Translation, cultural adaptation, and content validity evaluation of a mental health literacy instrument in Bolivia.

The majority of items were rated as 'good' or 'excellent' in relevance, comprehensiveness, and comprehensibility at the item level.

• I-CVI scores indicated 97.14% of items rated 'good' or 'excellent' for relevance
• 83.02% of items rated 'good' or 'excellent' for comprehensiveness
• 94.34% of items rated 'good' or 'excellent' for comprehensibility
• Content validation was conducted with eight experts who rated each item using a 4-point Likert scale

Scale-level Content Validity Index using universal agreement (S-CVI/UA) scores fell well below the recommended threshold for all three content validity dimensions.

• S-CVI/UA score for relevance was 0.32, below the recommended threshold
• S-CVI/UA score for comprehensiveness was 0.25, below the recommended threshold
• S-CVI/UA score for comprehensibility was 0.32, below the recommended threshold
• These scores indicated a lack of universal agreement among the eight experts

Scale-level Content Validity Index using average method (S-CVI/Ave) scores indicated moderate consensus among experts across all three dimensions.

• S-CVI/Ave score for relevance was 0.88
• S-CVI/Ave score for comprehensiveness was 0.84
• S-CVI/Ave score for comprehensibility was 0.87
• These scores reflect moderate consensus among the panel of eight experts

Qualitative expert interviews identified minor issues related to terminology and phrasing but resulted in retention of all items after minor revisions.

• Items that did not achieve optimal I-CVI and modified kappa scores were examined during the qualitative phase
• Semi-structured interviews were conducted with the same eight experts who completed the quantitative rating
• Experts identified minor issues related to terminology and phrasing that could affect clarity
• Following minor revisions, all items were retained in the final instrument

The study adapted three existing instruments for use in the Bolivian urban context using a mixed-methods translation and cultural adaptation process.

• Three instruments were adapted: the Mental Health Literacy Scale (MHLS, O'Connor 2015), the Perceived Devaluation and Discrimination Scale (PDDS, Link 1987), and the Mental Health Problem Recognition module (MHPR, Burrone 2021)
• A forward and backward translation process was used following best practices for cultural adaptation of patient-reported outcomes
• A pilot test with 10 participants evaluated comprehension and usability
• The final adapted instrument consists of 53 items

Culturally validated mental health literacy instruments remain scarce in low- and middle-income countries including Bolivia, motivating the need for this adaptation.

• Mental health literacy encompasses individuals' knowledge, attitudes, and beliefs about mental health
• Accurate MHL measurement helps identify knowledge gaps, reduce stigma, and encourage help-seeking
• The study was situated in the Bolivian urban context
• The authors note the instrument provides a foundation for broader application in Spanish-speaking and Latin American contexts