Year : 2021  |  Volume : 33  |  Issue : 1  |  Page : 1-4

The impact of age and education level in the linguistic validation of the Acute Cystitis Symptom Score (ACSS) questionnaire

1 Department of Urology, Tzaneio General Hospital of Piraeus, Piraeus, Greece
2 Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
3 Department of Urology, Technical University of Munich, Munich, Germany

Correspondence Address:
Konstantinos Stamatiou
Department of Urology, Tzaneio General Hospital of Piraeus, Piraeus
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/HUAJ.HUAJ_19_21

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Introduction/Purpose: The Acute Cystitis Symptom Score (ACSS) was developed as a simple and self-reporting questionnaire for diagnosing and monitoring acute uncomplicated cystitis in female patients. It consists of 18 questions placed in four subcategories: (1) typical symptoms, (2) differential diagnosis, (3) quality of life and (4) coexisting gynecological conditions. It has been translated into many languages. The purpose of this work is the linguistic evaluation of ACSS in the Greek language. Materials and Methods: The translation of ACSS into Greek was carried out in accordance with international standards and guidelines. The process consisted of 4 stages: in the 1st and 2nd stage a translation was made into the target language (Greek) from the original (Russian, English) by native speakers, while reverse translation and re-evaluation was made by experts whose mother tongue language is the target language. In stage 3, a cognitive assessment was performed by female subjects with and without a history of uncomplicated urinary tract infection. At this stage, based on the degree of understanding, the final draft was chosen between the two drafts of different origins (Russian or English). In stage 4: the final clinical evaluation was performed by female subjects with acute episode of uncomplicated cystitis (Arm 1 - Patients) and female subjects undergoing treatment for any other diseases (Arm 2 - Control). The Memorandum of Understanding between the Greek Study Group of ACSS and the copyright holders of ACSS was made on 17 November 2019 while it has been approved by the Ethics Committee of the Hospital. The diagnosis of acute uncomplicated cystitis was made based on the history and results of laboratory findings. Results: The two pre-final versions in Greek were randomly applied to 15 healthy women aged between 89 and 22 years. The mean age of the final sample was 23.84 years. The level of education differed between a doctorate and a primary school diploma with most participants graduating from universities (8/30) and high school (8/30). According to the answers, 20 women would prefer the English standard translation, compared to 10 women, who preferred the Russian translation. The 2: 1 ratio was similar whether the participants had higher education or not. No significant difference was observed in the mean age of the participants who chose one or the other version. Conclusion: The process of translating and adapting a study instrument such as a questionnaire for a different ethnic group is a difficult task since it requires to adapt it in a culturally relevant and comprehensible form despite peculiarities of the target language. Considering these difficulties, we were able to develop a linguistically validated Greek version of the ACSS, which now can be used for clinical and research purposes in a multidisciplinary fashion.

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