Cross-Cultural Equivalence and Evaluation of Psychometric Properties of Voice Handicap Index Into Persian *Negin Moradi, †Abbas Pourshahbaz, *Majid Soltani, *Shiva Javadipour, ‡Hedieh Hashemi, and §Nasibeh Soltaninejad, *Ahvaz, yTehran, zSemnan, and xZahedan, Iran Summary: Quality of life is one of the important aspects in the assessment of health and treatment data output. The purpose of this study was to adapt and determine reliability and validity of Voice Handicap Index (VHI) in Persian. The subjects were 80 patients with voice disorders and 80 volunteers without any voice disorders as a control group. All subjects filled in the Persian version of VHI. The test was repeated 2 weeks later. The reliability and validity were stud- ied. All items had significant discrimination coefficient. The internal consistency and reliability of test and retest in VHI total score and three subtests were achieved. It seems that the Persian version of VHI is a valid and reliable question- naire, which voice therapists may use for completing their evaluation for patients with voice disorders, and it gives more information about the nature of voice disorder to specialists. Key Words: Voice Handicap Index(VHI)–Persian–Voice disorder. INTRODUCTION Patients with voice disorders have reported some problems inter- fering with their occupations and that they experienced the same with social, emotional, communication, and physical functions in their daily and personal lives 1,2 ; hence, in recent years, specialists and voice therapists have attempted to develop methods and construct new tools such as self-report questionnaires to do a comprehensive study of voice disorders and evaluate the pa- tients’ view about the problem. Traditional clinical evaluations of larynx only put the emphasis on the objective measurement methods, such as acoustic and aerodynamic, and the other di- mensions of the resulting damages, such as the impact of a voice disorder on the patients’ quality of life, emotions, attitudes, and concerns, were not considered and evaluated or were paid less at- tention to. 3 Symptoms or complaints reported by clients contain valuable information needed by the voice specialist. 4,5 Not only these are necessary in the diagnostic process but also they provide the specialists with knowledge about the trend of the treatment and its due changes the patients undergo. 6–8 Today, it is greatly recommended to make a comprehensive evaluation of impairment, disability, and handicap in patients with voice disorders. 9 Voice Handicap Index (VHI) questionnaire was de- veloped by Jacobson et al 3 with the intention of studying the pa- tients with voice disorder and understanding the disability caused by the problem. It involves the functional, physical, and emo- tional components. Each component contains 10 items, and each item is responded to by a five-point scale ranging from 0 to 4 (never-to-always). 3 Many researchers have attempted to adapt the questionnaire to their own native languages and cul- tures and presented the results to the scientific societies. A review of these shows that the questionnaire has been translated into dif- ferent languages, 5,10–25 but not into the Persian language, before the current research. Despite the fact that the specialists all agreed on an approved test to be used in a comprehensive speech and language evalu- ation, it was the poor background of doing the test construction in Iran, 26 which necessitated the present research to pursue both translation and adaptation of VHI questionnaire. METHOD Translation procedure According to the basic rules and instructions by International Quality of Life Assessment Project for a cross-culturally mean- ingful translation of any test-related wordings, 27,28 the authors contributed to have VHI questionnaire with a plain and understandable wording for all in Persian language. An official permission for the questionnaire use was requested from both American Speech-Language-Hearing Association and Prof. B.H. Jacobson, the test developer, before taking any further step. At the beginning, two English translators and a speech and language pathologist, whose native language was Persian, were asked to translate the questionnaire from English into Per- sian with a simple, short, and clear wording. Here, three indepen- dent translations were presented, while a panel of experts discussed on them as the primary translation forms. 27,29–31 The panel included a translator, three speech and language pathologists, and a clinical psychologist who was experienced in the field of psychometry and psychological test translation- interpretation. The panel discussed about some topics such as the clarity of translation (ie, using simple and understandable words), the use of general and common words in Persian lan- guage (ie, avoiding the use of jargon or metaphorical words), and the conceptual equivalence (ie, conceptual representation which was used in the main test). In fact, a panel of experts was requested to measure the content validity of all items and determine whether each is translated correctly and implies the Accepted for publication September 25, 2012. From the *Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur Univer- sity of Medical Sciences, Ahvaz, Iran; yDepartment of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran; zFaculty of Rehabilitation Sci- ences, Semnan University of Medical Sciences, Semnan, Iran; and the xFaculty of Reha- bilitation Sciences, Zahedan University of Medical Sciences, Zahedan, Iran. Address correspondence and reprint requests to Abbas Pourshahbaz, Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran. E-mail: apourshahbaz@yahoo.com Journal of Voice, Vol. 27, No. 2, pp. 258.e15-258.e22 0892-1997/$36.00 Ó 2013 The Voice Foundation http://dx.doi.org/10.1016/j.jvoice.2012.09.006