N42 The Interpretation of Illness Questionnaire: preliminary results from the Italian translation and validation in the Inflammatory Bowel Disease setting
Authors: Martinato RN PhD M , Monaco E , Iervolino C , Büssing A , Comoretto R I , Gregori D 
Published: January 2025

Abstract

Background
Understanding how patients interpret their illness is essential for delivering comprehensive care, especially in chronic conditions like Inflammatory Bowel Disease (IBD). The Interpretation of Illness Questionnaire (IIQ – Figure 1), an 8-item 5-point Likert scale questionnaire, helps assess patients' cognitive and emotional responses to their illness. Yet it has not been used among IBD patients. This study aimed to translate and validate the IIQ for the Italian IBD patient population.

Methods
The IIQ was translated into Italian and validated following a structured 6-step process (Figure 2) already adopted in previous studies [1]: forward and backward translation, expert panel review, and both face- and content-validation (quantitative validation). A panel of 10 experts, including specialists in nursing, psychology, gastroenterology, and patients conducted the quantitative validation. The Think Aloud (TOL) technique was then adopted to perform qualitative validation (currently in progress) to ensure the questionnaire was clear and relevant to IBD patients confirming both face- and content-validation asking 20 participants to verbalize their thoughts while completing the questionnaire, allowing to capture real-time insights into their understanding, interpretation, and potential challenges with questionnaire’s items.

Results
The face validation process showed that experts and patients rated the questionnaire items as clear and easily understandable with a rate between 0.9 and 1.0 in every single item and an overall rate of 0.92, excluding the need for items reformulation. The Scale Content Validity Index (S-CVI) was calculated at 0.94, while the Item Content Validity Index (I-CVI) was in a range between 0.9 and 1.0 in every item, indicating excellent relevance and coverage of the interpretation of illness constructs. The qualitative validation, conducted so far with the participation of 4 out of 20 patients, confirmed the understanding and correct interpretation of the individual items and of the whole questionnaire, ruling out potential challenges in completing the questionnaire.

Conclusion
The Italian version of the IIQ is a valid instrument for assessing how IBD patients interprets their illness. This validated tool can assist healthcare professionals in tailoring interventions to support better coping and psychological adaptation in IBD care. A pilot study adopting the TOL technique is confirming the clarity and cultural relevance of the translated questionnaire. The finalized Italian version will be subsequently administered to IBD patients in a larger pilot study [2] to assess its reliability. Future studies are encouraged to explore the use of IIQ in other European languages and contexts to enhance holistic patient care.

References
[1]Martinato M, Ranzato C, Faggian E, et al. Knowledge assessment among subjects with chronic venous leg ulcer in outpatient setting: Translation and adaptation of a tool to identify subjects at risk of poor understanding. Wound Repair Regen. 2023;31(5):679-687. doi:10.1111/wrr.13107
[2]Martinato M. N-ECCO Grant Spiritual needs of patients with inflammatory bowel disease and their caregivers: a European cross-sectional nursing study. J Crohns Colitis. 2024;18(Supplement_1):i2274. doi:10.1093/ecco-jcc/jjad212.1437