Cross-cultural adaptation and psychometric validation of the Sinhala version of the Hazardous Drug Handling Questionnaire (Si-HDHQ)

Imagine the hospital as a high-stakes kitchen where chefs (oncology nurses) are preparing a very special, very dangerous meal: chemotherapy. If they spill a drop or breathe in a tiny bit of the steam, it can hurt them just as much as the food is meant to help the patient. To keep these chefs safe, experts have created a giant "Safety Checklist" called the Hazardous Drug Handling Questionnaire (HDHQ). For years, this checklist only existed in English, like a recipe book written in a language the Sri Lankan chefs couldn't read.

This paper is the story of how a team of researchers took that English recipe book and translated it into Sinhala, the local language of Sri Lanka, to create a new version called the Si-HDHQ. But they didn't just swap words; they had to make sure the new book made sense in the Sri Lankan kitchen.

The Translation Adventure: Making the Recipe Fit the Kitchen

Imagine trying to translate a recipe that says, "Ask your 'Supervisor' for help." In the US, that word might mean one thing, but in Sri Lanka, nurses have specific titles like "Sister," "In-charge Nurse," or "Matron." The researchers realized that if they kept the word "Supervisor," the nurses might get confused. So, they swapped it for the local titles.

They also had to deal with ingredients that didn't exist in Sri Lanka. The original book mentioned "lab coats," but the researchers found out that nurses in Sri Lanka don't actually wear those for this specific job. So, they took the lab coat instructions out of the book entirely. They even kept some English words like "chemotherapy" and "PPE" (Personal Protective Equipment) right inside the Sinhala sentences, like leaving a few English spices in a local dish, because the nurses knew those terms better than any Sinhala translation.

The Taste Test: Does the New Book Work?

Once the new Sinhala book was ready, the researchers had to see if it actually worked. They handed it out to 250 oncology nurses at the National Cancer Institute in Sri Lanka. Think of this as a massive taste test to see if the recipe was clear and if the questions actually measured what they were supposed to measure.

1. Does it taste right? (Content Validity)
A panel of five experts (like master chefs and food critics) tasted every single question. They gave it a thumbs-up, saying the questions were relevant and clear. Almost every section got a perfect score, meaning the experts agreed the book was ready for the kitchen. However, one question about "Interpersonal Influences" (how much nurses think their coworkers care about safety) got a low score from one expert. The researchers decided to keep it anyway because it had been used in other studies before, but they admitted it was a bit of a gamble.

2. Is the recipe consistent? (Internal Consistency)
The researchers checked if the questions in each section were all asking about the same thing. For nine out of eleven sections, the answers were consistent, like a recipe where every step leads logically to the next. The score for consistency (called Cronbach's alpha) was between 0.603 and 0.892. Two sections, "Chemotherapy Exposure Knowledge" and "Conflicts of Interest," had scores a little lower than the ideal 0.70, suggesting those topics are a bit messy and hard to pin down with just one set of questions.

3. Does it measure one thing or many? (Construct Validity)
Here is where things got interesting. The researchers tried to see if the questions grouped together neatly.

• The "Risk Perception" section (how scared the nurses are of the drugs) was perfectly clear: all three questions pointed in the same direction, like a single arrow hitting the bullseye.
• But the other sections? They were more like a jigsaw puzzle with multiple pictures. For example, the "Work Safety Climate" section didn't just show one picture; it broke down into seven different factors, like safety leadership, workload, and equipment availability. This wasn't a mistake; it just meant that in Sri Lanka, "safety climate" is a complex idea made of many different parts, not just one simple feeling.

4. Does it stick? (Reliability)
To see if the book gave the same answers over time, 50 nurses took the test twice, a few weeks apart. The results were stable, with scores ranging from 0.674 to 0.924. This means if a nurse said, "I always wear gloves," they were likely to say the same thing a few weeks later. The book is reliable.

The Surprising Discovery: The "Floor" Effect

One of the most vivid findings was a "floor effect" in the section about how often nurses see their coworkers wearing safety gear. About 19.2% of the nurses (that's 48 people) scored at the very bottom, meaning they almost never saw their peers wearing protective gear.

This isn't a flaw in the book; it's a real-life observation. The book didn't fail to measure the data; it successfully measured a sad reality: in this hospital, safety gear isn't being worn by the team as often as it should be. It's like a thermometer that correctly reads "freezing" when the room is actually cold. The paper argues this is a genuine pattern that needs fixing, not a broken tool.

The Verdict

The paper concludes that the Sinhala version of the Hazardous Drug Handling Questionnaire (Si-HDHQ) is a valid and reliable tool. It has been successfully adapted to fit the Sri Lankan context, with its own unique cultural flavors and missing ingredients removed.

The authors suggest that this new tool can now be used to study and improve safety practices for oncology nurses in Sri Lanka. They don't claim it has solved the safety problem yet; rather, they have built a sturdy, accurate ruler that can finally measure the problem clearly, so that future interventions can be designed to fix it. The ruler is ready, but the work of making the kitchen safe is just beginning.