate careful cross-cultural adaptation before such instruments can be reliably used in different settings.

This study aimed to culturally adapt, translate, and validate the Maleka Stroke Community Re-Integration Measure for Yoruba-speaking stroke survivors in Nigeria. The adaptation process followed the internationally recognized guidelines of the American Association of Orthopaedic Surgeons (AAOS) for the cross-cultural adaptation of self-report measures. Initially, an expert review panel identified 17 items in the original English version that required cultural modification to ensure their relevance within the Yoruba socio-cultural environment. The revised English version was subsequently translated independently into Yoruba by two professional forward translators, after which a consensus version was developed. This version underwent independent back-translation into English by two bilingual translators to verify semantic and conceptual equivalence. Following further expert evaluation, a pre-final Yoruba version was produced.

The pre-final instrument was pilot-tested among 30 Yoruba-speaking stroke survivors, consistent with AAOS recommendations, using cognitive debriefing interviews to determine item clarity, cultural appropriateness, and respondent comprehension. Based on participant feedback, an additional 22 items were modified to improve cultural suitability. Furthermore, a new response category, "Not Available," was incorporated into Domains Two and Five to distinguish respondents who lacked access to particular facilities or opportunities from those who were physically unable to perform the specified activities. This modification enhanced the instrument's contextual relevance and interpretability.

To establish the psychometric properties of the adapted instrument, both the culturally adapted English version and the final Yoruba version were administered to 60 stroke survivors, comprising equal numbers of male and female participants. The Yoruba version was re-administered after one week to evaluate test-retest reliability. Participants had a mean age of 59.98 ± 10.32 years.

Statistical analysis revealed no significant difference between the overall scores obtained from the adapted English version and the final Yoruba version (z = -0.00, p = 1.00), demonstrating strong equivalence between both versions. Similarly, comparisons across individual domains showed no statistically significant differences, providing evidence of satisfactory concurrent validity. Test-retest analysis demonstrated excellent reliability, with a strong positive correlation between the first and second administrations of the Yoruba MSCRIM (r = 0.89, p < 0.001). Internal consistency analysis also indicated acceptable to excellent reliability across the instrument's domains, with Cronbach's alpha coefficients ranging from 0.36 to 0.96.

The findings establish that the Yoruba version of the Maleka Stroke Community Re-Integration Measure is a culturally appropriate, valid, reliable, and internally consistent assessment instrument for evaluating community reintegration among Yoruba-speaking stroke survivors. The availability of this validated tool provides rehabilitation professionals and researchers with a standardized instrument capable of generating accurate assessments within the Yoruba cultural context, thereby supporting improved clinical decision-making, outcome evaluation, and future stroke rehabilitation research in Nigeria.