International Urogynecology Journal

, Volume 28, Issue 6, pp 851–856 | Cite as

A validated translation of a survey for measuring incontinence knowledge in Chinese-speaking American immigrants

  • Rujin JuEmail author
  • Nazema Siddiqui
  • Joanne Garrett
  • Liping Feng
  • Michael Heit
Original Article


Introduction and hypothesis

Urinary incontinence is common amongst Chinese immigrants. These women are a rapidly growing population in the USA who require unique assessment tools due to language barriers. Presently, there are no Chinese language surveys to assess knowledge of urinary incontinence. Our goal was to translate and validate a urinary incontinence knowledge survey from English into Chinese.


The English language Urinary Incontinence Quiz (UIQ) developed and validated by Branch et al. for the Educational Demonstration of Urinary Continence Assessment and Treatment for the Elderly program assesses general knowledge of urinary incontinence as a disease entity. We translated it into Chinese using the forward translation/back translation technique. The Chinese and English versions were then administered to bilingual volunteers in a nonrandomized order during a single encounter. Their responses were analyzed using Cohen’s kappa coefficient to establish the validity of the translated knowledge survey.


Minimal reconciliation was needed in construction of the Chinese survey. Minor English grammatical corrections were made to the back-translated English survey. One question testing two knowledge concepts was separated into two questions to allow clear testing of both concepts individually. Twenty-one bilingual participants performed the validity testing. Over 50% (8 out of 15) of the questions showed nearly perfect agreement with a kappa coefficient >0.80, 5 out of the 15 questions showed substantial agreement with kappa coefficients between 0.61 and 0.8 and two questions showed moderate agreement with kappa coefficients between 0.4 and 0.6.


We validated a translation of the UIQ for assessment of urinary incontinence knowledge in Chinese-speaking immigrants to the USA.


Chinese–American Incontinence Knowledge Translation Urinary Validation 



We would like to thank Minghua Zhu and Weiguo Zhang for their time and effort in the translation process.

Compliance with ethical standards

Conflicts of interest

Rujin Ju, Joanne Garrett, Liping Feng, Michael Heit: none. Nazeema Siddiqui: research grant from Medtronics Inc and funding from National Institute of Diabetes and Digestive and Kidney Diseases (K12 DK100024).


  1. 1.
    Melville JL, Katon W, Delaney K, Newton K. Urinary incontinence in US women: a population-based study. Arch Intern Med. 2005;165(5):537–42. doi: 10.1001/archinte.165.5.537.CrossRefPubMedGoogle Scholar
  2. 2.
    Sung VW, Raker CA, Myers DL, Clark MA. Ambulatory care related to female pelvic floor disorders in the United States, 1995–2006. Am J Obstet Gynecol. 2009;201(5):508.e1–6. doi: 10.1016/j.ajog.2009.06.016.CrossRefGoogle Scholar
  3. 3.
    Wu JM, Kawasaki A, Hundley AF, Dieter AA, Myers ER, Sung VW. Predicting the number of women who will undergo incontinence and prolapse surgery, 2010 to 2050. Am J Obstet Gynecol. 2011;205(3):230 e1–5. doi: 10.1016/j.ajog.2011.03.046.CrossRefGoogle Scholar
  4. 4.
    Margalith I, Gillon G, Gordon D. Urinary incontinence in women under 65: quality of life, stress related to incontinence and patterns of seeking health care. Qual Life Res. 2004;13(8):1381–90.CrossRefPubMedGoogle Scholar
  5. 5.
    Shaw C, Tansey R, Jackson C, Hyde C, Allan R. Barriers to help seeking in people with urinary symptoms. Fam Pract. 2001;18(1):48–52.CrossRefPubMedGoogle Scholar
  6. 6.
    Dunivan GC, Komesu YM, Cichowski SB, Lowery C, Anger JT, Rogers RG. Elder American Indian women’s knowledge of pelvic floor disorders and barriers to seeking care. Female Pelvic Med Reconstr Surg. 2015;21(1):34–8. doi: 10.1097/SPV.0000000000000103.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Bush TA, Castellucci DT, Phillips C. Exploring women’s beliefs regarding urinary incontinence. Urol Nurs. 2001;21(3):211–8.PubMedGoogle Scholar
  8. 8.
    Willis-Gray MG, Sandoval JS, Maynor J, Bosworth HB, Siddiqui NY. Barriers to urinary incontinence care seeking in White, Black, and Latina women. Female Pelvic Med Reconstr Surg. 2015;21(2):83–6. doi: 10.1097/SPV.0000000000000100.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Heit M, Blackwell L, Kelly S. Measuring barriers to incontinence care seeking. Neurourol Urodyn. 2008;27(3):174–8. doi: 10.1002/nau.20473.CrossRefPubMedGoogle Scholar
  10. 10.
    The Rise of Asian Americans. 2012. Accessed 21 August 2016.
  11. 11.
    US Census Bureau. In: Vintage 2009: National Tables. Available at: Accessed 19 August 2012.
  12. 12.
    Huang AJ, Thom DH, Kanaya AM, Wassel-Fyr CL, Van den Eeden SK, Ragins AI, et al. Urinary incontinence and pelvic floor dysfunction in Asian-American women. Am J Obstet Gynecol. 2006;195(5):1331–7. doi: 10.1016/j.ajog.2006.03.052.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Branch LG, Walker LA, Wetle TT, DuBeau CE, Resnick NM, Branch LG, Walker LA, Wetle TT, DuBeau CE, Resnick NM. Urinary incontinence knowledge among community-dwelling people 65 years of age and older. J Am Geriatr Soc. 1994;42(12):1257–61.Google Scholar
  14. 14.
    CDC Translation Protocol Appendix 2. In: Center for Disease Control Translation Protocol. Accessed 1 June 2016.
  15. 15.
    Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33(1):159–74.CrossRefPubMedGoogle Scholar
  16. 16.
    Su TH, Lau HH. Validation of a Chinese version of the short form of the pelvic organ prolapse/urinary incontinence sexual questionnaire. J Sex Med. 2010;7(12):3940–5. doi: 10.1111/j.1743-6109.2010.01891.x.CrossRefPubMedGoogle Scholar
  17. 17.
    Liao YM, Dougherty MC, Boyington AR, Lynn MR, Palmer MH. Developing and validating a Chinese instrument to measure lower urinary tract symptoms among employed women in Taiwan. Nurs Outlook. 2006;54(6):353–61. doi: 10.1016/j.outlook.2006.09.003.CrossRefPubMedGoogle Scholar
  18. 18.
    Choi EP, Lam CL, Chin WY. Validation of the international prostate symptom score in Chinese males and females with lower urinary tract symptoms. Health Qual Life Outcomes. 2014;12:1. doi: 10.1186/1477-7525-12-1.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Chou EC, Hung MJ, Yen TW, Chuang YC, Meng E, Huang ST, et al. The translation and validation of Chinese overactive bladder symptom score for assessing overactive bladder syndrome and response to solifenacin treatment. J Formos Med Assoc. 2014;113(8):506–12. doi: 10.1016/j.jfma.2012.07.044.CrossRefPubMedGoogle Scholar
  20. 20.
    Yiu MK, Li CM, Hou SM, Wong CW, Tam S, Chu SK. Reliability and validity of the overactive bladder symptom score in Hong Kong Chinese. Hong Kong Med J. 2013;19(6):504–10. doi: 10.12809/hkmj133878.PubMedGoogle Scholar
  21. 21.
    Zhu L, Wang X, Shi H, Xu T, Lang J, Tang X. Reliability and validity of a Chinese version of the Modified Body Image Scale in patients with symptomatic pelvic organ prolapse. Int J Gynaecol Obstet. 2015;130(2):187–9. doi: 10.1016/j.ijgo.2015.03.026.CrossRefPubMedGoogle Scholar
  22. 22.
    Chan SS, Choy KW, Lee BP, Pang SM, Yip SK, Lee LL, et al. Chinese validation of urogenital distress inventory and incontinence impact questionnaire short form. Int Urogynecol J. 2010;21(7):807–12. doi: 10.1007/s00192-010-1102-8.CrossRefPubMedGoogle Scholar
  23. 23.
    Chan SS, Cheung RY, Yiu AK, Li JC, Lai BP, Choy KW, et al. Chinese validation of pelvic floor distress inventory and pelvic floor impact questionnaire. Int Urogynecol J. 2011;22(10):1305–12. doi: 10.1007/s00192-011-1450-z.CrossRefPubMedGoogle Scholar
  24. 24.
    Wang H, Lau HH, Hung MJ, Huang WC, Zheng YW, Su TH. Validation of a mandarin Chinese version of the pelvic organ prolapse/urinary incontinence sexual questionnaire IUGA-revised (PISQ-IR). Int Urogynecol J. 2015;26(11):1695–700. doi: 10.1007/s00192-015-2744-3.CrossRefPubMedGoogle Scholar
  25. 25.
    Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 2011;17(2):268–74. doi: 10.1111/j.1365-2753.2010.01434.x.CrossRefPubMedGoogle Scholar
  26. 26.
    Albright J, de Guzman C, Acebo P, Paiva D, Faulkner M, Swanson J. Readability of patient education materials: implications for clinical practice. Appl Nurs Res. 1996;9(3):139–43.CrossRefPubMedGoogle Scholar
  27. 27.
    Sentell T, Braun KL, Davis J, Davis T. Health literacy and meeting breast and cervical cancer screening guidelines among Asians and whites in California. Springerplus. 2015;4:432. doi: 10.1186/s40064-015-1225-y.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Jing W, Likun G. China to regulate use of simplified characters. 2009.
  29. 29.
    Wilson EV, Lankton NK, editors. Some unfortunate consequences of non-randomized, grouped-item survey administration in IS research. Proceedings of the 2012 International Conference on Information Systems; 2012; Orlando, FLGoogle Scholar

Copyright information

© The International Urogynecological Association 2016

Authors and Affiliations

  1. 1.Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive SurgeryIndiana UniversityIndianapolisUSA
  2. 2.Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive SurgeryDuke UniversityDurhamUSA
  3. 3.Department of Obstetrics and Gynecology, Division of Women’s Primary HealthUniversity of North Carolina, Chapel HillChapel HillUSA
  4. 4.Department of Obstetrics and Gynecology, Division of Maternal Fetal MedicineDuke UniversityDurhamUSA

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