The leprosy case detection delay (CDD) questionnaire: Indonesian translation, cross-cultural adaptation, and evaluation

Background Case detection delay (CDD) is associated with grade 2 disability (G2D) in leprosy, a substantial disease burden worldwide. The standardized CDD questionnaire was developed to determine the period of CDD and its related factors. In Indonesia, the incidence of leprosy and G2D is high and an instrument to measure CDD is lacking. This study describes the translation and cross-cultural adaptation process and evaluates the CDD questionnaire in the Indonesian context. Methods We first did forward-backward translation into Bahasa Indonesia and cross -culturally adapted the CDD questionnaire. We then performed face-to-face three-step test interviews in a pilot test to evaluate the understanding of leprosy patients and the content validity of the CDD questionnaire (n = 15). Finally, the reliability and construct validity of the CDD questionnaire were tested in 50 leprosy patients in Tegal Regency, Indonesia. Results The interviews showed that leprosy patients understood the CDD question-naire well. The content and construct validity were adequate according to linguistic validation and statistical hypothesis testing. The internal consistency test with a Cronbach alpha showed that the CDD questionnaire measures one underlying con-struct. The reproducibility test, including the test-retest reliability and agreement test, indicated excellent reliability.Conclusions The version of the CDD questionnaire in Bahasa Indonesia is an instrument with good validity and reliability to determine CDD in Indonesia. We recommend its implementation in the leprosy control programme of Indonesia for monitoring early case detection and thereby avoiding leprosy disability.