Elsevier

Psychiatry Research

Volume 237, 30 March 2016, Pages 196-200
Psychiatry Research

Validation of the French version of the Acceptability E-scale (AES) for mental E-health systems

https://doi.org/10.1016/j.psychres.2016.01.043Get rights and content

Highlights

  • Mental-health organizations have to deal with the use of E-health systems.

  • There is a lack of psychometric tools to evaluate acceptability of E-health systems.

  • This study aimed to validate a French version of the Acceptability E-scale (AES).

  • The psychometric properties of the French AES version were satisfactory.

  • The AES may provide important information on satisfaction and usability.

Abstract

Despite the increasing use of E-health systems for mental-health organizations, there is a lack of psychometric tools to evaluate their acceptability by patients with mental disorders. Thus, this study aimed to translate and validate a French version of the Acceptability E-scale (AES), a 6-item self-reported questionnaire that evaluates the extent to which patients find E-health systems acceptable. A forward–backward translation of the AES was performed. The psychometric properties of the French AES version, with construct validity, internal structural validity and external validity (Pearson's coefficient between AES scores and depression symptoms on the Beck Depression Inventory II) were analyzed. In a sample of 178 patients (mean age=46.51 years, SD=12.91 years), the validation process revealed satisfactory psychometric properties: factor analysis revealed two factors: “Satisfaction” (3 items) and “Usability” (3 items) and Cronbach's alpha was 0.7. No significant relation was found between AES scores and depression symptoms. The French version of the AES revealed a two-factor scale that differs from the original version. In line with the importance of acceptability in mental health and with a view to E-health systems for patients with mental disorders, the use of the AES in psychiatry may provide important information on acceptability (i.e., satisfaction and usability).

Introduction

Patient-reported outcomes (PROs), including measures of satisfaction, have gained increasing attention in the mental-health services (Boyer et al., 2009, Crow et al., 2002, Fitzpatrick, 1991). Indeed, patient satisfaction has become one of the important PROs and a contributing outcome in the assessment of health care quality (Zendjidjian et al., 2014b). Patient satisfaction with caregiving is a strong predictor of future behaviors, in particular treatment adherence (Ware and Davies, 1983, Zendjidjian et al., 2014a, Zendjidjian et al., 2014b), and provides important information for improving the quality of health care organizations (Cleary and McNeil, 1988).

Given the increased prevalence of chronic disease, in particular of mental and brain disorders (Wykes et al., 2015), health care organizations now have to deal with the increased use of E-health systems (Chouvarda et al., 2015). Such systems facilitate: i) communication and coordination between patient and healthcare professionals (in primary care and hospital), and ii) medical decisions for diagnosis, prognosis and therapeutic follow-up (Chouvarda et al., 2015). While the extent to which patients are satisfied with E-health systems and find them acceptable should be evaluated, there is a lack of psychometric tools to evaluate it.

The Acceptability E-scale (AES) presents some advantages in the field of patient-reported outcomes in E-health systems (Tariman et al., 2011). It is a generic and validated questionnaire that can accurately evaluate satisfaction with a broad range of E-health systems (Carlson et al., 2001, Mullen et al., 2004, Taenzer et al., 2000), a point that differentiates it from other questionnaires that may have no clear validation process and which focus only on satisfaction with one precise E-health solution. It is also based on 6 items (with a 5-point Likert scale for each item), which is time-efficient and increases its usability in clinical practice. Furthermore, it is a self-reported questionnaire, which is recognized as the most reliable method to measure satisfaction (Crow et al., 2002).

Despite French being the 6th most widely spoken world language with 220 million speakers (Organization International de la francophonie, 2009), the AES has not previously been translated and validated in French. Thus, in order to better evaluate satisfaction with E-health solution in native French speakers, this study sought to design and validate a French version. Translating questionnaires may be dependent on cultural background (Brislin, 1970) so before using any translated questionnaire, a transcultural validation should be undertaken according to specific rules and methods. In the present study we analyzed the psychometric properties of the French AES version in a sample of French patients that was interviewed with a virtual agent, which are the most innovative E-health solution to sustain a clinical evaluation (Philip et al., 2014). In this study, the virtual agents made a clinical evaluation of depressive symptoms.

Section snippets

Participants

Outpatients were recruited by psychiatrists in Bordeaux University Hospital from November 2014 to June 2015 in a consecutive sample design. Inclusion criteria were: native French-speaking adult patients (>18 years) with any type of psychiatric or sleep complaints. Exclusion criteria were: insufficient capacity to consent to and understand and answer the self-report questionnaires.

Gender, age, year of education and antidepressant treatment were noted. Patients were given a clinical interview

Sample characteristics

A total of 178 native French speakers were included. None of the patients reported any difficulties in understanding the items of the AES.

The mean age was 46.51 years old (SD=12.91, range: [19–64] years old), 57.3% (102) were women, the mean number of years of education was 13.36 (SD=3.07), 14.6% (26) were being treated with antidepressant treatment, and 19.7% (35) had a diagnosis of current MDD according to the psychiatrist's evaluation. Age was not significantly different between patients

Discussion

The aim of this study was to translate and validate the French version of the AES in order to make it available for evaluating satisfaction with E-health systems in French-speaking patients. Transcultural validation supported the structural validity of the instrument but revealed some differences with the original version (Tariman et al., 2011).

In the original version, principal component factor analysis found only one factor with all 6 items with a value of item load equal to or greater than

Conflict of interest

We report no conflicts of interest.

Acknowledgments

Special thanks to Muriel Bacarisse, Cédric Valtat, and Aurélien Boiseau for selecting participants, collecting and monitoring data and for administrative, technical, and logistic support. We acknowledge the ANR-PHENOVIRT.

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