Linguistic and cultural adaptation of internet-based cognitive behavioral therapy for tinnitus to Indian English : methods and readability outcomes

Abstract

BACKGROUND : Tinnitus often causes distress, irritability, difficulty sleeping, and lack of concentration due to its consistent persistence. Cognitive behavioral therapy (CBT) is a proven psychological treatment that can reduce tinnitus-related distress and can be provided via the Internet (ICBT). Such evidence-based, accessible treatments are not yet available in India. The increasing access to eHealth interventions in India will support and increase access to interventions like ICBT. This study aims to adapt ICBT for tinnitus to Indian English, ensuring it is culturally, linguistically, and contextually appropriate for the Indian population. METHOD : The material was carefully reviewed by an audiologist, a linguist, a psychologist and a psychiatrist. The adaptation procedure primarily followed the ISPOR Principles of Good Practice for the translation and cultural adaptation, with a few adaptations from the Ecological validity model. Conflicts were resolved with consensus among all professionals. Then, the content was validated by the psychologist and psychiatrist. Additionally, readability adjustments ensured comprehensibility of the target population. RESULTS : A total of 76 (54 words and 22 phrases) were recommended for modification for reasons including cultural adaptation, lexicon, linguistic relevance, and concept coverage. Lexicons were the highest reason (52%) for modification. The material was critically validated by the expert committee and finalized based on comprehensibility, cultural appropriateness, and concept coverage, as the average scores were above 8 (benchmark pre-determined) for all modules. The readability scores also fell within the pre-determined criteria to finalize the material. CONCLUSION : This material has been adapted and validated for the Indian population, and it can now be further developed as a treatment program. This represents a significant step towards establishing standard, evidence-based tinnitus treatment protocols in India. Further studies should examine the feasibility, efficacy, and effectiveness of ICBT for the Indian population through clinical trials.