Cultural adaptation of a survey to assess medical providers' knowledge of and attitudes towards HIV/AIDS in Albania

PLoS One. 2013;8(3):e59816. doi: 10.1371/journal.pone.0059816. Epub 2013 Mar 27.


Though the HIV/AIDS epidemic in Southeastern Europe is one of low reported prevalence, numerous studies have described the pervasiveness of medical providers' lack of knowledge of HIV/AIDS in the Balkans. This study sought to culturally adapt an instrument to assess medical providers' knowledge of and attitudes towards HIV/AIDS in Albania. Cultural adaptation was completed through development of a survey from previously validated instruments, translation of the survey into Albanian, blinded back translation, expert committee review of the draft instrument, focus group pre-testing with community- and University Hospital Center of Tirana-based physicians and nurses, and test-retest reliability testing. Blinded back translation of the instrument supported the initial translation with slight changes to the idiomatic and conceptual equivalences. Focus group pre-testing generally supported the instrument, yet some experiential and idiomatic changes were implemented. Based on unweighted kappa and/or prevalence adjusted bias adjusted kappa (PABAK), 20 of the 43 questions were deemed statistically significant at kappa and/or PABAK ≥0.5, while 12 others did not cross zero on the 95% confidence interval for kappa, indicating their probable significance. Subsequently, an instrument to assess medical providers' knowledge of and attitudes toward HIV/AIDS for an Albanian population was developed which can be expanded within Albania and potentially to other countries within the Balkans, which have an Albanian-speaking population.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acquired Immunodeficiency Syndrome / epidemiology*
  • Adaptation, Psychological*
  • Albania / epidemiology
  • Attitude of Health Personnel*
  • Culture*
  • Focus Groups
  • Health Care Surveys / statistics & numerical data*
  • Health Knowledge, Attitudes, Practice*
  • Health Personnel / statistics & numerical data*
  • Humans
  • Reproducibility of Results
  • Surveys and Questionnaires

Grant support

Funding for this study was provided by the Center for East Europe and Eurasia Studies at Stanford University Summer Research Fellowship, Medical Scholars Grant from the Infectious Diseases Society of America, and the Stanford University Goodrich Traveling Medical Scholars grant to Shane D. Morrison. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.