Translation, Adaptation and Validation of Children with Cochlear Implants: Parental Perspectives- CCIPP Questionnaire in Malayalam

Abstract

Cochlear implantation has been a transformational intervention for children with severe to profound sensorineural hearing loss, improving their speech, language, and auditory skills. However, routine clinical assessments may not fully capture the quality of life of the child and parental perspectives. The Children with Cochlear Implants: Parental Perspectives Questionnaire is a CI-specific quality of life questionnaire which provides insights into the parental perceptions of the child’s functioning across different domains like communication, General functioning, Self-reliance etc. Despite its global relevance, there is a lack of validated version in Malayalam-speaking individuals. Hence the current study aimed at translating, adapting and validating the CCIPP questionnaire for Malayalam-speaking populations (CCIPP-M). The study was conducted in two stages. Stage 1 involved translation and adaptation, which involves forward and backward translation, reconciliation, cognitive debriefing, and expert review to ensure linguistic accuracy and cultural relevance. Stage 2 involved validation, assessing the psychometric properties of the final Malayalam version through data collected from 33 parents of children (aged 2–14 years) who had received cochlear implants and undergone at least six months of rehabilitation. Statistical analyses were performed using SPSS software v26. This included descriptive statistics, Cronbach’s alpha for internal consistency, intraclass correlation for test-retest reliability, and Pearson’s correlation for discriminant validity. The CCIPP-M demonstrated good internal consistency across domains (Cronbach’s α ≥ 0.70), strong test-retest reliability, and acceptable discriminant validity. Test-retest reliability was established through intraclass correlation, and discriminant validity was assessed using Pearson’s correlation coefficients. Friedman’s test revealed statistically significant differences across the ten CCIPP-M domains (χ² = 198.03, p < .001), indicating that the parental perception varied across the ten different domains of the questionnaire. Bonferroni-adjusted pairwise comparisons showed significant differences between many domain pairs, especially those involving communication, self-reliance, and social relationships. A subgroup analysis using the Mann-Whitney U test showed that parents of children who had used cochlear implants for more than three years reported significantly higher scores in the communication domain, indicating better perceived outcomes with longer CI use. Spearman’s correlation analysis revealed positive relationships between several domains, suggesting association across dimensions like communication, general functioning, social relationships, and support. No significant correlations were observed with chronological age or age at implantation. The findings confirmed that the CCIPP-M is a reliable and valid tool for assessing parental perspectives on the quality of life and rehabilitation outcomes of children with cochlear implants in the Malayalam-speaking community. Hence, this study fills a crucial gap by offering a culturally and linguistically appropriate instrument for clinical and research use in Kerala, thereby enhancing the evaluation of paediatric cochlear implant programs and contributing to better individualized care and policy development.