Evaluation of the psychometric properties of the UBACC questionnaire in a multi-country psychiatric study in Africa

Patricia Kipkemoi; Mary S Mufford; Dickens Akena; Melkam Alemayehu; Lukoye Atwoli; Lori B Chibnik; Bizu Gelaye; Stella Gichuru; Symon M Kariuki; Karestan C Koenen; Edith Kwobah; Joseph Kyebuzibwa; Rehema M Mwema; Charles R J C Newton; Adele Pretorius; Dan J Stein; Anne Stevenson; Rocky E Stroud 2nd; Solomon Teferra; Zukiswa Zingela; Kristianna Post; Kristina J Korte

doi:10.1016/j.comppsych.2024.152526

Evaluation of the psychometric properties of the UBACC questionnaire in a multi-country psychiatric study in Africa

Compr Psychiatry. 2024 Nov:135:152526. doi: 10.1016/j.comppsych.2024.152526. Epub 2024 Aug 26.

Authors

Patricia Kipkemoi¹, Mary S Mufford², Dickens Akena³, Melkam Alemayehu⁴, Lukoye Atwoli⁵, Lori B Chibnik⁶, Bizu Gelaye⁷, Stella Gichuru⁸, Symon M Kariuki⁹, Karestan C Koenen¹⁰, Edith Kwobah⁸, Joseph Kyebuzibwa³, Rehema M Mwema¹¹, Charles R J C Newton⁹, Adele Pretorius¹², Dan J Stein¹², Anne Stevenson¹³, Rocky E Stroud 2nd¹⁴, Solomon Teferra⁴, Zukiswa Zingela¹⁵, Kristianna Post¹⁴, Kristina J Korte¹⁶

Affiliations

¹ Neuroscience Unit, KEMRI-Wellcome Trust Research Program, Kenya; Global Initiative for Neuropsychiatric Genetics Education in Research (GINGER) Program, Harvard T.H. Chan School of Public Health and the Stanley Center for Psychiatric Research at the Broad Institute of Harvard and MIT, USA; Complex Trait Genetics Department, Center for Neurogenomics and Cognitive Research, Vrije Universiteit Amsterdam, Netherlands. Electronic address: pkipkemoi@kemri-wellcome.org.
² Global Initiative for Neuropsychiatric Genetics Education in Research (GINGER) Program, Harvard T.H. Chan School of Public Health and the Stanley Center for Psychiatric Research at the Broad Institute of Harvard and MIT, USA; SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa.
³ Department of Psychiatry, School of Medicine, College of Health Sciences, Makerere University, Uganda.
⁴ Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Ethiopia.
⁵ Department of Mental Health, School of Medicine, Moi University College of Health Sciences, Kenya; Brain and Mind Institute and Department of Medicine, Medical College East Africa, the Aga Khan University, Kenya.
⁶ Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, USA.
⁷ Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA.
⁸ Department of Mental Health, Moi Teaching and Referral Hospital, Eldoret, Kenya.
⁹ Neuroscience Unit, KEMRI-Wellcome Trust Research Program, Kenya; Department of Psychiatry, University of Oxford, UK.
¹⁰ Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.
¹¹ Neuroscience Unit, KEMRI-Wellcome Trust Research Program, Kenya.
¹² SAMRC Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, South Africa.
¹³ Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, USA; Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa.
¹⁴ Stanley Center for Psychiatric Research, Broad Institute of Harvard and MIT, USA; Department of Epidemiology, Harvard T. H. Chan School of Public Health, USA.
¹⁵ Executive Dean's Office, Faculty of Health Sciences, Nelson Mandela University, South Africa.
¹⁶ Department of Epidemiology, Harvard T. H. Chan School of Public Health, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, USA.

PMID: 39208558
DOI: 10.1016/j.comppsych.2024.152526

Abstract

Background: The University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) is a tool to assess the capacity of participants to consent in psychiatric research. However, little is known about the psychometric properties in low and middle-income countries. This study aimed to examine the psychometric properties of the UBACC.

Methods: We examined the reliability, latent factor structure, and item response of the first attempt of the UBACC items in a sample of 32,208 adults (16,467 individuals with psychosis and 15,741 controls) in Ethiopia, Kenya, South Africa, and Uganda; exploring these properties in the full sample and stratified by country, diagnostic status, sex, and ethnolinguistic language groups.

Results: Exploratory factor analysis (EFA) suggested a two-factor model for the overall sample. However, a three-factor model was more appropriate when examining the latent structure across country, language, and sex. Confirmatory factor analyses (CFA) revealed an adequately fitting three-factor model for the full sample and across country, sex, and language. A two-factor model, however, was more appropriate for English and Amharic languages. Across all groups, the internal consistency of the UBACC was low, indicating below-threshold reliability (Cronbach's α (95 % CI = 0.58 (0.57-0.59). Using a multidimensional item-response theory framework for the full sample revealed that UBACC item 8, measuring understanding of the benefits of study participation, was the most discriminating item. Many of the other items had below-threshold discriminating characteristics.

Conclusion: EFA and CFA converged towards a two and three-dimensional structure for the UBACC, in line with the developers of the original scale. The differences in properties between populations and language groups, low internal consistency, and below-threshold item functioning suggest that investigations into the cultural and linguistic nuances are still warranted. Understanding the utility of consent tools, such as the UBACC, in underrepresented populations will be a part of the larger process which ensures that research participants are adequately protected.

Keywords: Africa; Genetic studies; Informed consent; Psychometric properties; UBACC.

MeSH terms

Adolescent
Adult
Ethiopia / ethnology
Factor Analysis, Statistical
Female
Humans
Kenya
Male
Middle Aged
Psychometrics* / instrumentation
Psychometrics* / standards
Psychotic Disorders / diagnosis
Psychotic Disorders / psychology
Reproducibility of Results
South Africa
Surveys and Questionnaires / standards
Uganda
Young Adult

Abstract

MeSH terms

Grants and funding