Abstract:
مقدمه: «سواد سلامت روانِ مثبت»، یعنی آگاهی از چگونگی حفظ و ارتقای سلامت روان، بخش عمدهای از تعریف سازمان بهداشت جهانی از سلامتی است. پرسشنامۀ آگاهی از سلامت روانِ مثبت نخستین ابزار سنجش سواد سلامت روانِ مثبت میباشد. هدف این مطالعه، ترجمه و تطابق فرهنگی این ابزار به زبان فارسی و سنجش ویژگیهای سایکومتریک آن بود.
روش: ترجمه و تطابق فرهنگی طبق روش بیتون و همکاران انجام شد. جامعۀ آماری عبارت بود از ایرانیان فارسیزبان باسواد با سن حداقل 15 سال و دارای توانایی استفادۀ ابتدایی از اینترنت. نسخۀ فارسی با نمونهگیری آسان در قالب آنلاین بین این افراد توزیع شد. روایی صوری و محتوا به شیوۀ کیفی، و روایی ساختار به کمک تحلیلهای عاملی اکتشافی و تاییدی بررسی شد. پایایی با بررسی همسانی درونی با محاسبۀ آلفای کرونباخ و دونیمهسازی سنجیده شد.
یافتهها: در فرآیند ترجمه توافق بالایی مشاهده و روایی صوری و محتوا با نظر متخصصان و مصاحبه با 30 نفر از گروه هدف تایید شد. سپس پرسشنامه توسط 1606 نفر تکمیل شد. روایی سازه طبق تحلیلهای عاملی اکتشافی و تاییدی رضایتبخش بود. پایایی طبق آلفای کرونباخ 0.81 و ضریب دونیمهسازی گاتمن 0.79 مناسب بود. نسخه نهایی دارای 1 عامل و 10 گویه و میانگین نمرۀ سواد سلامت روانِ مثبت 4.21 از 5 (SD = 0.72) بود.
بحث: پرسشنامه سواد سلامت روان مثبت در افراد 15 سال به بالای باسواد و دارای تواناییهای ابتدایی استفاده از اینترنت روایی و پایایی مناسبی دارد؛ لذا میتواند در سنجش آگاهی افراد از عوامل موثر بر حفظ و ارتقای سلامت روان و بررسی اثربخشی مداخلههای مربوطه استفاده شود.
Abstract
Introduction. Higher mental health literacy is related to many desirable mental health outcomes. Most studies, however, have focused on disease-oriented MHL and have not investigated positive MHL (PMHL) i.e. understanding how to maintain and improve one's mental health. This study aimed to translate a measure of PMHL named Mental Health Positive Knowledge (MHPK) to Persian and check its psychometric properties.
Methods. The translation and cultural adaptation process was performed according to Beaton et al. Any Iranian individual with a minimum age of 15 years, literacy for reading and writing, and basic internet skills could be included using a convenient method of sampling. Face and content validity were assessed by qualitative methods. Exploratory and confirmatory factor analyses were used to investigate construct and convergent validity. The split-half method and internal consistency were examined as reliability measures.
Findings. Forward and backward translations and expert panel session were used. To investigate psychometric properties a total of 1606 individuals with a mean age of 29.9 years (SD = 9.14) were recruited; 176 participants were below 18. Exploratory and confirmatory factor analyses showed a construct compatible with the original version. Cronbach's alfa of 0.81 and Guttman split-half coefficient of 0.79 were measured as reliability indices. The final version contains 1 factor and 10 items and average MHPK score was 4.21 (SD = 0.72).
Discussion. Using the MHPK questionnaire which is a measure of positive mental health literacy (PMHL) can improve MHL investigations and can help to evaluate mental health educational interventions. This study showed that the Persian MHPK is a valid and reliable measure of PMHL for literate individuals with an age of 15 years and higher.
Extended Abstract
Introduction:
Mental health literacy (MHL) is a derivative of the known concept of health literacy. It is a modifiable factor that can affect a wide range of beliefs and behaviors related to mental health. In recent conceptualizations four domains are suggested to construct MHL including 1) being familiar with mental disorders, 2) stigma against disorders and treatment, 3) help-seeking competency, and 4) understanding factors that keep and improve onechr('39')s mental health which is known as positive mental health literacy (PMHL).
Many studies around the world have shown that higher MHL is related to desirable outcomes like higher help-seeking behavior, less stigma, better treatment compliance, and more effective communication with mental health providers. Most of these studies, however, have focused on disease-oriented MHL; i.e. have not investigated PMHL. This is not compatible with the World Health Organization (WHO)chr('39')s definition of health which insisted that health is not just the absence of disease. This gap limits peoplechr('39')s and professionalchr('39')s understanding of mental health to the medical model. Some researchers, therefore, have suggested including PMHL in MHL investigations in adults and adolescents.
Despite the high variability among MHL measures most of them are disease-oriented. In recent years more attention is being paid to awareness of mental health maintenance and promotion, i.e. PMHL. The first PMHL questionnaire was introduced in 2017 and is named Mental Health Positive Knowledge (MHPK). It is a single construct instrument with 10 brief questions in the English language. The average of all questions makes up the total score which is from 0 to 5. The MHPK is tested in a population of Norwegian adolescents and the total score of 4 is considered as a preliminary cut-off of sufficient PMHL.
Using MHPK can fill the gap between the daily practice of mental health staff and standard definitions of health and mental health and extend our understanding of MHL beyond disease concepts. It can also be used to determine the efficacy of positive mental health educational interventions. Several studies have investigated positive mental health and its determinants in the Iranian population. No study however was found to explore PMHL, i.e. peoplechr('39')s awareness of positive mental health. There was also no instrument to measure PMHL in the Persian language according to the literature review. To use a valid instrument that is developed in another language and culture, it is necessary to ensure its compatibility with the target population. This study, therefore, aimed to translate MHPK to the Persian language with proper cultural adaptation along with checking its psychometric properties.
Methods:
The translation and cultural adaptation process was performed according to Beaton et al. It included two forward and two backward translated versions and an expert panel that resulted in a refined Persian MHPK with satisfactory face and content validity. This Persian version was used in the pretest, i.e. asking 30 participants from the target population to fill the questionnaire and interviewing with them about its clarity and propriety. The final version and demographic questions were prepared as an online form and could be filled by any Iranian individual with a minimum age of 15 years, literacy for reading and writing, and basic internet skills. Answering all questions was necessary to submit the form therefore there were no missing data. Exploratory and confirmatory factor analyses were used to investigate the construct validity of Persian MHPK. The split-half method and measuring Cronbachchr('39')s alfa were used to investigate its reliability. Mean, standard deviation (SD), 95% confidence interval (95% CI), and frequency were used to describe data. SPSS Statistics for Windows, version 16 (SPSS Inc., Chicago, Ill., USA) and Mplus software version 7.4 were used. Participants were kept anonymous and the research protocol was approved by the ethics committee of Iran University of Medical Sciences. There was no conflict of interest for the authors.
Results:
Forward and backward translations were quite similar to each other and the original English questionnaire. Expert panel members discussed the accuracy and appropriateness of the Persian version and agreed easily on details. A brief explanation was added to some items in parenthesis to be sure about the face and content validity. In the pretest, 30 individuals with a mean age of 27.9 participated including 8 adolescents and all of them found the instrument clear and without offensive content. Four of them, however, were not sure about the exact meaning of item number 8 ("Setting limits for what is OK for you"). To investigate psychometric properties a total of 1606 individuals from different cities of the country were recruited. The mean age was 29.9 (SD = 9.14) and ranged from 15 to 69; 176 participants were adolescents with ages below 18 years old. Most of the participants (71.9%) were female and 235 of them (15.2%) didnchr('39')t have a university degree. The average MHPK score was 4.21 (SD = 0.72) with a 95% CI of 4.18 – 4.25. Near a quarter of participants (24.4%) scored below the preliminary cut-off and may be considered to have insufficient PMHL. Females and participants with master or higher university degrees showed significantly higher MHPK scores (both p values
Discussion:
In this study, the MHPK questionnaire which is a measure of positive mental health literacy (PMHL) was translated to Persian by using a standard method to ensure its validity and cultural adaptation. Afterward, its psychometric properties were investigated and showed good validity and reliability. Persian MHPK is a single factor instrument according to exploratory and confirmatory factor analyses; this is compatible with the construct of the original version. The average MHPK score evaluated in Norwegian adolescents by the original version has been 4.51 and less than 20% of them showed insufficient scores. These results are better than the findings of the currents study with much more educated participants. The better results in the Norwegian sample may be due to the effects of the translation process on scores or may be another example of higher MHL in developed countries compared to developing nations like Iranians. Females showed higher PMHL both in the Norwegian sample and in the current study. A big sample size with considerable diversity and standard methodology were advantages of this study but there are some limitations. All of the high school students who participated in this study were from Tehran, the capital of the country. Besides, all participants were capable of using the internet. Therefore, some psychometric properties may need to be tested before using the instrument in different communities. Validity and reliability could be inspected in more detail. Persian MHPK is the first Persian instrument to evaluate PMHL and is one of the few in the world. Using it besides conventional disease-oriented MHL measures can improve MHL evaluation in accordance with the WHO definition of health and mental health. Furthermore, adding PMHL concepts to mental health education interventions can make them applicable for all people regardless of being mentally healthy or ill. This study showed that Persian MHPK is a valid and reliable measure of PMHL for literate individuals with an age of 15 years and higher.