Cross-cultural adaptation of the breast cancer and lymphoedema symptom experience index (BCLE-SEI) in Marathi

Introduction
The burden of breast cancer is considerable in India. One of the common side effects of breast cancer treatment is breast cancer-related lymphedema (BCRL). BCRL is associated with many symptoms, such as swelling, heaviness, tightness, pain and discomfort and poor quality of life. The Breast Cancer-related Lymphedema Symptom Experience Index (BCLE-SEI) captures the presence of BCRL-related symptoms and their severity and distress. BCLE-SEI is not available in Indian languages. The purpose of this study was to cross-culturally adapt the Breast Cancer and Lymphedema Symptom Experience Index (BCLE-SEI) in Marathi and evaluate its psychometric properties.
Methods
The BCLE-SEI was translated back-translated, and the equivalence of the consolidated back translation was checked following established guidelines. The Marathi version of the BCLE-SEI was then validated in 170 women with or at risk of developing breast cancer-related lymphedema. The content validity, exploratory factor analysis, internal consistency, test-retest reliability, and hypothesis testing were analyzed.
Results
The content validity of the BCLE-SEI Marathi was sufficient. The comprehensibility, comprehensiveness and items’ relevance were confirmed by 97, 97 and 99% of the participants, respectively. The results of the exploratory factor analysis showed two factors in the symptom scale and three factors in the impact scale, which explained 44.5% and 53.3% of the total sample variance, respectively. The internal consistency ranged from α = 0.86 to 0.93. The test-retest reliability (ICC2,1) was 0.87a (95% CI = 0.8 to 0.9, p<0.0005) for the symptoms scale and 0.86a (95% CI = 0.8 to 0.9, p<0.00) for the impact scale. More than 50% of the hypotheses set a priori were true; thus, constructive validity was established.
Conclusions
This study established the psychometric properties of the BCLE-SEI Marathi questionnaire. Hence, the BCLE-SEI-Marathi questionnaire is recommended for use in assessing the symptom experience of women with BCRL who can read and write in Marathi.