Cross-cultural adaptation and validation of the communicative effectiveness index in Malayalam for persons with aphasia

Background Persons with aphasia (PWA) often experience difficulties in functional communication (i.e. the ability to use language effectively in real-world contexts), primarily due to their linguistic impairments. Given the growing emphasis on functional communication assessment in clinical practice and research, and the fact that most available tools are developed in English, there is a need to adapt and validate such tools for individuals who speak languages other than English.Aim The aim of this study was to translate and adapt communication effectiveness index (CETI) into Malayalam, a South Indian language, and examine its psychometric properties.Methods & Procedures The study included a total of 70 participants (n = 70), comprising 35 PWA and their 35 primary caregivers. CETI was adapted to Malayalam by following standard procedures for cross-cultural adaptation. Item level and scale level content validity index (i.e. I-CVI and S-CVI) were calculated with ratings obtained by 8 SLPs and 5 laypersons. Construct validity was measured by comparing overall CETI scores with that of the aphasia quotient (AQ) scores obtained on Test of Aphasia in Malayalam. The adapted tool was administered on the primary caregivers to calculate internal consistency. Test-retest reliability was measured by re-administering the tool in 15% of the caregivers after a two-four-week interval.Outcomes & Results The CETI-Malayalam exhibited strong psychometric properties. Content validity was supported by individual item content validity index (I-CVI) values exceeding 0.93 and a scale-level content validity index (S-CVI) greater than 0.98 for relevance and clarity. Construct validity was demonstrated by a significant positive correlation (r = 0.915) between CETI and AQ scores. Internal consistency was excellent, with Cronbach’s alpha (α) of 0.98 and split-half reliability of 0.96. Intraclass correlation coefficient (ICC) was 0.99, suggesting high test-retest reliability.Conclusion The CETI-Malayalam is a reliable and valid tool for evaluating functional communication skills of Malayalam-speaking PWA.