The translation and validation of the LittlEARS auditory questionnaire in isiZulu

Nefolovhodwe, Thendo Faith

The translation and validation of the LittlEARS auditory questionnaire in isiZulu

Thesis / Dissertation

2025

Publisher

Universiy of Cape Town

Department

Division of Communication Sciences and Disorders

Faculty

Faculty of Health Sciences

Abstract

Hearing loss is a significant contributor to years lived with disability worldwide, affecting approximately 34 million children whose daily lives are substantially impaired. To mitigate the detrimental effects of untreated hearing impairment, paediatric audiologists aim to identify hearing loss as early as possible. This proactive approach enables them to implement timely interventions, ensuring that infants and young children receive the support they need to develop communication skills and overall well-being. Early detection is crucial for optimizing developmental outcomes and enhancing quality of life for these individuals. However, most existing audiological diagnostic tools were developed for older children and are not suitable for assessing auditory development of infants and young children who are not yet verbal. In South Africa, the lack of contextually relevant assessment tools hinders the provision comprehensive audiological rehabilitation. The LittlEARS Auditory Questionnaire (LEAQ) is a parent/caregiver questionnaire that evaluates age-dependent auditory behaviours in the prelingual stage (0-2 years). It screens the auditory development of children with normal hearing as well as those with hearing loss who are fitted with hearing aids or cochlear implants. The responses obtained from the questionnaire are derived from observations made by caregivers or parents since assessing auditory behaviours in paediatric populations is often more complex than in adults. This reliance on caregiver insights is crucial, as formal testing methods may not capture the nuances of a child's auditory experiences. The LEAQ contains questions tailored to specific age groups with the auditory response complexity increasing as the child progresses through different developmental stages. Originally developed in Germany, the LEAQ has been translated into at least 21 languages. Therefore, translating and validating this tool for South Africa's multilingual and multicultural context is essential. This study aimed to (1) translate the English version of the LEAQ into isiZulu, and (2) validate the isiZulu translation. Methods: The study aimed to (1) translate the English version of the LEAQ into isiXhosa and (2) validate the isiZulu translation. Translation Process: (1) Forward translation from English to isiZulu, (2) back translation from isiZulu to English, and (3) an expert committeereview. Validation process: An expert panel (n=6) used acontent validity questionnaire to evaluate the appropriateness and relevance of LEAQ items. 57 isiZulu-speaking parent/caregiver participants completed both the isiZulu version of the LEAQ and a face validity questionnaire. The reliability of the translated LEAQ was assessed through item and scale analysis. Results: Item Content Validity Index (I-CVI) results (0.8-1) indicated relevance across all items of the LEAQ. ScaleContent Validity Index (S-CVI) (0.914) indicated a high content validity of the isiZulu LEAQ. Face validity analysis indicated that all items on the LEAQ achieved an agreement score of ≥80%. The indices of difficulty (0.71-1), signifying that all items on the isiZulu LEAQ were easily comprehensible. All items presented with strong discrimination power ≥0.2. The Cronbach's alpha results indicated good internal consistency with α = 0.86. Conclusion: The findings indicated that following a rigorous translation procedure is useful, as it allows for the identification of any inaccuracies or discrepancies during the translation phases to attain the best quality translation. The statistical analysis indicated that the translated isiZulu LEAQ is valid. Therefore, the questionnaire is appropriate for the use amongst isiZulu speakers.