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

Abstract

BACKGROUND: Mental health literacy (MHL)-individuals' knowledge, attitudes, and beliefs about mental health-plays a key role in promoting public mental health. Accurate MHL measurement helps identify knowledge gaps, reduce stigma, and encourage help-seeking. However, culturally validated instruments remain scarce in low- and middle-income countries, including Bolivia. OBJECTIVES: This study aimed to carry out the translation cultural adaptation and content validity assessment of an instrument designed to comprehensively assess the construct of mental health literacy in the Bolivian urban context. METHODS: A mixed-methods design was used, including forward and backward translation, following best practices for cultural adaptation of patient-reported outcomes. 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. Content validation assessment was conducted with eight experts who rated each item's relevance, comprehensiveness, and comprehensibility using a 4-point Likert scale. Item-level Content Validity Index (I-CVI), modified kappa, Scale-level Content Validity Index (S-CVI), and readability statistics were calculated. This was followed by semi-structured interviews with the same experts to refine items and assess conceptual clarity. A pilot test with 10 participants evaluated comprehension and usability. RESULTS: The I-CVI scores from the quantitative phase indicated that the majority of items were rated as "good" or "excellent" in terms of relevance (97.14%), comprehensiveness (83.02%), and comprehensibility (94.34%). The obtained S-CVI/UA scores fell well below the recommended threshold for relevance (0.32), comprehensiveness (0.25), and comprehensibility (0.32), indicating a lack of universal agreement among experts. The S-CVI/Ave scores indicated moderate consensus among experts for relevance (0.88), comprehensiveness (0.84), and comprehensibility (0.87). Items that did not achieve optimal I-CVI and modified kappa scores were examined during the qualitative phase. Experts identified minor issues related to terminology and phrasing that could affect clarity. Following minor revisions, all items were retained. CONCLUSION: This study presents a culturally adapted, content-validated instrument for assessing MHL in Bolivia. The final version, consisting of 53 items, demonstrates strong content validity and provides a solid foundation for further psychometric evaluation and broader application in Spanish-speaking and Latin American contexts.