RESUMEN

El objetivo de este trabajo es adaptar el Cuestionario de Enfrentamientos (CQ), la Escala de Síntomas (SRT) y la Escala de Depresión del Centro de Estudios Epidemiológicos (CES-D) al medio indígena mediante la metodología de los laboratorios cognitivos. El interés es contar con instrumentos que permitan evaluar el malestar psicológico y cómo enfrentan el consumo excesivo de sustancias las familias del Valle del Mezquital.

La investigación consta de dos fases y se llevó a cabo en una comunidad del municipio del Cardonal, Estado de Hidalgo, donde aproximadamente 60% de la población de más de cinco años de edad habla una lengua indígena, principalmente otomí o ñahñú.

En la primera fase participó una muestra no probabilística de 43 mujeres entre 16 y 60 años de edad que hablaban castellano, además de ñahñú, que se contactaron en reuniones comunitarias. Para invitarlas a participar, se les explicaron los objetivos del estudio y se pidió su autorización para grabar las entrevistas. Se empleó la metodología del laboratorio cognitivo concurrente por escrutinio en su modalidad individual. Cada uno de los reactivos originales y sus opciones de respuesta se leyeron tantas veces como fue necesario, y después se preguntó: ¿Qué quiere decir esta pregunta?, ¿Cómo podría decirse de otra manera? o bien, ¿Cómo le explicaría esto a otra persona de su comunidad?

Con este método se lograron versiones de comprensión más fácil, ya que se retomaron términos de uso común entre la población de estudio; en consecuencia, se redujo el tiempo de aplicación de los tres cuestionarios.

En la fase 2 se procedió a validar la versión final de los tres instrumentos con una muestra no probabilística de 191 mujeres, que se contactaron en el centro de salud de la cabecera municipal. En el caso del CQ, la mejor solución se obtuvo al probar una estructura de 27 reactivos distribuidos en tres factores que explicaron 41.6% de la varianza (23.6%, 10.5% y 7.4%, respectivamente). El primero de ellos se denominó Involucramiento asertivo, incluye 11 reactivos y tiene una confiabilidad de .8147. El segundo factor se nombró involucramiento emocional, consta de 12 reactivos, con una confiabilidad de .8411. El tercer factor se compone de cuatro reactivos que refieren acciones de búsqueda de independencia con una confiabilidad de .6689. El alpha de Cronbach para la escala global fue de .8707.

La versión final del SRT quedó integrada por 29 reactivos; así se obtuvieron dos factores que explican 32.5% de la varianza total (26.3% y 6.2%, respectivamente). El primero de ellos está integrado por 17 reactivos que exploran la salud física; el nivel de confiabilidad de esta subescala es de .8557. El segundo factor consta de 12 reactivos que indagan aspectos de tipo psicológico y en conjunto obtuvieron una confiabilidad de .8222. La confiabilidad de la escala de 29 reactivos fue de .9012 y la media total de 19.4 (SD=9.7).

La versión adaptada del CES-D consta de 19 reactivos (alpha=. 9105); con ellos se integraron tres factores. El factor 1 está compuesto por 11 reactivos que en conjunto tuvieron una confiabilidad de .9031 y se denominó afecto negativo. El factor 2 consta de cinco reactivos que exploran las relaciones interpersonales; su confiabilidad es de .7581. La estructura del tercer factor, conformado únicamente por tres reactivos, comprende síntomas relacionados con el afecto positivo; la confiabilidad de estos tres reactivos es de .6051.

La metodología de los laboratorios cognitivos fue muy útil para traducir los reactivos a un lenguaje equivalente sin afectar la validez y confiabilidad de los instrumentos. Los hallazgos de este estudio deben considerarse con cautela ya que la muestra de la que provienen los datos no es representativa de la población otomí. Sin embargo, contribuyen a distinguir algunas particularidades sobre cómo se manifiesta la sintomatología depresiva en mujeres de origen ñahñú y a ampliar el conocimiento sobre las variaciones culturales del enfrentamiento.

Palabras clave: Validación; Cuestionario de Enfrentamientos; Escala de Síntomas; CES-D; población indígena; México

SUMMARY

The present paper is a part of a broader research project aimed at adapting a brief intervention model to help families cope with substance abuse for its application to an indigenous population.

Due to cultural differences between urban and indigenous contexts, the adaptation of psychological instruments to assess the intervention outcomes is a major need. Poortinga and Van de Vijver point out that transferring an instrument from the cultural group where it has been designed to another group is a common and economic practice; however, it can lead to invalid conclusions. For this reason, the adaptation must be pursued according to a thorough systematic process in order to develop reliable, understandable, and culture-sensitive instruments.

Cognitive laboratories are among the different methods to evaluate instruments previous to its final application. Its main utility is to generate information about the quality of an instrument and about the way a single question is interpreted, accepted or rejected in different cultural groups.

The objective of this article is to adapt the Coping Questionnaire (CQ), the Symptom Rating Test (SRT) and the Center for Epidemiologic Studies Depression Scale (CES-D) for its use in indigenous population through the cognitive laboratories method. The main interest is to develop instruments to assess psychological distress and how people cope with excessive drinking in the Mezquital Valley.

To accomplish this objective, a two-phase study was carried out. Language adaptation for all three instruments was completed in phase 1, while the validation and identification of the psychometric properties of the new version took place during phase 2. The study was carried out in a community located in Municipio del Cardonal, Hidalgo, where around 60% of the population aged 5 or older speak an indigenous language, mainly Otomi also known as Ñahñu.

The participants in phase 1 were 43 bilingual (Spanish-Ñahñu) women aged between 16 and 60 years, whose main activity was housekeeping. Women were contacted at community meetings, and they agreed to participate voluntarily once the objectives of the study were explained. They were also asked to authorize the recording of the interviews. The language adaptation was performed through the concurrent probing method of cognitive laboratory in its individual modality. Each one of the original items and answer options were read aloud as many times as needed. Immediately following the response, every participant was asked: What does this question mean?, Could you rephrase it?, How would you explain this question to another person in your community?.

All comments were taken into account to rewrite each item. The instructions of all three questionnaires were also simplified to facilitate understanding. As a result of this procedure, the phrasing of 26 out of the 30 items of the CQ changed. The way the SRT questions were written was adjusted so that they could be used in an interview, which is why nearly all the items were modified. As for the CES-D, 9 items were modified, while 11 remained as in the original. Through this method, versions that were easier to understand were achieved, since commonly used terms among the population being studied were incorporated, which in turn reduced the time required to apply the three questionnaires.

During the second phase, the researchers proceeded to validate the final version of the three instruments with a non-probabilistic study of 191 women who were contacted in the health center of the municipal head town; these were inhabitants of 30 of the 92 communities comprising the Municipio del Cardonal. All of them spoke Spanish, 65.8% were aged between 26 and 45 (X=35.2, SD=10.05), 29.5% had completed their primary school studies, while 26% had finished junior high school. Their main activity was housekeeping (69.9%), while 78.5% of the interviewees said they were in close contact with a person who drank heavily. The three instruments were applied individually by a previously trained psychologist and nurse, which took an average of 25 minutes.

The power of discrimination of each item was determined. Those in which no significant differences were found between groups at either end of the spectrum were excluded from the factorial analyses. Factorial analyses were undertaken for the main components using Oblimin rotation to obtain the factorial structure of each instrument and eventually the overall internal reliability and that of each sub-scale was obtained.

In the case of the CQ, the best solution was obtained by testing a 27-item structure distributed among three factors that explained 41.6% of the variance (23.6%, 10.5% and 7.4%, respectively). The first of these, called assertive engagement, includes 11 items that ex- plore coping styles such as control, tolerance, assertiveness and support for the users, which have a reliability rate of .8147. The second factor, called emotional engagement consists of 12 items referring to emotional reactions, avoidance and inaction, with a reliability rate of .8411. The third factor consists of four items referring to actions involving the search for independence, with a reliability rate of .6689. Cronbach’s alpha for the overall scale was .8707.

The final version of the SRT consisted of 29 items. Two factors were obtained that explained 32.5% of the total variance (26.3% and 6.2%, respectively). The first of these comprises 17 items exploring physical health, the reliability of this scale being .8557. The second factor consists of 12 items that explore psychological aspects, which together obtained a reliability rate of .8222. The reliability of the 29-item scale was .9012, while the total mean was 19.4 (SD=9.7).

The adapted version of the CES-D consists of 19 items (alpha=. 9105) comprising three factors. Factor 1 comprises 11 items which together had a reliability of .9031 and which is known as negative affect. Factor 2 consists of five items that explore interpersonal relations, with a reliability rate of .7581. The structure of the third factor, consisting solely of three items, includes symptoms related to positive affect, the reliability of these three items being .6051.

The methodology of cognitive laboratories proved extremely useful in translating the items into an equivalent language without affecting the validity and reliability of the instruments, since the statistical analyses show that the adapted versions of the instruments have appropriate psychometric characteristics, with acceptable reliability levels.

As for the factorial analysis, the factorial structure of the CQ reported by Orford et al. was not corroborated. Nevertheless, the structure found in this study provides a better reflection of the way alcohol consumption problems are dealt with in this population where actions tending towards independence are uncommon, while emotional engagement strategies are much more frequent.

At the same time, the SRT structure proved very similar to that mentioned in other research conducted in Mexico. The highest percentages of answers on the scale of physical symptoms agree with other studies that document a high degree of somatization among Mexican women.

The CES-D structure was found to differ from Radloff ’s original, although the behavior of positive affect items was very similar to that found among Mexican women of rural origin from Jalisco and female teenagers from Zacatecas.

The findings of this study should be regarded cautiously, since the sample from which the data were taken is not representative of the Otomi population. However, they help to distinguish certain particularities of the way depressive symptomatology is expressed in women of Ñahñu origin and to increase knowledge of the cultural variations of coping.

Key words: Validation; Coping Questionnaire; Symptom Rating Test; CES-D; indigenous population; Mexico