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Danish Translation, Cultural Adaptation and Validation of the Shared Decision Making Questionnaire - Patient Version (SDM-Q-9-Pat)

Mette Hulbæk, Marianne J Jørgensen, Hanne Mainz, Regner Birkelund, Jesper Bo Nielson, Birgit Debrabant, Jette Primdahl


Aims and objectives: No validated version of the 9-item Shared Decision Making Questionnaire (SDM-Q-9) in Danish is available. The aim of the study was to translate, culturally adapt and psychometrically test a Danish version of the SDM-Q-9 in 2 patient groups: elderly patients from outpatient gynecology clinics and a group of younger patients from an outpatient sports clinic.

Method: The SDM-Q-9, patient version, was translated into Danish through a standardized forward-backward translation performed by 4 independent translators, followed by cognitive interviewing of 11 outpatients from the 2 patient groups. The process was adjusted by an expert panel. The psychometric testing was performed at 5 Danish hospital departments. Reliability (internal consistency) was estimated by Cronbach’s alpha. Construct validity was determined by confirmatory and explanatory factor analysis.

Results: A total of 268 patients (218 gynecological and 50 knee patients) were included. The scale had high reliability (Cronbach’s alpha of 0.94). A high ceiling effect was found (44% with the highest rating). None of the tested models in the confirmatory analysis had a good fit. The explanatory factor analysis for the whole sample yielded a unidimensional factor, which explained 91% of variances with high factor loadings of more than 0.7.

Conclusion: The Danish version of the SDM-Q-9 is a well-accepted, reliable and - despite the challenges of a high ceiling effect - valid instrument in the tested populations. Further psychometrical testing in other populations is necessary as well as research with other convergent instruments to demonstrate consistency over time and between patient groups.


Anterior cruciate ligament injuries, clinical decision-making, factor analysis, patient involvement, patient perspectives, person-centered healthcare, psychometric testing, treatment options, urogynecology

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