‘Are culturally relevant measures of pain coping strategies needed in African primary care? Findings from the cross-cultural adaptation and validation of the Coping Strategies Questionnaire among people living with chronic low back pain in Nigeria

Problem

Globally, chronic low back pain (LBP) is the leading cause of disability; and most patients report first to primary care centres. Pain coping strategies are important in the persistence of disabling symptoms. However, the exact influence of these coping strategies is unknown in non-English speaking African contexts including Nigeria due to lack of relevant outcome instruments. Qualitative research evidence in rural Nigeria suggests coping strategies such as ‘escaping from the self’, ‘escaping from others’, increased spirituality or religiosity, drug dependence, increased conventional or alternative health care use. The extent to which these strategies facilitate positive or negative adjustment to pain is unclear. Globally, the Coping Strategies Questionnaire (CSQ) is the most commonly used measure of pain coping strategies. This study aimed to cross-culturally adapt and psychometrically test the CSQ for non-English speaking Igbo populations in Nigeria.

Approach

Translation, cultural adaptation, test-retest measurements and cross-sectional study of psychometric properties were conducted. The CSQ was forward and back translated by clinical and non-clinical translators. The translations were evaluated by an expert review committee. The translated measure was piloted amongst 12 rural Nigerian dwellers with chronic LBP using the think-aloud cognitive interviewing style. Internal consistency (Cronbach’s alpha), test–retest reliability (intra-class correlation coefficient – ICC, and Bland–Altman plot), and minimal detectable change were examined amongst 50 people with chronic LBP in rural and urban Nigerian populations. Construct validity was determined by assessing the correlations between the adapted CSQ and measures of disability, pain intensity, fear avoidance beliefs, and illness perceptions using Spearman’s correlation analyses and performing an exploratory factor analysis with 200 adults living with chronic LBP in rural Nigeria.

Findings

The cross-cultural adaptation sample were all rural dwellers with seven men and five women. The test-retest reliability sample were 40% rural dwellers with 32 women and 18 men. The construct validity sample were all rural dwellers with 112 men and 88 women.

Only 14 out of 42 items were reportedly adopted in this population including all items of catastrophising subscale, and all but one item of praying and hoping subscale. Catastrophising (0.85) and praying and hoping (0.86) subscales had the highest Cronbach’s alpha. All subscales had high ICCs (0.77 to 0.91) with Bland-Altman plots that showed good agreement. All coping strategies were positively correlated with self-reported disability, pain intensity, fear avoidance beliefs and illness perceptions. Catastrophising subscale had the highest values (0.589-0.614; 0.469). A seven-factor structure was produced with different items from the original CSQ except for the catastrophising subscale.

Consequences

Catastrophising, and praying and hoping may be the relevant pain coping strategies in this population. More culturally relevant measures of pain coping strategies that include adaptive coping strategies may need to be developed for African contexts such as Nigeria.