Chinese-adapted youth attitude to noise scale: Evaluation of validity and reliability Xiaofang Zhu1, Ali Bihi1, Xiaolan Hu1, Yaqi Lv1, Ali Abbas1, Xian Zhu1, Lingyan Mo2, Xiaoxia Peng1,3 Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, 2Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, 3Center of Clinical Epidemiology and Evidence-Based Medicine, Beijing Children’s Hospital, Capital Medical University, Beijing, China 1

Abstract Noise exposure is central to hearing impairment, especially for adolescents. Chinese youth frequently and consciously expose themselves to loud noise, often for many hours. Hence, a Chinese-adapted evaluative scale to measure youth’s attitude toward noise could rigorously evaluate data validity and reliability. After authenticating the youth attitude to noise scale (YANS) originally developed by Olsen and Erlandsson, we purposively sampled and surveyed 642 freshmen at Capital Medical University in Beijing, China. To establish validity, we conducted confirmatory factor analysis according to Olsen’s classification. To establish reliability, we calculated Cronbach’s alpha coefficient and split-half coefficient. We used Bland-Altman analysis to calculate the agreement limits between test and retest. Among 642 students, 550 (85.67%) participated in statistical analysis (399 females [72.55%] vs. 151 males [27.45%]). Confirmatory factorial analysis sorted 19 items into four main subcategories (F1–F4) in terms of factor load, yielding a correlation coefficient between factors 40 dB in the better hearing ear in adults and >30 dB in the better hearing ear in children. According to the World Health Organization, more than 360 million people (5%) worldwide (i.e., 328 million adults and 32 million children) have disabling hearing impairment.[1] Most of these people live in low- and middle-income countries. Moreover, approximately one-third of people older than 65 years of age, most living in South Asia, Asia Pacific, and sub-Saharan Africa, have Access this article online Quick Response Code:

Website: www.noiseandhealth.org DOI: 10.4103/1463-1741.137055 PubMed ID: ***

Noise & Health, July-August 2014, Volume 16:71, 218-222

a disabling hearing loss. For example, a national sample survey on hearing disability in China shows that 27.8 million Chinese citizens suffer from hearing impairment; 30,000 have hearing impairment from birth.[2] Today, China is not only the world’s fastest developing country, but it also has one of the fastest growing “aging populations.”[3,4] Therefore, hearing impairment is an increasingly serious health crisis in China and worldwide. Because half of all cases of hearing loss are avoidable through primary prevention,[1] it is imperative to understand the cause of hearing disability. However, it is very difficult to differentiate between exact and general causes.[5] Noise exposure is central to hearing impairment, especially for adolescents.[6] Although short periods of amplified sound do not cause hearing impairment, chronic exposure results in cumulative damage.[7] The growing popularity of Western culture (i.e., pop music, cinemas, and loud parties) among Chinese youth results in frequent and conscious exposure to loud noise, often for many hours.[8] In addition, the fusion of social practices (e.g., Karaoke TV (KTV), personal audio 218

Zhu, et al.: Chinese adapted YANS and evaluation of its validity and reliability

systems, and electronic gaming centers) that include amplified sound is without a doubt an existing but often ignored phenomenon.[9] Moreover, noise pollution from industry, construction, and transportation has become increasingly prominent in China during the past two decades.[10,11] Hence, constant exposure to loud noise is a serious health hazard that requires the development of tools to control, identify, and prevent hearing impairment. The youth attitude to noise scale (YANS), an effective instrument developed by Widén and Erlandsson,[6] was used in Sweden, Brazil,[12] and USA.[13] YANS consists of 19 items assessed on a 5-point Likert scale that ranges from “totally disagree” to “totally agree.” However, due to differing social and cultural conditions, a universal questionnaire is impractical in assessing youth’s attitude towards noise. Cross-cultural adaptation of YANS must encompass both language (translation) and culture.[14] Moreover, validated questionnaire translation demands linguistic terms that properly reflect a population’s social and cultural conditions. Therefore, a country’s unique beliefs and habits require psychometric measures that reflect its culture. In China, hearing impairment is evolving into a significant social and public health problem. Because the original YANS questionnaire is not completely compatible with the Chinese population for the aforementioned reasons, it is necessary to create an adapted scale to evaluate youth’s attitude toward noise that can demonstrate its properties through measurement and rigorous evaluation of its validity and reliability. A Chinese adaption of YANS will help identify the level of information regarding noise exposure in Chinese youth as well as their own perceptions and behavior regarding noise and essentially seek a proper instrument to interoperate these findings.

Methods Authentication of the youth attitude to noise scale questionnaire Widén and Erlandsson developed YANS,[6] and Zocoli et al. translated YANS into the Portuguese language.[12] Widén et al. translated YANS for use in the USA.[13] The most commonly used YANS version contains 19 items that reflect four issues: 1. Attitudes toward noise associated with youth culture, 2. Attitudes associated the ability concentrate in noisy environments, 3. Attitudes concerning day-to-day noises, and 4. Attitudes that influence the sound environment [Annex 1, original version of YANS]. All answers are based on a 5-point Likert scale ranging from 1 (fully disagree) to 5 (fully agree). In the Chinese adaptation discussed here, we score some items (Nos. 2, 5, 6, 8, 9, 10, 11, 14, and 17) inversely (i.e., score 5 = score 1). A low score implies a more negative attitude toward noise and a high score implies a more positive attitude towards noise. 219

Authentication of YANS involved many intricacies and stages. First, a three-member team, including a foreign language expert, an audiologist, and a linguist, translated the questionnaire from English to Chinese. Next, an audiologist proficient in written communication between Chinese and English conducted counter-translation. A thorough comparison of both versions identified minimal differences and determined that the translated version did not hinder the validity of the questionnaire. Finally, a group of experts approved the Chinese YANS [Annex 2, Chinese-adapted version of YANS]. Validity assessment of YANS content considered the difference between Western and Chinese culture and their adherent social environment. Six audiologists from Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University (CMU), and the Ministry of Education rated each item according to its relevance to Chinese culture. Using a 4-point scale where 1 is “fully irrelevant” and 4 is “fully relevant,” we calculated the relevancy of each item according to the item-level content validity index (number of scores given divided by number of experts). For the scale-level content validity index, we calculated the percentages of each item’s score by each expert divided by number of experts. In the original YANS, items 1, 4, 9, and 12 received a poor score from all of our experts. Therefore, we conducted an in-depth interview among 10 freshmen students, who agreed that the above-mentioned items (discos, rock concert, dances, sporting event) were not of social norm. Consequently, we replaced those items with items that are more common in China (i.e., KTV, cinema, food court, and gaming centers), further altering the questionnaire. Survey process To provide a fair consensus, we purposively sampled freshman students at CMU, which attracts students from across China. Inclusion criteria for the study comprised being a freshman student of either gender, aged between 16 and 20 years. All participants were studying medicine, public health, or nursing at CMU. The Institutional Review Board and the Ethics Committee at CMU approved our study protocol. Initially, researchers contacted university officials to inform them about the procedural implementation of the questionnaire. Because enrollment at CMU requires a physical and health examination, it made sense to include an evaluative questionnaire as part of their health checkup. Hence, the nonresponse rate was minimal. We invited 19 monitors from 19 classes (freshman students) to participate in an orientation to the questionnaire and informed them about each item on the questionnaire, its content, and purpose. After attaining complete understanding of the questionnaire, monitors distributed the questionnaire to their respective classes. To avoid any misunderstanding, a research team member accompanied monitors while they explained the Noise & Health, July-August 2014, Volume 16

Zhu, et al.: Chinese adapted YANS and evaluation of its validity and reliability

questionnaire to their classmates. Participants were asked to complete the questionnaire by themselves in

Chinese-adapted youth attitude to noise scale: evaluation of validity and reliability.

Noise exposure is central to hearing impairment, especially for adolescents. Chinese youth frequently and consciously expose themselves to loud noise,...
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