| Summary: | The Rose Angina Questionnaire (RAQ) is an important measure of coronary heart disease prevalence. It has been shown to perform inconsistently across some ethnic groups in Britain. For multi-ethnic survey research, an angina screening instrument with greater cross-cultural validity is required. Objectives: To assess the need for, and feasibility of, modifying the RAQ to produce a cross-culturally valid angina screening tool for use in Punjabi, Cantonese and English speakers. Participants expressed a range of health beliefs and behaviours. Perceptions and significance of pain and chest pain varied. However, whilst there were some themes that varied between groups, no dominant themes in the cultural construction of health, pain or cardiovascular knowledge emerged that may significantly influence RAQ response between language groups. Individual differences such as general anxiety about health, or awareness of cardiac symptoms, were more likely to affect perception of, and response to, RAQ items. Problems were encountered with the Punjabi and Cantonese translations of the RAQ, where inappropriate translocations may have produced distorted data on angina prevalence. For example, the translation for “chest” was interpreted by some Pakistani and fewer Chinese woman to mean “breasts”. “Waling uphill” was translated in Chinese as “walking the hill”, without stipulation of the direction, so that some Cantonese speakers interpreted the question as pertaining to walking downhill. In addition, many Chinese interpreted RAQ items to be referring to breathlessness rather than chest pain due to ambiguous wording. Standardised administration of questionnaire items by an interviewer may also be difficult to establish. The process of lay assessment of questionnaire appropriateness using bilingual project workers also raised methodological challenges- the assessment task was difficult for participants to understand and for bilingual project workers to implement. There is evidence that existing Punjabi and Cantonese versions of the Rose Angina Questionnaire should be modified further before being used in multi-ethnic surveys. Current versions are unlikely to be yielding data that is equivalent or comparable across groups. Other language versions may also require investigation to ensure comparability.
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