Background Delays in initiating therapy in patients with Rheumatoid Arthritis (RA) adversely affect treatment outcomes such as disease activity, functional capacity and radiographic progression. Delays can be attributed to the patient, healthcare professional and the healthcare system. In Belgium and the UK, patient-related delay was shown to contribute most to overall treatment delay. A standardized instrument for measuring patients' help-seeking behaviour after symptom onset could aid in a better understanding of patient-related delay in RA.

Objectives To develop a Flemish version of the original DELAY (delays in evaluating arthritis early) questionnaire following guidelines for cross-cultural adaptation and validation in Flemish speaking patients with early RA.

Methods Firstly, the British questionnaire was independently forward translated by three Flemish speaking biomedical researchers (DDC, AE, SS), all fluent in the source language. A first Flemish consensus version was drafted by these three forward-translators and a rheumatologist (PV), including adaptation to intercultural differences. Secondly, a backward translation was carried out by one independent Flemish native translator (FD), naive to RA research and with advanced English language skills. This backward translated version was compared to the original questionnaire and discrepancies were discussed with the backward-translator, a forward translator (DDC) and a rheumatologist (PV) before drafting a new Flemish consensus version. This second draft was evaluated for clarity and comprehensibility by a group of five expert patients with RA and by a group of 6 healthcare professionals of our RA team, resulting in a pre-final Flemish version. Subsequently, for internal validation of the pre-final version, we randomly selected five Flemish patients with RA from the University Hospitals Leuven. After having read the questionnaire, these patients were individually inquired by DDC, and their comments were addressed in a final Flemish version of the questionnaire. External validation was performed by doing a test re-test evaluation in a consecutive sample of Flemish patients with early RA. Internal consistency and reproducibility were measured by Cronbach's alpha and the intra-class correlation coefficient (ICC), respectively.

Results For the external validation, 32 patients were invited to participate. The questionnaire was completed twice within 2 weeks by 26 patients. The Flemish DELAY questionnaire showed satisfactory internal consistency (Cronbach's alpha, 0.95). Also reproducibility was satisfactory (ICC, 0.86).

Conclusions The standardized translation and validation process preserved the content, construct validity and reproducibility of the original DELAY questionnaire and resulted in a valid version for mapping patient-related delay in Flemish patients with early RA.

1. Stack RJ et al. The development and initial validation of a questionnaire to measure help-seeking behaviour in patients with new onset rheumatoid arthritis. Health Expect 2015;18(6):2340–55

Disclosure of Interest None declared