METHODS

https://doi.org/10.5005/jp-journals-10023-1260
International Journal of Phonosurgery & Laryngology
Volume 14 | Issue 2 | Year 2024

Cross-cultural Adaptation and Translation with Psychometric Properties of Gujarati Version of Evaluation of Ability to Sing Easily Scale for Gujarati Singers: A Methodological Study

Jinal J Parikh¹, Megha S Sheth²

¹Department of Physiotherapy, Ph.D Scholar, Gujarat University, Gujarat University, Khyati Institute of Physiotherapy, Ahmedabad, Gujarat, India

²Department of Physiotherapy, Suresh Brahmkumar Bhatt College of Physiotherapy, Ahmedabad, Gujarat, India

Corresponding Author: Jinal J Parikh, Department of Physiotherapy, Gujarat University, Khyati Institute of Physiotherapy, Ahmedabad, Gujarat, India, e-mail: jinalparikh.phd@gmail.com

Received on: 12 June 2024; Accepted on: 16 October 2024; Published on: 15 November 2024

ABSTRACT

Aims and background: To cross-culturally adapt and translate the Australian English version of the “Evaluation of Ability to Sing Easily” (EASE) scale and to find the validity and reliability of the Gujarati version of “EASE” for the Gujarati singers.

Materials and methods: Permission for cross-cultural adaptation and translation of the Australian English version of the “EASE” scale into the Gujarati language for Gujarati singers was obtained from the author and it was translated with methods directed by the World Health Organization (WHO). For evaluation of psychometric properties, 10 Gujarati professional voice teachers and 13 vocal students were recruited for validity and reliability, respectively.

Result: Content validity index for EASE-G item no. 1-22 was 1 as all experts had agreed for relevance of all the voice descriptors asked in સ્કેલ. The interclass correlation [ICC] was 0.89 which showed good reliability and almost perfect agreement as repeatability and coefficient of Cronbach’s alpha for internal consistency was 0.94 which showed excellent reliability level for overall EASE -G scale scores.

Conclusion: Analysis of psychometric properties has shown that the Gujarati version of “EASE” is a valid and reliable self-administered tool to assess vocal loading as an ability to sing for Gujarati singers.

Clinical significance: The Gujarati version of the “EASE” scale can be used for assessing perceptual singing function specifically for Gujarati singers who know the Gujarati language only.

How to cite this article: Parikh JJ, Sheth MS. Cross-cultural Adaptation and Translation with Psychometric Properties of Gujarati Version of Evaluation of Ability to Sing Easily Scale for Gujarati Singers: A Methodological Study. Int J Phonosurg Laryngol 2024;14(2):43-46.

Source of support: Nil

Conflict of interest: None

Keywords: Evaluation of ability to sing easily scale, Singers, Translation, World Health Organization.

INTRODUCTION

Singing is a vocal art, which requires a healthy physical, mental, and emotional status to learn and perform.¹ Globally, from ancient time singing has been a part of the occupation, entertainment, worshiping, and in the current era as therapy² also. Many professional singers and singer students practice singing as a part of their daily activity, resulting in excessive stress on their vocal health leading to difficulty in singing (dysphonia) specifically. This ultimately leads to voice disuse/overuse and compromises their daily singing practice and/or professional singing life, which in turn gives affection to physical, professional, mental and emotional health.

Dysphonia is a term used for a very wide range of dysfunctions related to voice which ranges from slight hoarseness to complete inability to speak or sing. The etiology of dysphonia can also be varied from congenital to acquired dysphonia. Vocal misuse or overuse which includes speaking/singing too loud with excessive-high pitch and/or vocal overload during vocal training are considered the most common causes of dysphonia.³

Frequent singing practice leads to vocal overload so vocal health should be assessed for the prevention and rehabilitation of voice dysfunction. Among various available methods to assess vocal health based on subjective and objective assessments done by ear, nose and throat (ENT) specialist and speech-language pathologists, one of the ways is self-reported dysphonia evaluation. There are various questionnaires/scales available to measure the vocal function or health subjectively as well, for example, glottal function index (GFI), singing voice handicap index (SVHI), singing voice handicap index-10 (SVHI-10), vocal performance questionnaire (VPQ), voice handicap index (VHI or VHI-30), voice rating scale (VRS), voice-related quality of life (VRQOL), voice symptom scale (VOISS), and evaluation of ability to sing easily (EASE).⁴

Evaluation of ability to sing easily and SVHI are basically used for singing function evaluation. EASE is a 22-item questionnaire designed by Australian author Phyland in 2013 to evaluate the current singing function status of singers. It assesses three factors vocal fatigue (VF), pathological risk indicator (PRI) of vocal function, and vocal concern (VC). The scale includes 10 items addressing VF, 10 items addressing PRI of vocal function, and 2 items addressing vocal confidence. Out of these 22 items, 19 negatively worded items are scored as: 1—not at all, 2—mildly, 3—moderately, and 4—extremely. Whereas, reverse scoring is done for three positively worded items: 4—not at all, 3—mildly, 2—moderately, and 1—extremely. The items measure the current vocal health, confidence, and singing function of the singer.⁵ English versions of EASE have strong internal consistency, intermediate content validity, strong construct validity, and intermediate measurement properties for hypothesis testing.⁶

Evaluation of ability to sing easily has been translated into Brazilian Portuguese,⁷ Chilean Spanish,⁸ Indian Kannada,⁹ and Netherland Dutch language.¹⁰ There is no assessment instrument available for singing function evaluation in the Gujarati language.

Construct validity of the questionnaire is the ability of it to truly measure what it purports to measure. In addition to this, face validity can also be considered as primary validity to determine translated questionnaire’s validity. Reliability or reproducibility is the ability of a questionnaire to produce the same results when administered at two different points in time. As measurement error is present in content sampling, changes in respondents and differences in the consistency of a questionnaire can be evaluated using its internal consistency and test-retest reliability, respectively.¹¹ For all those singers who know only Gujarati language, self-administered singing function evaluation scale is needed for easy assessment of singing. So, the aim of this study is to translate, cross-culturally adapt the English version of EASE scale in Gujarati language which can help to evaluate the singing function of Gujarati singers and also to find the validity and reliability of it.

MATERIALS AND METHODS

Materials

For EASE scale translation:

Original Australian English version of the EASE scale.
Online form of validity and reliability of Gujarati version of the EASE scale for psychometric properties of the Gujarati version of the EASE scale

Methods

Study Design: Methodological Study

Cross-cultural adaptation and translation of the EASE scale in Gujarati language by using WHO guidelines for scale translation.¹²

The Institutional Ethics Committee [Dr Jivraj Mehta Smarak Health Foundation (ECR/274/Inst/GJ/2013/RR-19)] approval was obtained prior to the commencement of the study. The clinical trial was registered under the Clinical Trial Registry—India (CTRI) (registration number: CTRI/2021/10/037698). Permission for cross-cultural adaptation and translation of the Australian English version of EASE to the Gujarati language was obtained from the author Phyland. The original Australian English version of the EASE score sheet was received by the author through e-mail.

The following steps suggested by WHO for linguistic translation were done to form the Gujarati version of EASE.

Step 1: For the forward translation, English version of EASE was given to two translators (English professor and Gujarati singing teacher) having knowledge of English language and Gujarati language as mother tongue. Translators were explained about the research design, methodology, and population to be addressed for this research project by primary research investigator. The translators were instructed for conceptual translation rather than just literal translation. The received translated Gujarati version EASE was analyzed by primary research investigator and the primary Gujarati translated version was developed.

Step 2: The primary Gujarati translated version was translated back to English by an independent translator (Professor in English Subject) and having no knowledge of original English version of EASE with emphasis on conceptual and cultural equivalence. The received back translated version was checked for its compatibility with original Australian English version by primary investigator and the EASE-G1 was formed.

Step 3: EASE-G1 was given to bilingual expert panel having knowledge of English and Gujarati which included four health care professionals and six singing teachers for linguistic evaluation. They had been asked to identify and resolve inadequate expressions or concepts of translation. The corrections suggested by expert panel were discussed and the Gujarati scale translation was modified according to the suggestions. At the end of the corrections a Gujarati translated version of EASE and EASE-G2 was formed.

Step 4: Pretesting respondents included 15 student singers of Ahmedabad city having age of >18 years using purposive sampling and having experience of singing for >3 months. The Gujarati translated EASE-G2 was given to respondents. They were asked to analyze items on their understanding level and they were allowed to ask questions if there was any doubt. Suggestions given by respondents were analyzed and final version of EASE-G was formed.

Step 5: At the end of the above mentioned procedure final Gujarati version of EASE named as EASE-G (EASE-Gujarati) was obtained and further evaluated for psychometric properties.

Validity of EASE-G

Experts for testing the validity of the EASE-G tool were selected using purposive sampling method. Ten singing teachers of Ahmedabad city having more than year of experience as professional vocal teacher and having Gujarati language as mother tongue were invited to participate in the study. For the validity of EASE-G, content validity was measured by the content validity index (CVI). Each expert was asked to check the relevancy of each item of EASE-G for singing functions evaluation and give a rating, 1—item is not relevant to singing function, 2—item is somewhat relevant to singing function, 3—item is quite relevant to singing function, and 4—item is highly relevant to singing function.¹³ The relevancy rating of each item of the scale was thus obtained from experts. Moreover, face validity was detected by asking the question “Do you agree that the EASE-G scale is valid to assess singing function?” “Yes” and “No” were two options given for reply.¹⁴

Reliability of EASE-G

Using purposive sampling, EASE-G was given to 13 vocal students having age of >18 years and resident of Ahmedabad city with singing experience more than 3 months. The study was explained to vocal students and they were asked to fill the EASE-G (T1). The EASE-G was collected, and was again given to the same vocal students after 3 days and they were asked to fill the EASE-G again (T2). Both the EASE-G scores were compared for reliability.

Statistics

Microsoft excel 2007 and IBM SPSS version 20 was used for statistical calculation.

RESULT

Table 1 shows the changes done in the translation and cross-cultural adaptation process of EASE in Gujarati language as per the scale translation guidelines provided by WHO.

**Table 1:** Cross cultural adaptation and translation procedure of EASE to EASE-G according to WHO guideline
S. no.	Australian English version of EASE	Forward translated EASE-G1	Backward translated	Final EASE-G
1	My voice is husky	મારો અવાજ કકશ છે	My voice is harsh	મારો અવાજ કકશ છે
2	My voice is dry/scratchy	મારો અવાજ શુક/તરડાયલો છે.	My voice is dry/dull	મારો અવાજ શુષ્ક/ખારાશવાળો છે.
3	My voice cracks and breaks	મારો અવાજ તરડાય અને તૂટી જાય છે.	My voice gets broken	મારો અવાજ તરડાય અને તૂટી જાય છે.
4	My throat muscles are feeling overworked	મારા ગળાના સ્નાયુઓ વધુ પડતો મ અનુભવે છે	My throat muscles feel excess stress	મારા ગળાના સ્નાયઓુ વધુ પડતો શ્રમ અનુભવે છે
5	My voice is breathy	મારો અવાજ ાસ ચડેલો લાગે છે	My voice gets panting	મારા અવાજમાં શ્વાસ ચડે છે
6	My singing voice feels good*	મારો ગાવાનો અવાજ સારો લાગે છે^*	I feel my singing good^*	મારો ગાવાનો અવાજ સારો લાગે છે^*
7	The onsets of my notes are delayed or breathy	મારા સ્વર શ૨ ૂ થવામાાં વલંબ થાય છે અથવા શ્વાસ ચડે છે	It takes time to get my vocal started or panting	મારા સ્વર શ૨ ૂ થવામાાં વલંબ થાય છે અથવા શ્વાસ ચડે છે
8	My voice feels strained	મારો અવાજમા તાણ અનુભવાય છે	My voice feels stressed	મારો અવાજમા તાણ અનુભવાય છે
9	I am worried about my voice	હું મારા અવાજ વશે ચતત છું	I am worried about my voice	હું મારા અવાજ વશે ચતત છું
10	I am having difficulty with my breath for long phrases	મને લાંબા શબ્દ પ્રયોગ માટે શ્વાસ લેવામાાં મુશ્કેલી પડે છે	I feel difficult to vocal long words	મને લાબા શબ્દ પ્રયોગ માટે શ્વાસ લેવામાાં મુશ્કેલી પડે છે
11	My top notes are breathy	મને ઊંચા સ્વરમા શ્વાસ ચડે છે.	I feel panting in high pitch	મને ઊંચા સ્વરમા શ્વાસ ચડે છે.
12	My voice sounds rich and resonant*	મારો અવાજ સમૃદ્ધ અને રણકતો છે^*	My voice is rich and fascinating	મારો અવાજ સમૃદ્ધ અને પ્રભાવશાળી છે^*
13	My voice is cutting out on some notes	અમુક સ્વર પર મારો અવાજ કપાઈ છે	My voice gets cut off on certain vowels	અમુક સ્વર પર મારો અવાજ કપાઈ છે
14	I am having difficulty singing softly	મને હળવાશથી ગાવામાં મુશ્કેલી થાય છે	I am getting difficulty in singing softly	મને હળવાશથી ગાવામાં મુશ્કેલી થાય છે
15	My voice is tired	મારો અવાજ થાકેલો છે	My voice is tired	મારો અવાજ થાકેલો છે
16	I am having difficulty changing registers	મને લય બદલવામાં મુશ્કેલી આવી રહી છે	I am getting difficulty in changing rhythm	મને લય બદલવામાં મુશ્કેલી આવી રહી છે
17	I am having difficulty with my high notes	મને મારા ઉચ્ચ સ્વરમાં મુશ્કેલી આવી રહી છે	I am getting difficulty in changing high pitch tone	મને મારા ઊંચા સ્વરમાં મુશ્કેલી આવી રહી છે
18	Singing feels like hard work	ગાયકી પવરશ્રમનો અનુભવ કરાવે છે	Singing experiences hard work	ગાયકી પવરશ્રમનો અનુભવ કરાવે છે
19	I am having difficulty projecting my voice	મને મારો અવાજ તાકતથી ગાવામા મુશ્કે લી આવી રહી છે	I am getting difficulty in presenting my voice	મને મારો અવાજ ભાર સાથે રજુ કરવામાાં મુશ્કેલી આવી રહી છે
20	I am concerned about my voice	હું મારા અવાજ માટે સજાક છું	I am aware about my voice	હું મારા અવાજનુાં વધારે ધ્યાન રાખુાં છું
21	My voice feels ready for performance if required*	જરૂરી હોય તો મારો અવાજ પ્રસ્તુતી માટે તૈયાર છે^*	My voice is ready to present if needed	જરૂરી હોય તો મારો અવાજ પ્રસ્તુતી માટે તૈયાર છે^*
22	I am having difficulty sustaining long notes	મને લાાંબી સ્વર બદ્ધતા ટકાવવામાં મુશ્કેલી આવી રહી છે	I am feeling difficulty to sustain long pitch vowels	મને લાબા સ્વર ટકાવવામાં મુશ્કેલી આવી રહી છે

*Reverse score (ઉલટુ આંક)

For content validity index (CVI) and face validity of EASE scale, out of 10 expert panel respondents of Ahmedabad city there were four female and six male respondents, these including four health care professionals. Average age of expert panel group was 33.2 ± 11.11 years (age range: 23–54 years) and average experience of their field is 12.1 ± 10.12 years (experience range: 5–27 years).

For content validity index, the sub-scale Item content validity index (I-CVI) [which is the experts in agreement divided by the number of experts] for item numbers 1–22 was 1 as all experts had agreed on the relevance of all the items asked in the questionnaire.¹³ All the experts agreed for all items present in scale so as experts are in agreement and universal agreement was 1, for both sub-scales. The scale-level content validity index (S-CVI) based on I-CVI average and proportion relevance was 1, and S-CVI based on universal agreement was 1.

The validity reviewer answered “Yes” to the question “Is the scale appropriate to evaluate ability to sing easily?” asked to detect face validity.¹⁴ This indicates that the EASE-G is valid for Gujarati singers.

For reliability of EASE 13 vocal students with an average age of 19.9 ± 1.1 years were included in the study. The Interclass correlation [ICC] was 0.89 which showed good reliability and almost perfect agreement as repeatability and coefficient of Cronbach’s alpha for internal consistency was 0.94 which showed excellent reliability level for overall EASE-G scale scores.

DISCUSSION

The aim of the study was to translate and cross-culturally adapt the Australian English version of the EASE scale into Gujarati language for Gujarati singers with evaluation of its psychometric properties. EASE-G is a self-reported scale to evaluate current singing function for Gujarati singers.

In this translation procedure, few Gujarati words have been translated into simple Gujarati language. These are from તરડાયેલો to ખરાશવાળો, રણકતો to ભાવશાળી, ાેપણ to ભાર સાથે રજુ, and સજાક to વધારે યાન for easy understanding in Gujarati language. EASE is the first singing function evaluation scale translated into Gujarati language and this self-administered symptom-based tool provides first step in assessment of singer’s voice or perceptual singing function.

The validity of EASE-G scale was evaluated with CVI, with the scoring of 10 ratters CVI was acceptable (CVI = 1) for all 22 items by all the ratters.

The internal consistency of EASE-G was good (α = 0.94) which was correlating to original Australian English version of EASE (α = 0.89),⁶ Indian Kannada EASE-K (α = 0.9),⁹ Portuguese Brazilian EASE-Br (α = 0.94),⁷ and Dutch Netherland EASE-NL (α = 0.89).¹⁰ There was no significant difference (ICC = 0.89, i.e., excellent reliability) found on two time point scale (day 1 and 3) for total EASE-G score.

CONCLUSION

The EASE Gujarati version, EASE-G has been proved as a valid and reliable tool for assessing perceptual singing function for Gujarati singers. Hence, EASE-G can be used as a quick screening tool with 22 short statements getting assessed on Likert scale for singing function in the Gujarati singers. This will further help to evaluate vocal fatigue, pathological risk factor, and vocal concern through three subscales for Gujarati singers.

Clinical Significance

The Gujarati version of “EASE” (EASE-G) can be used for assessing singing function specifically for Gujarati singers who have knowledge of Gujarati language only. This will ease an assessor to communicate and document regarding vocal/singing function of Gujarati singer. EASE-G can also be used as an outcome measure of any research, training or treatment for Gujarati singers.

ORCID

Jinal J Parikh https://orcid.org/0009-0002-4150-8655

Megha S Sheth https://orcid.org/0000-0002-5090-8522

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