Skip to main content

Only two subscales of the Coping Strategies Questionnaire are culturally relevant for people with chronic low back pain in Nigerian Igbo populations: a cross-cultural adaptation and validation study

Abstract

Background

Pain coping strategies are important in the chronicity of low back pain and the associated disability. However, their exact influence is unknown in many African contexts such as rural Nigeria due to lack of outcome instruments with which to measure them. This study aimed to cross-culturally adapt and psychometrically test the Coping Strategies Questionnaire (CSQ) in Igbo populations in Nigeria.

Methods

The CSQ was forward and back translated by clinical and non-clinical translators; evaluated by an expert review committee. The translated measure was piloted amongst twelve rural Nigerian dwellers with chronic low back pain (CLBP) using the think-aloud cognitive interviewing style. Internal consistency (Cronbach’s alpha), test–retest reliability (intra-class correlation coefficient—ICC and Bland–Altman plot), and minimal detectable change were examined amongst 50 people with CLBP in rural and urban Nigerian populations. Construct validity was determined by assessing the correlations between the adapted CSQ and measures of disability, pain intensity, fear avoidance beliefs, and illness perceptions using Spearman’s correlation analyses with 200 adults with CLBP in rural Nigeria. Exploratory factor analyses using Kaiser criterion (eigenvalue) and parallel analysis as methods for determining dimensionality were conducted with the same sample.

Results

Fourteen out of 42 items were routinely adopted in this population including all items of catastrophising subscale, and all but one item of praying and hoping subscale. Catastrophising and praying and hoping subscales had the highest Cronbach’s alpha. All subscales had high ICCs with Bland–Altman plots that showed good agreement. All coping strategies were positively correlated with self-reported disability and pain intensity with catastrophising subscale having the highest values. Seven-factor and three-factor structures were produced with the Kaiser criterion and parallel analysis, with different items from the original CSQ, except for catastrophising.

Conclusions

Catastrophising and praying and hoping may be the relevant coping strategies in this population. More culturally relevant measures of pain coping strategies that include adaptive coping strategies may need to be developed for African contexts such as rural Nigeria.

Background

Pain coping is the effortful response or strategy utilised by an individual to manage the external or internal strains imposed by pain being experienced. Passive pain coping involves withdrawal or relinquishing control of the pain being experienced to an external agent expected to relieve pain. In contrast, active coping requires an individual to initiate instrumental action to address the pain being experienced. Systematic review evidence suggest that passive coping strategies are important contributors to chronic low back pain (CLBP) disability [1]. Passive pain coping strategies have been shown to include depending on others for daily tasks, perceived inability to control pain, hoping for better pain medications from doctors [2]; distraction and praying, helplessness and hopelessness [3] in high income countries.

Distraction and praying/hoping have been shown to be more predictive of pain intensity, whereas ignoring pain sensations and coping self-statements have been more associated with disability [4]. Diverting attention and praying/hoping are associated with greater pain, disability, depression, and pain-related anxiety, less uptime, and worse work status in another study [5]. Praying, hoping, and catastrophising have been associated with more anticipatory anxiety, greater anxiety during painful activity, and reduced range of motion from the onset of pain increase to the point of pain tolerance [6]. Contradictory findings were found in a study showing that increased use of praying and hoping strategies following treatment were significantly related to decreases in reported pain intensity [7]. However, the use of a non-validated pain diary of verbally reported pain intensity, and merging praying/hoping with diverting attention may have influenced findings in the latter. Diverting attention is sometimes useful in CLBP [8]. Passive coping strategies such as focusing on pain, restricting social activities, and depending on pain medication have been consistently associated with poor CLBP outcomes including disability and sick leave [9,10,11,12].

Conversely, active pain coping strategies are believed to be adaptive. They have been characterised as staying busy or active, distracting attention from the pain and taking part in physical activity, exercise or physiotherapy, and are associated with neither an increase nor decrease in the risk of developing a new episode of LBP [13] nor did they predict sick leave [9]. The use of coping self-statements such as telling oneself that you can cope with the pain regardless of intensity, was associated with lower skin conductance during anticipation of pain, and greater range of motion [6]. In another study in America, coping self-statements were labelled as denial of pain, and were not associated with positive outcomes [7], similar to findings in urban South Africa [14, 15]. Diverting attention was associated with increased pain intensity, while helplessness was related to depression and functional impairment in the USA based study [7].

Active and passive coping strategies may differ in different contexts due to cultural differences in coping with pain [16]. Hence, the relative importance of different coping strategies may well vary in different cultures and according to the outcome measures included. In addition, temperament traits influence pain experience and behaviour [17]. For instance, maladaptive pain coping strategies can be associated with personality characteristics, in particular, high levels in Harm Avoidance (cautious, fearful, tense, apprehensive, nervous, doubtful, insecure, passive or pessimistic) and low levels in Self-Directedness (immature, weak, fragile, destructive, irresponsible, unreliable, and poorly integrated when not conforming to the direction of a mature leader) [18]. Harm Avoidance is associated with pain-related anxiety including pain-catastrophising, sometimes regarded as a coping strategy, which can be associated with physical inactivity and disuse which can further worsen disability and pain intensity [19]. Moreover, personality characteristics may vary across cultures [20]. Pain medication dependence, searching for permanent cure, and activity pacing were a few of the pain coping strategies highlighted in qualitative studies conducted in rural Nigeria [21, 22]. The influence of pain coping strategies on CLBP disability have not been quantitatively investigated in rural Nigeria possibly due to lack of culturally sensitive measures.

Aims

There are currently no outcome tools for measuring pain coping strategies in the Igbo Nigerian population. The Coping Strategies Questionnaire (CSQ) is the most widely used self-report measure of pain coping strategies. Therefore, this study aims to:

  • Cross-culturally adapt the CSQ into Nigerian Igbo.

  • Psychometrically test the CSQ in rural and urban Igbo populations in Nigeria.

Methods

Study designs

Translation and cultural adaptation, test–retest measurements, and cross-sectional study of the psychometric properties of the CSQ were performed among Igbo populations with chronic low back pain living in rural and urban settings in Nigeria.

Ethical issues

Ethical approvals were obtained from King’s College London (Ref: BDM/13/14-99) and University of Nigeria Teaching Hospital (Ref: UNTH/CSA/329/Vol.5). Written permission was obtained from the original developers of the questionnaire. Informed consent was sought and obtained from all the participants involved in this study. Participants were attended to in their homes and workplaces and were not given remuneration for participating in the study.

Outcome measures

Coping Strategies Questionnaire (CSQ)

CSQ was developed to assess cognitive and behavioural coping strategies for dealing with pain [23]. Further validation of the CSQ following initial development by the original developers of the measure produced the 42-item version which was obtained by removing the eighth subscale ‘increasing pain behaviours’. The original authors found that the eight subscale had an unacceptable level of internal consistency and recommended the use of the 42-item version of the CSQ as the standard CSQ [23]. CSQ consists of seven subscales with six items each: (diverting attention [items 3, 9, 12, 26, 27, 38], reinterpreting pain sensation [items 1, 4, 10, 16, 29, 41], catastrophising [items 5, 11, 13, 25, 33, 37], ignoring pain sensations [items 17, 19, 21, 24, 30, 35], praying or hoping [items 14, 15, 18, 22, 28, 36], coping self-statements [items 6, 8, 20, 23, 31, 32] and increased behavioural activities [items 2, 7, 34, 39, 40, 42]). Each item has a numeric rating scale ranging from 0 (never do that) to 6 (always do that). Hence each subscale has a maximum score of 36 and a minimum score of 0. A higher score indicates greater use of a particular coping strategy. Additional two items assess overall effectiveness of pain control and ability to decrease pain. The internal consistencies of the subscales range between 0.71 and 0.85 [23].

Eleven-point box scale (BS-11)

The BS-11 is an eleven-point numeric scale for pain intensity [24]. It consists of eleven numbers (0 through 10) surrounded by boxes. Zero represents ‘no pain’ and 10 represents ‘pain as bad as you can imagine’ or ‘worst pain imaginable’. It is easy to comprehend and administer, with high test–retest reliability in both literate and illiterate patients with rheumatoid arthritis (ICC = 0.96 and 0.95, respectively). BS-11 has high correlations (0.86–0.95) with the visual analogue scale (VAS) in patients with rheumatic and other chronic pain conditions; and a reduction of 2 points is clinically significant [24].

Igbo Roland Morris Disability Questionnaire (Igbo-RMDQ)

The RMDQ is simple to administer, easily understood, and is most suitable for population-based studies [25]. The Igbo-RMDQ [26], adapted from the original version [27], is a 24-item back specific self-report measure. Each item has possible scores of 0 or 1. A total maximum score of 24 signifies the highest disability and 0 denotes no disability. The Igbo-RMDQ has good face and content validity, construct validity (moderately high correlations [r > 0.6] with performance-based disability and pain intensity), internal consistency (α = 0.84), test–retest reliability (intraclass correlation coefficient = 0.80) [26], and responsiveness (2–3-point change from baseline is considered clinically important) [25].

Igbo World Health Organisation Disability Assessment Schedule (Igbo-WHODAS 2.0)

The Igbo-WHODAS 2.0 is a 36-item interviewer administered questionnaire that assesses six domains of disability. These include cognition (understanding and communicating), mobility (getting around), self-care (taking care of oneself), getting along with people (good relationship with people), life activities (maintaining an individual’s household or work/school activities) and participation (participating in society and the impact of the health problem on them and their family). Difficulties encountered are measured within the last 30 days. The measure has good face and content validity, construct validity, internal consistency, test–retest reliability and responsiveness. The complex scoring method considers multiple levels of difficulty for each item. It involves summing recoded item scores in each domain, summing all six domain scores, and converting the total score into a value that range from 0 (no disability) to 100 (maximum disability) [28].

Igbo fear avoidance beliefs questionnaire (Igbo-FABQ)

The Igbo-FABQ is a sixteen-item back pain-specific self-report tool that measures the level to which pain is believed to be caused or aggravated by general physical activity (FABQ-PA) and work-related activities (FABQ-W) [29]. The two subscale scores give a total score of 66. Greater scores reflect more fear avoidance beliefs [30]. The physical activity subscale (FABQ-PA) has five items, each with a score ranging from 0 (completely disagree) to 6 (completely agree). Item 1 is a distractor and is not scored. The maximum score for FABQ-PA is 24 and the minimum is 0, with higher scores indicating stronger fear avoidance beliefs related to physical activity. FABQ-W has 11 items, each with a score ranging from 0 (completely disagree) to 6 (completely agree). Items 8, 13, 14, 16 are distractors, and do not contribute to total score. The maximum score for FABQ-W is 42 and minimum score is 0 with higher scores indicating stronger fear avoidance beliefs related to work activities. Igbo-FABQ has good face and content validity, construct validity, internal consistency, test–retest reliability and responsiveness [29]. A change of 13 from baseline is clinically significant [31].

Igbo Brief Illness Perceptions Questionnaire (Igbo-BIPQ)

The Igbo-BIPQ is a self-report measure of cognitive and emotional illness perceptions [32] adapted from the original English version [33] with eight items (consequences, timeline, personal control, treatment control, identity, illness concern, coherence and emotional representation), each of which assesses one dimension of illness perceptions. There is an incremental ten-point scale in each item, anchored at 0 and 10 depicting minimal and maximal level of the assessed dimension. The eight items may be combined as one total score, or each item may be assessed separately to give eight dimensions of illness perceptions [33]. Eighty and 0 are the maximum and minimum total scores. A higher score signals a more threatening view of an illness [33]. The ninth item is open and is the causal item. Igbo-BIPQ has good face and content validity, construct validity, internal consistency, test–retest reliability and responsiveness [32].

Cross-cultural adaptation

Participants

A clinical musculoskeletal physiotherapist (bilingual in English and Igbo, native Igbo speaker) who had been practicing in Nigeria for 18 years; and three non-clinical translators (two native English speakers and one native Igbo speaker; all bilingual in English and Igbo) were involved in the cross-cultural adaptation. Two of the non-clinical translators (one native English speaker and one native Igbo speaker) were linguistic experts. Two English experts (health psychologist and academic physiotherapist) in the United Kingdom, and two Igbo experts (clinical psychologist and clinical physiotherapist) in Nigeria made up the expert review committee.

Twelve adults recruited conveniently from a rural population in Enugu State pre-tested/piloted the adapted measure. They were invited to participate in this study via telephone, but data were collected face-to-face following informed consent. Only participants whose CLBP were non-specific (not due to malignancy, spinal fracture, infection, inflammation, or cauda equina syndrome) were recruited.

Procedure

The questionnaire was translated and culturally adapted following evidence-based guidelines for a period of one month [34, 35] (Fig. 1).

Fig. 1
figure 1

Translation and cultural adaptation stages

One bilingual clinical musculoskeletal physiotherapist and one bilingual non-clinical professional translator (native Igbo speakers, bilingual in Igbo and English) forward translated the original CSQ from English to Igbo. Item definitions were provided for the clinical translator to promote understanding of the construct being assessed. Item definitions were not provided for the non-clinical translator to ensure that the translation replicated the lay language used in Igbo culture. T1 and T2 versions of the questionnaire were produced respectively.

A synthesis of T1 and T2 was then performed following discussions between the two forward translators. This was mediated by the first author who is bilingual in English and Igbo to produce a T-12 version. Inconsistencies in the translations were noted by the lead author.

The two back translators back-translated the T-12 CSQ version from Igbo to English. They were both native English speakers from non-clinical backgrounds and blinded to the original measure. One of these back translators was an Igbo/English linguistic expert/professional translator. Hence, BT1 and BT2 back-translated English versions were produced. Back translation validated the translation process ensuring that the translated (T-12) CSQ version was reflecting the construct in the original CSQ.

T1, T2, T-12, BT1 and BT2 versions were subsequently discussed by the expert review committee together with the four translators to produce the pre-final Igbo-CSQ. This committee aimed to achieve semantic, idiomatic, experiential and conceptual equivalence [34]. The expert committee explored Igbo and English words to assess if they meant the same thing, if any item had multiple meanings, and if there were any grammatical difficulties in the translations. The committee helped to formulate alternative Igbo idioms, where English versions were not applicable in the population. The committee also ensured that questionnaire items were experienced similarly in English and Igbo cultures. The committee determined that the words in the items, instructions, and response options had similar conceptual meanings in Igbo and English cultures. They ensured that the Igbo words used were simple and basic.

The pre-final Igbo CSQ was field tested in rural Nigeria among the twelve rural adults. The lead author interviewer-administered the pre-final CSQ using the ‘think-aloud’ cognitive interviewing procedure to assess comprehensibility, acceptability of items and cultural equivalence. Each item was read out by the lead author. Participants were asked to verbalise their thoughts as they tried to answer each question. They were asked if they understood each item, what they understood from each item, the meaning of their chosen response, and if they found any item offensive or irrelevant. They were encouraged to keep verbalising their thoughts while their responses were recorded by the first author. Items that were offensive, irrelevant, or unclear were reviewed by the external review committee together with the translators. This was aimed at ensuring that equivalence was maintained in Nigeria to confirm face and content validity. Technical equivalence was assured via the use of interviewer-administration with all participants.

Psychometric testing

This took place following the completion of the cross-cultural adaptation phase and lasted for another one month.

Sample size

Sample for reliability testing

A minimum sample size of 27 will detect an intra-class correlation coefficient of 0.9 at a 95% confidence interval [28]. A convenience sample of 50 people with non-specific CLBP, between the ages of 18 and 69 years, were recruited from rural and urban communities in Enugu State, Nigeria. This sample was used for the estimation of internal consistency (Cronbach’s alpha), test–retest reliability (intra-class correlation coefficient—ICC and Bland–Altman plot), and minimal detectable change.

Sample for construct validity investigation

A sample of 194 would give an 80% power to detect a very small correlation coefficient of 0.2 at α level of 0.05. Evaluation of construct validity was done as part of a different study aimed at determining the biopsychosocial factors associated with chronic low back pain disability in rural Nigeria [36]. A representative sample of 200 adults, aged 18 to 69 years, with non-specific CLBP were recruited from rural communities in Enugu State, Nigeria using multistage cluster sampling [36]. A total of ten rural communities from ten rural local government areas were randomly selected. Ten community health workers (CHWs) were recruited and trained to collect data from 20 participants randomly selected from each community, resulting in a total of 200 participants. Informed consent was obtained prior to data collection.

Procedure

A training manual was developed, tested and used for training the CHWs for interviewer-administration of the questionnaires. The CHWs were trained on strategies to prevent bias to participants’ responses, and ensure that all questionnaire items were completed. Fidelity checks during data collection ensured that data collection was per protocol. CHWs firstly screened participants using screening questions and a body chart to ascertain that pain was non-specific and in the lower back. Igbo versions of CSQ, BS-11, RMDQ, WHODAS 2.0, FABQ and BIPQ were interviewer-administered with Likert scales presented to participants as ‘flash cards’ as each corresponding item was read out by each CHW.

The Igbo-CSQ was completed at baseline, and repeated 7 to 10 days after, for test–retest reliability investigation amongst the convenience sample of 50 rural and urban participants. The same CHW collected data from each participant on the two occasions.

Igbo versions of CSQ, BS-11, RMDQ, WHODAS 2.0, FABQ and BIPQ were completed at one time-point in a cross-sectional design among the random sample of 200 rural dwellers.

Recruiting different samples enabled a wider applicability of the questionnaire in rural and urban Nigeria, and across literacy levels.

Data analyses

Data analyses were completed with IBM SPSS version 22 and JASP version 0.14.1. Visual and statistical methods were used to assess data normality.

Reliability

Intra-class correlation coefficient (ICC) was used to assess test–retest reliability and evaluated how consistently the Igbo-BIPQ measured illness perceptions over time. A two-way random effects model (with the assumption that measurement errors could arise from either raters or subjects), using an absolute agreement definition between test–retest scores was utilised. Good, very good and excellent ICCs were defined as 0.7, 0.8 and 0.9 respectively [37]. The extent to which all the questionnaire items measure the same construct was investigated using internal consistency (Cronbach’s alpha), and was graded as strong (0.7–1.0), moderate (0.3–0.6) and low/weak (0–0.2) [38]. Visual assessment of the agreement between test–retest measurements were done by plotting mean Igbo-CSQ scores against difference in total Igbo-CSQ scores using Bland–Altman plots. This accounted for the weakness of ICC, which might indicate strong correlations between two measurements with little or no agreement [39].

Standard error of measurement (SEM) and minimal detectable change (MDC) also contributed to reliability investigations. MDC is the smallest change detected by a measure that truly denotes a noticeable change that is not from measurement error. MDC should be sufficiently small to detect minimal clinically important difference [40]. MDC was calculated using the standard error of measurement (SEM) (based on the distribution method), and the reliability of the questionnaire [40]. SEM was estimated using standard deviation (SD) of the sample and the test–retest reliability (R) of the Igbo-CSQ using Eq. (1) below [40]:

$${\text{SEM}} = {\text{SD}}\surd \left( {1 - {\text{R}}} \right)$$
(1)

Equation (1) Standard Error of Measurement.

MDC was estimated with Eq. 2 below:

$${\text{MDC}} = {1}.{96}*\surd {2}*{\text{SEM}}$$
(2)

Equation (2) Minimal Detectable Change where 1.96 = 95% confidence interval of no change; √2 = two measurements [40].

Validity

Construct validity is the degree to which an outcome tool measures the construct it was intended to measure [41]. The domain of construct validity assessed was convergent validity using Spearman correlation coefficient (non-parametric data), and was rated as weak (0–0.2), moderate (0.3–0.6), or strong (0.7–1.0). Convergent validity assesses whether two tools that measure constructs that are assumed to be theoretically related, are related indeed. There are no Igbo pain coping tools. Hence, relationships between pain coping strategies and self-reported numeric pain intensity (BS-11), self-reported back pain specific disability (Igbo-RMDQ), self-reported generic disability (Igbo-WHODAS), self-reported fear avoidance beliefs (Igbo-FABQ), and self-reported illness perceptions (Igbo-BIPQ) reported in the literature were used for validity assessment adopting hypotheses set a priori. Regarding the relationships between the CSQ subscales, pain intensity and disability, catastrophising subscale is expected to have at least a moderate correlation with pain intensity measured with the BS-11 and disability measured with the Igbo-RMDQ and Igbo-WHODAS as suggested in people with CLBP [42,43,44]. Diverting attention, reinterpreting pain sensations, praying or hoping, and increased behavioural activities subscales are expected to have low to moderate correlations with pain intensity measured with the BS-11, and disability measured with the Igbo-RMDQ and Igbo-WHODAS [4,5,6, 9,10,11,12, 45]. Ignoring pain sensations and coping self-statements subscales are not expected to be significantly correlated with pain intensity measured with the BS-11, and disability measured with the Igbo-RMDQ and Igbo-WHODAS [5, 45]. Pain control and pain decrease are expected to be negatively correlated with pain intensity measured with the BS-11, and disability measured with the Igbo-RMDQ and Igbo-WHODAS [6].

Regarding the relationships between the coping strategies and fear avoidance beliefs, negative coping strategies and catastrophising (which may or may not be regarded as a coping strategy) is expected to be positively associated with fear avoidance beliefs [46, 47]. Negative coping strategies include passive coping which are often classified to include praying or hoping, coping self-statements, diverting attention, ignoring pain sensations [3, 5, 6, 9,10,11,12,13] However, the definitions of active, passive, positive, or negative coping strategies appear to differ in different contexts due to cultural differences in coping with pain [16, 48].

Regarding known relationships between coping strategies and illness perceptions, passive coping strategies are known to be stimulated by maladaptive illness perceptions [49]. They are therefore expected to be positively correlated.

Exploratory factor analysis (EFA) was used to determine the number of factors influencing the Igbo-CSQ, that is, its dimensionality [50]. EFA was applied according to Kaiser Meyer Olkin (KMO) and the Bartlett’s test with a minimum eigenvalue for retention set at 1.0 (Kaiser’s rule) [51]. Parallel analysis was included as an additional method for determining the number of factors to be retained in the Igbo-CSQ to compensate for the weakness of the Kaiser criterion which can overestimate or underestimate the number of factors to be retained. In contrast, the parallel analyses shows fewer fluctuations in its accuracy and is more robust [52, 53]. For both methods of determining dimensionality (Parallel analysis and Kaiser criterion), promax (oblique) rotation, which assumes that factors can be related, was done, and factor loadings less than 0.3 were suppressed as recommended; and extraction was done using principal axis factoring as the data had a non-normal distribution [50, 54]. Empirical guidelines are useful, but they are not always correct, and the true number of factors is unknown in reality. Therefore several methods for estimating the number of factors should be utilised and the meanings of findings investigated [52, 53]. The accuracy of empirical guidelines is more likely to be compromised when factors are highly correlated, factor loadings are low, the number of factors is large, and the sample size is small; hence multiple criteria, including relevant theory and previous research, should be used to determine the number of factors to retain [54, 55]. Statistics experts recommend selecting from among a set of competing theoretical explanations the model that best balances the desirable characteristics of parsimony and fit to observed data in terms of interpretability and conceptual sense [54, 55]. Therefore, the number of factors of the adapted measure and their underlying associations were investigated and compared with the original CSQ. Factor pattern coefficients were used for the factor loadings. Scree plot was used for the visual exploration of the retained and excluded factors as recommended [54, 55]. The number of factors and the underlying relationships between Igbo-CSQ items were then compared with the factor structures of the original CSQ to enhance an understanding of population characteristics.

Floor and ceiling effects

When a significant number of participants score the maximum or the least score on a measure, ceiling or floor effect occurs. This implies that the two extremes of the scale are not sufficiently differentiated. For this study, 15% or above was regarded as floor or ceiling effect (Lim et al. 2015). This was estimated for each of the seven subscales found in the original CSQ.

Results

Participant characteristics

Table 1 describes the sociodemographic characteristics of the participants in the cross-cultural adaptation, test–retest reliability and construct validity samples.

Table 1 Demographic characteristics of participants in the three samples

Cross-cultural adaptation findings

For item 1, the Igbo equivalent of ‘I try to forget the pain or behave as if the pain is not in my body…’ was used in place of ‘I try to feel distant from the pain…’ during the synthesis of the forward translations due to lack of an Igbo equivalent for ‘feel distant’. Similarly, in item12, the team used Igbo version of ‘I play some different games in my mind or play mental games…’ in place of ‘I play mental games….’ as the literal translation is an idiomatic Igbo expression that was not understood by everyone especially younger people. For item 29, translators agreed on ‘…is not inside my body’ which echoes the original item because there is no Igbo phrase for ‘…outside of my body’. For item 42, there are no exact Igbo equivalents for ‘active’ and ‘project’ hence the team agreed on ‘I do something that involves moving my body like doing household chores or other works’ to reflect the original item ‘I do something active, like household chores or projects’. Although comprehension of the adapted CSQ was confirmed during verbal pre-testing in rural Nigeria, participants reported not routinely doing the activities in questionnaire items 1, 2, 3, 4, 7, 8, 9, 10, 12, 16, 17, 18, 19, 20, 21, 23, 24, 26, 27, 29, 30, 32, 35, 38, 40, 41, and 42.

Psychometric properties

No missing data were recorded. Table 2 illustrates the reliability of the adapted CSQ. Bland–Altman plots showed acceptable agreement between test–retest values of the subscales of the Igbo-CSQ as mean differences were close to zero and most points were within the 95% limits of agreement of the mean differences (Additional file 1). Table 3 depicts the construct validity of the adapted CSQ using correlations with measures of disability, pain intensity, fear avoidance beliefs, and illness perceptions. All subscales of the adapted CSQ had moderate correlations with disability (Igbo-RMDQ and the Igbo-WHODAS) and fear avoidance beliefs. Weak to moderate correlations were found between the subscales of the adapted CSQ and illness perceptions (Igbo-BIPQ) except for ignoring sensations, which had no correlations with illness perceptions. The CSQ control and decrease pain items had no significant correlations except for weak positive correlations between CSQ control and disability (Igbo-WHODAS), CSQ control and fear avoidance beliefs, CSQ decrease pain and fear avoidance beliefs. Notably, there was a moderate negative correlation between CSQ control and illness perceptions (Igbo-BIPQ). Table 4 describes the seven-factor structure of the adapted CSQ using the Kaiser criterion for determining dimensionality. 44.64% of the items had factor loadings above 0.5. Factor 1 had main loadings from 4 items of the original reinterpreting pain sensations subscale, 4 items of the original ignoring sensations subscale, 2 items of the original increased behavioural activities subscale, 1 item of the original diverting attention subscale. Factor 2 was loaded mainly by all items of the original praying or hoping subscale, and 4 out of 6 items of the original coping self-statements subscale. Factor 3 had main loadings from 5 out of 6 items of the original diverting attention subscale, and 3 out of 6 items of the original increased behavioural activities subscale. Factor 4 was loaded mainly by all items of the original catastrophising subscale only. Factor 5 was loaded by only 3 items with each item of the original ignoring sensations, coping self-statements and increased behavioural activities subscales. Factor 6 was loaded by 2 items of the original reinterpreting pain sensations subscale, 1 item of the original catastrophising subscale, and one item of the original coping self-statements subscale. Factor 7 was loaded mainly by 1 item of the original ignoring sensations subscale. The catastrophising factor was the only one that retained the structure (100%) of the original measure. Praying and hoping combined with coping self-statements appeared to be one distinct coping strategy as opposed to two strategies in the original measure. Table 5 and Fig. 2 illustrate the three-factor structure of the Igbo-CSQ using the parallel analysis for determining dimensionality. 90.48% of the items had factor loadings above 0.5 but two items (CSQ12 and CSQ31) had no factor loadings (factor pattern coefficients) and were excluded. Factor 1 had loadings from all items of the original reinterpreting pain sensations subscale, increased behavioural activities subscale, ignoring sensations subscale, diverting attention subscale except for one item (CSQ12 which had no factor loading and was excluded), and one item of the original coping self-statements subscale. Factor 2 had loadings from all items of the original praying and hoping subscale and all but two items (4 out of 6 items) of the original coping self-statements (CSQ31 had no factor loading and was hence excluded, and CSQ32 loaded on factor 1). Factor 3 had loadings from all items of the original catastrophising subscale. Once again, the catastrophising factor was the only one that retained the structure (100%) of the original measure, and praying and hoping combined with coping self-statements appeared to be one coping strategy.

Table 2 Reliability of Igbo-CSQ
Table 3 Spearman’s correlation between Igbo-CSQ subscales, and self-reported back pain specific disability (Igbo-RMDQ), self-reported generic disability (Igbo-WHODAS), self-reported numeric pain intensity (BS-11), self-reported fear avoidance beliefs (Igbo-FABQ), and self-reported illness perceptions (Igbo-BIPQ)
Table 4 Exploratory factor analysis of the Igbo-CSQ using the Kaiser criterion to determine dimensionality
Table 5 Exploratory factor analysis of the Igbo-CSQ using the parallel analysis to determine dimensionality
Fig. 2
figure 2

Scree plot of Igbo-CSQ using the parallel analysis for determining dimensionality

Findings from investigating floor and ceiling effects

11 (5.5%) and 0 (0.0%) people scored 0 and 36 respectively on the original reinterpreting pain sensation subscale. 7 (3.5%) and 0 (0.0%) people scored 0 and 36 respectively on the original catastrophising subscale. 0 (0.0%) and 1 (0.5%) people scored 0 and 36 respectively on the original diverting attention subscale. 1 (0.5%) and 0 (0.0%) people scored 0 and 36 respectively on the original ignoring sensations subscale. 0 (0.0%) and 8 (4.0%) people scored 0 and 36 respectively on the original praying or hoping subscale.

Discussion

Although translation of the CSQ (Additional file 2) was without complications, and comprehensibility was confirmed among these rural Nigerian dwellers with CLBP, the pilot sample of twelve people reported not adopting most of the activities listed in the questionnaire items in response to pain. Of the 42 items in the questionnaire, only 14 items (5, 6, 11, 13, 14, 15, 22, 25, 28, 33, 34, 36, 37, 39) were reported as commonly adopted in the pilot sample of twelve people. These included all items of the catastrophising subscale, and all but one item of the praying and hoping subscale. In the only praying and hoping item 18 not commonly adopted, ‘I try to think years ahead, what everything will be like after I’ve gotten rid of the pain’, participants wished to be rid of their pain, but did not tend to imagine what a future without their pain would be like. One item from the coping self-statements subscale and two items from the increased behavioural activities subscale were also common in this population. Item 6 of the coping self-statements subscale ‘I tell myself to be brave and carry on despite the pain’, found to be common in the pilot sample of twelve people, has been shown to be adaptive or maladaptive [21]. Those who carried on and increased their activity level too much in an attempt to ‘fight back against their pain’ might report more disability. In contrast, those who carried on with daily activity but paced their activity level reported less disability [21]. Some participants in the pilot sample of twelve people leave their house and perform some activities in response to pain, but these activities do not typically involve going to the movies or shopping as stated in item 2 of the increased behavioural activities subscale. Similarly, although participants sometimes do something they enjoy in response to pain, this was not watching TV or listening to music as stated in item 40 of the increased behavioural activities subscale. Not all the other items were never adopted in this population. Some uncommon items were activities that although are performed in this population, were not usually in response to pain. For instance, although the participants in the pilot sample of twelve people might sometimes do something active like household chores or projects (item 42 of the increased behavioural activities subscale), it was not usually in response to having pain. Previous qualitative studies in this population suggests that this behaviour was often in response to positive beliefs such as not regarding CLBP as an illness which facilitates a relinquishment of the sick role that enabled active behavioural adaptation such as pacing activities of daily living [21]. Hence, catastrophising and praying and hoping appeared to be the only consistently adopted coping strategies in this population.

Of important note is the possible influence of culture on personality trait which can both influence pain perception and expression including pain coping strategies [17,18,19,20]. People of African ancestry are said to report higher levels of pain unpleasantness, emotional response to pain and pain behavior, in response to similar levels of pain intensity than other ethnic groups [56,57,58]. However, other studies have reported little influence of ethnicity on pain experience, after controlling for pain duration, economic, educational and social factors [59, 60]. The Africans in these studies were African Americans and so may not represent Africans in Africa. The possible influence of acculturation and adjustment, with possible differential adverse influence on mental health were not considered in these studies. The personality traits of Nigerian Igbos living with chronic low in Nigeria and their possible influence on pain coping strategies need to be investigated in future studies. A previous qualitative study in rural Nigeria suggests some cultural explanations for persistent back pain [22]. For instance, Nigerian Igbos were believed to have low pain tolerance, which when combined with their perceived inordinately high ambitions, were believed to drive behaviour such as constant working and lack of rest, which maintained pain persistence [22].

Praying and hoping (0.86) and catastrophising (0.85) had the highest Cronbach’s alpha, suggesting that these coping strategies may be more consistent in this population than ignoring pain sensations (0.66) with the least Cronbach’s alpha. This concurs with findings from the cross-cultural adaptation and previous qualitative findings in this population [21]. In contrast, ignoring pain sensations may be more popular than praying and hoping in western settings [61, 62]. All subscales of the adapted CSQ had high ICCs ranging between 0.77 and 0.91 with Bland–Altman plots that showed good agreement.

None of the coping strategies of the adapted CSQ subscales appeared adaptive in this population as they were all positively correlated with self-reported disability and pain intensity. This contradicts findings in western culture where diverting attention and increasing physical activity, ignoring pain sensations, and coping self-statements can be adaptive [5, 8, 45]. Notably, the catastrophising subscale had the strongest positive correlation with pain intensity, and self-reported disability, again suggesting its consistency and significant role in this population. Diverting attention had the strongest correlations with fear avoidance beliefs and illness perceptions suggesting that adopting this coping strategy might be related to higher fear avoidance beliefs and greater threatening view of CLBP. One of the two pain self-efficacy items (pain decrease) did not have any significant negative correlation with any of the outcomes. However, the other pain self-efficacy item (pain control) had a significant negative correlation with illness perceptions. This suggests that there is perception of adequate control of CLBP when CLBP is not viewed as a threatening illness. Previous research showed that illness perceptions and fear avoidance beliefs were the most important predictors of both self-reported and performance-based disability in this population [36]. These associations must however be interpreted with caution considering that most of these subscales (apart from catastrophising and praying and hoping subscales) may lack relevance in this population.

Using the Kaiser criterion to determine dimensionality, a seven-factor solution of the adapted CSQ was produced like the original measure [23]; but items in the factors were different. In contrast, a three-factor solution was produced using the parallel analysis to determine dimensionality. Catastrophising subscale was the only factor reproduced as in the original measure in both methods of determining dimensionality, again suggesting that this is a consistent strategy in this population. However, the exact definition of catastrophising in CLBP is conflicting. It is regarded as a cognitive coping strategy [23, 63,64,65], or as part of the fear avoidance model [46, 66, 67]. Other authors believe the construct is indistinguishable from negative mood, beliefs, adjustment or contextual pain factors [6, 68,69,70]. The concepts of emotional distress and pain coping strategies need to be clarified in future studies in this population. Furthermore, praying/hoping and coping self-statements appeared to be one distinct strategy in this population utilising both methods of determining dimensionality. The remaining four coping strategies in the Kaiser criterion, and the remaining one coping strategy in the parallel analysis, did not appear to be defined or consistent in this population. Despite these findings, there were no floor or ceiling effects in any of the original subscales in the adapted Igbo-CSQ. New pain coping strategies measures may need to be developed to reflect how people coped with CLBP in rural African contexts such as rural Nigeria. Patient generated outcomes may also prove useful in measuring coping strategies in these contexts by allowing participants to list all the ways they managed their CLBP which can then be analysed categorically. It is important to identify adaptive coping strategies that may be useful in reducing pain and disability in this population which can then be the focus of complex behaviour change interventions.

Strengths and limitations

This study enabled the identification of the relevant pain coping strategies in Nigerian Igbo populations, particularly those in rural Nigeria, from the commonly used CSQ. Pilot/field testing of the Igbo-CSQ among participants living with CLBP in rural Nigeria by interviewer-administration using the ‘think-aloud’ cognitive interviewing procedure which allowed participants to identify the relevant and non-relevant coping strategies confirmed face and content validity to an extent. The identified pertinent strategies in the questionnaire can be interviewer-administered, and will have great utility, especially among illiterate rural dwellers with chronic pain, who are often neglected despite being highly vulnerable. Other strengths of the study include acceptable reliability and construct validity characteristics of the relevant coping strategies. Construct validity is supported by the use of multiple measures including that of disability, pain intensity, fear avoidance beliefs, and illness perceptions. The relevant subscales of the Igbo-CSQ can be used to validate new measures of coping strategies in this population. The use of EFA was warranted in this study as the Igbo-CSQ was just adapted for use for the first time in this population. EFA allowed an exploration of the underlying structure of this measure in this new population which can then be tested using confirmatory factor analysis. Specifically, confirmatory factor analysis of the Igbo-CSQ can be conducted in this population in future studies to determine the model fit indices for the observed EFA structure of the Igbo-CSQ found in this study, as well as the model fit indices for the factor structures found in the original CSQ measure and other factor structures of the CSQ reported in the literature. Findings can then confirm the subscales and the structures of the Igbo-CSQ most suitable for this population.

A limitation of this study is the lack of statistical investigation of item redundancy. The lack of statistical and systematic examination of item redundancy could have distorted the content validity.

Conclusions

This study aimed to cross-culturally adapt and test the CSQ in rural and urban Nigerian populations. This study found that catastrophising and praying and hoping may be the only relevant subscales of the CSQ in Nigeria, and are both maladaptive coping strategies. More culturally relevant measures of pain coping strategies that include adaptive coping strategies may need to be developed for Africa, particularly rural African contexts such as rural Nigeria.

Availability of data and materials

Data is available on request due to ethical restrictions imposed by Biomedical and Health Sciences, Dentistry, Medicine and Natural and Mathematical Sciences Research Ethics Subcommittees (BDM RESC) Kings College London. Requests for data access may be made to BDM RESC Kings College London through email bdm@kcl.ac.uk.

Abbreviations

CSQ:

Coping Strategies Questionnaire

LBP:

Low back pain

CLBP:

Chronic low back pain

ICC:

Intra-class correlation coefficient

SEM:

Standard error of measurement

MDC:

Minimal detectable change

BS-11:

Eleven-point box scale

Igbo-RMDQ:

Igbo Roland Morris Disability Questionnaire

Igbo-WHODAS:

Igbo World Health Organisation Disability Assessment Schedule

Igbo-FABQ:

Igbo fear avoidance beliefs questionnaire

Igbo-BIPQ:

Igbo Brief Illness Perceptions Questionnaire

CHWs:

Community health workers

EFA:

Exploratory factor analysis

References

  1. Ramond A, Bouton C, Richard I, Roquelaure Y, Baufreton C, Legrand E, Huez J-F (2011) Psychosocial risk factors for chronic low back pain in primary care—a systematic review. Fam Pract 28:12–21

    Article  PubMed  Google Scholar 

  2. Abbott AD, Tyni-Lenné R, Hedlund R (2010) The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy 96:213–221

    Article  PubMed  Google Scholar 

  3. Koleck M, Mazaux J-M, Rascle N, Bruchon-Schweitzer M (2006) Psycho-social factors and coping strategies as predictors of chronic evolution and quality of life in patients with low back pain: a prospective study. Eur J Pain 10:1–11

    Article  PubMed  Google Scholar 

  4. Woby S, Watson P, Roach N, Urmston M (2005) Coping strategy use: does it predict adjustment to chronic back pain after controlling for catastrophic thinking and self-efficacy for pain control? J Rehabil Med 37:100–107

    Article  PubMed  Google Scholar 

  5. McCracken LM, Eccleston C (2003) Coping or acceptance: what to do about chronic pain? Pain 105:197–204

    Article  PubMed  Google Scholar 

  6. Jensen MP, Turner JA, Romano JM, Karoly P (1991) Coping with chronic pain: a critical review of the literature. Pain 47:249–283

    Article  PubMed  Google Scholar 

  7. Turner JA, Clancy S (1986) Strategies for coping with chronic low back pain: relationship to pain and disability. Pain 24:355–364

    Article  PubMed  Google Scholar 

  8. McCracken LM, Goetsch VL, Semenchuk EM (1998) Coping with pain produced by physical activity in persons with chronic low back pain: immediate assessment following a specific pain event. Behav Med 24:29–34

    Article  CAS  PubMed  Google Scholar 

  9. Dawson AP, Schluter PJ, Hodges PW, Stewart S, Turner C (2011) Fear of movement, passive coping, manual handling, and severe or radiating pain increase the likelihood of sick leave due to low back pain. Pain 152:1517–1524

    Article  PubMed  Google Scholar 

  10. Mercado AC, Carroll LJ, Cassidy JD, Côté P (2005) Passive coping is a risk factor for disabling neck or low back pain. Pain 117:51–57

    Article  PubMed  Google Scholar 

  11. Viniol A, Jegan N, Hirsch O, Leonhardt C, Brugger M, Strauch K, Barth J, Baum E, Becker A (2013) Chronic low back pain patient groups in primary care—a cross sectional cluster analysis. BMC Musculoskelet Disord 14:294

    Article  PubMed  PubMed Central  Google Scholar 

  12. Mitchell T, O’Sullivan PB, Smith A, Burnett AF, Straker L, Thornton J, Rudd CJ (2009) Biopsychosocial factors are associated with low back pain in female nursing students: a cross-sectional study. Int J Nurs Stud 46:678–688

    Article  PubMed  Google Scholar 

  13. Jones GT, Johnson RE, Wiles NJ, Chaddock C, Potter RG, Roberts C, Symmons DPM, Macfarlane GJ (2006) Predicting persistent disabling low back pain in general practice: a prospective cohort study. Br J Gen Pract 56:334–341

    PubMed  PubMed Central  Google Scholar 

  14. Van Vuuren BJ, Van Heerden HJ, Becker PJ, Zinzen E, Meeusen R (2006) Fear-avoidance beliefs and pain coping strategies in relation to lower back problems in a South African steel industry. Eur J pain 10:233–239

    Article  PubMed  Google Scholar 

  15. Van Vuuren B, Zinzen E, Van Heerden HJ, Becker P, Meeusen R (2005) Psychosocial factors related to lower back problems in a South African manganese industry. J Occup Rehabil 15:215–225

    Article  PubMed  Google Scholar 

  16. Connor-Smith JK, Flachsbart C (2007) Relations between personality and coping: a meta-analysis. J Pers Soc Psychol 93:1080

    Article  PubMed  Google Scholar 

  17. Rzeszutek M, Oniszczenko W, Schier K, Biernat-Kałuża E, Gasik R (2016) Pain intensity, temperament traits and social support as determinants of trauma symptoms in patients suffering from rheumatoid arthritis and low-back pain. Int J Rheum Dis 19:412–419

    Article  PubMed  Google Scholar 

  18. Gustin SM, Burke LA, Peck CC, Murray GM, Henderson LA (2016) Pain and personality: do individuals with different forms of chronic pain exhibit a mutual personality? Pain Pract 16:486–494

    Article  PubMed  Google Scholar 

  19. Knaster P, Estlander A-M, Karlsson H, Kaprio J, Kalso E (2012) Temperament traits and chronic pain: the association of harm avoidance and pain-related anxiety. PLoS ONE 7:e45672

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Church AT (2016) Personality traits across cultures. Curr Opin Psychol 8:22–30

    Article  PubMed  Google Scholar 

  21. Igwesi-Chidobe CN, Kitchen S, Sorinola IO, Godfrey EL (2017) “A life of living death”: the experiences of people living with chronic low back pain in rural Nigeria. Disabil Rehabil. https://doi.org/10.3109/09638288.2016.1161844

    Article  PubMed  Google Scholar 

  22. Igwesi-Chidobe CN, Sorinola IO, Kitchen S, Godfrey EL (2018) Unconventional practitioners’ causal beliefs and treatment strategies for chronic low back pain in rural Nigeria. Heal Serv Insights. https://doi.org/10.1177/1178632918808783

    Article  Google Scholar 

  23. Rosenstiel AK, Keefe FJ (1983) The use of coping strategies in chronic low back pain patients: relationship to patient characteristics and current adjustment. Pain 17:33–44

    Article  PubMed  Google Scholar 

  24. Hawker GA, Mian S, Kendzerska T, French M (2011) Measures of adult pain: Visual analog scale for pain (vas pain), numeric rating scale for pain (nrs pain), mcgill pain questionnaire (mpq), short-form mcgill pain questionnaire (sf-mpq), chronic pain grade scale (cpgs), short form-36 bodily pain scale (sf.). Arthritis Care Res (Hoboken) 63:S240–S252

    Article  Google Scholar 

  25. Roland M, Fairbank J (2000) The Roland–Morris disability questionnaire and the Oswestry disability questionnaire. Spine 25:3115–3124

    Article  CAS  PubMed  Google Scholar 

  26. Igwesi-Chidobe CN, Obiekwe C, Sorinola IO, Godfrey EL (2019) Assessing self-reported disability in a low-literate population with chronic low back pain: cross-cultural adaptation and psychometric testing of Igbo Roland Morris disability questionnaire. Disabil Rehabil. https://doi.org/10.1080/09638288.2017.1416185

    Article  PubMed  Google Scholar 

  27. Roland M, Morris R (1983) A study of the natural history of back pain: part 1: development of a reliable and sensitive measure of disability in low-back pain. Spine 8:141–144

    Article  CAS  PubMed  Google Scholar 

  28. Igwesi-Chidobe CN, Kitchen S, Sorinola IO, Godfrey EL (2020) World Health Organisation Disability Assessment Schedule (WHODAS 2.0): development and validation of the Nigerian Igbo version in patients with chronic low back pain. BMC Musculoskelet Disord 21:755

    Article  PubMed  PubMed Central  Google Scholar 

  29. Igwesi-Chidobe CN, Amarachukwu C, Sorinola IO, Godfrey EL (2019) Translation, cultural adaptation and psychometric testing of Igbo fear avoidance beliefs questionnaire in mixed rural and urban Nigerian populations with chronic low back pain. PLoS ONE. https://doi.org/10.1371/journal.pone.0216482

    Article  PubMed  PubMed Central  Google Scholar 

  30. Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52:157–168

    Article  PubMed  Google Scholar 

  31. George SZ, Fritz JM, McNeil DW (2006) Fear-avoidance beliefs as measured by the fear-avoidance beliefs questionnaire: change in fear-avoidance beliefs questionnaire is predictive of change in self-report of disability and pain intensity for patients with acute low back pain. Clin J Pain 22:197–203

    Article  PubMed  Google Scholar 

  32. Igwesi-Chidobe CN, Sorinola IO, Godfrey EL (2020) Igbo Brief Illness Perceptions Questionnaire: a cross-cultural adaptation and validation study in Nigerian populations with chronic low back pain. J Back Musculoskelet Rehabil 34:399–411

    Article  Google Scholar 

  33. Broadbent E, Petrie KJ, Main J, Weinman J (2006) The brief illness perception questionnaire. J Psychosom Res 60:631–637

    Article  PubMed  Google Scholar 

  34. Beaton DE, Bombardier C, Guillemin F, Ferraz MB (2000) Guidelines for the process of cross-cultural adaptation of self-report measures. Spine 25:3186–3191

    Article  CAS  PubMed  Google Scholar 

  35. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, Erikson P (2005) Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR task force for translation and cultural adaptation. Value Health 8:94–104

    Article  PubMed  Google Scholar 

  36. Igwesi-Chidobe CN, Coker B, Onwasigwe CN, Sorinola IO, Godfrey EL (2017) Biopsychosocial factors associated with chronic low back pain disability in rural Nigeria: a population-based crosssectional study. BMJ Glob Health. https://doi.org/10.1136/bmjgh-2017-000284

    Article  PubMed  PubMed Central  Google Scholar 

  37. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420

    Article  CAS  PubMed  Google Scholar 

  38. Tavakol M, Dennick R (2011) Making sense of Cronbach’s alpha. Int J Med Educ 2:53

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bland JM, Altman D (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 327:307–310

    Article  Google Scholar 

  40. de Vet HC, Terwee CB, Ostelo RW, Beckerman H, Knol DL, Bouter LM (2006) Minimal changes in health status questionnaires: distinction between minimally detectable change and minimally important change. Health Qual Life Outcomes 4:54

    Article  PubMed  PubMed Central  Google Scholar 

  41. Grotle M, Brox JI, Vollestad NK (2003) Cross-cultural adaptation of the Norwegian versions of the Roland-Morris Disability Questionnaire and the Oswestry Disability Index. J Rehabil Med 35:241–247

    Article  CAS  PubMed  Google Scholar 

  42. Picavet HSJ, Vlaeyen JWS, Schouten JSAG (2002) Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. Am J Epidemiol 156:1028–1034

    Article  PubMed  Google Scholar 

  43. Moix J, Kovacs FM, Martín A, Plana MN, Royuela A (2011) Catastrophizing, state anxiety, anger, and depressive symptoms do not correlate with disability when variations of trait anxiety are taken into account. a study of chronic low back pain patients treated in Spanish pain units [NCT00360802]. Pain Med 12:1008–1017

    Article  PubMed  Google Scholar 

  44. Severeijns R, Vlaeyen JWS, van den Hout MA, Weber WEJ (2001) Pain catastrophizing predicts pain intensity, disability, and psychological distress independent of the level of physical impairment. Clin J Pain 17:165–172

    Article  CAS  PubMed  Google Scholar 

  45. Cano A, Mayo A, Ventimiglia M (2006) Coping, pain severity, interference, and disability: the potential mediating and moderating roles of race and education. J Pain 7:459–468

    Article  PubMed  PubMed Central  Google Scholar 

  46. Wertli MM, Eugster R, Held U, Steurer J, Kofmehl R, Weiser S (2014) Catastrophizing—a prognostic factor for outcome in patients with low back pain: a systematic review. Spine J 14:2639–2657

    Article  PubMed  Google Scholar 

  47. Pincus T, McCracken LM (2013) Psychological factors and treatment opportunities in low back pain. Best Pract Res Clin Rheumatol 27:625–635

    Article  PubMed  Google Scholar 

  48. Jordan MS, Lumley MA, Leisen CC (1998) The relationships of cognitive coping and pain control beliefs to pain and adjustment among African-American and Caucasian women with rheumatoid arthritis. Arthritis Rheum Off J Am Coll Rheumatol 11:80–88

    Article  CAS  Google Scholar 

  49. Dempster M, Howell D, McCorry NK (2015) Illness perceptions and coping in physical health conditions: a meta-analysis. J Psychosom Res 79:506–513

    Article  PubMed  Google Scholar 

  50. Yong AG, Pearce S (2013) A beginner’s guide to factor analysis: focusing on exploratory factor analysis. Tutor Quant Methods Psychol 9:79–94

    Article  Google Scholar 

  51. Kaiser HF (1960) The application of electronic computers to factor analysis. Educ Psychol Meas 20:141–151

    Article  Google Scholar 

  52. Sheytanova T (2015) A Monte Carlo study comparing three methods for determining the number of principal components and factors

  53. Coughlin KB (2013) An analysis of factor extraction strategies: a comparison of the relative strengths of principal axis, ordinary least squares, and maximum likelihood in research contexts that include both categorical and continuous variables

  54. Costello AB, Osborne J (2005) Best practices in exploratory factor analysis: four recommendations for getting the most from your analysis. Pract Assess Res Eval 10:7

    Google Scholar 

  55. Watkins MW (2020) A step-by-step guide to exploratory factor analysis with R and RStudio. Routledge

    Book  Google Scholar 

  56. Peacock S, Patel S (2008) Cultural influences on pain. Rev pain 1:6–9

    Article  PubMed  PubMed Central  Google Scholar 

  57. Riley JL III, Wade JB, Myers CD, Sheffield D, Papas RK, Price DD (2002) Racial/ethnic differences in the experience of chronic pain. Pain 100:291–298

    Article  PubMed  Google Scholar 

  58. Edwards RR, Moric M, Husfeldt B, Buvanendran A, Ivankovich O (2005) Ethnic similarities and differences in the chronic pain experience: a comparison of African American, Hispanic, and white patients. Pain Med 6:88–98

    Article  PubMed  Google Scholar 

  59. Portenoy RK, Ugarte C, Fuller I, Haas G (2004) Population-based survey of pain in the United States: differences among white, African American, and Hispanic subjects. J Pain 5:317–328

    Article  PubMed  Google Scholar 

  60. Tait RC, Chibnall JT (2014) Racial/ethnic disparities in the assessment and treatment of pain: psychosocial perspectives. Am Psychol 69:131

    Article  PubMed  Google Scholar 

  61. Jensen IB, Linton SJ (1993) Coping Strategies Questionnaire (CSQ): reliability of the Swedish version of the CSQ. Cogn Behav Ther 22:139–145

    Google Scholar 

  62. Burckhardt CS, Henriksson C (2001) The Coping Strategies Questionnaire-Swedish version: evidence of reliability and validity in patients with fibromyalgia. Scand J Behav Ther 30:97–107

    Article  Google Scholar 

  63. Albaladejo C, Kovacs FM, Royuela A, del Pino R, Zamora J, Network SBPR (2010) The efficacy of a short education program and a short physiotherapy program for treating low back pain in primary care: a cluster randomized trial. Spine 35:483–496

    Article  PubMed  Google Scholar 

  64. Swartzman LC, Gwadry FG, Shapiro AP, Teasell RW (1994) The factor structure of the Coping Strategies Questionnaire. Pain 57:311–316

    Article  PubMed  Google Scholar 

  65. Harland NJ, Georgieff K (2003) Development of the Coping Strategies Questionnaire 24, a clinically utilitarian version of the Coping Strategies Questionnaire. Rehabil Psychol 48:296

    Article  Google Scholar 

  66. Vlaeyen JWS, Linton SJ (2012) Fear-avoidance model of chronic musculoskeletal pain: 12 years on. Pain 153:1144–1147

    Article  PubMed  Google Scholar 

  67. Vlaeyen JWS, Linton SJ (2000) Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain 85:317–332

    Article  PubMed  Google Scholar 

  68. Kovacs FM, Moix J, Royuela A, Seco J (2014) Re: Wertli MM, Burgstaller JM, Weiser S, et al. Influence of catastrophizing on treatment outcome in patients with nonspecific low back pain. A systematic review. Spine 2014; 39: 263–73. Spine 39:1829

    Article  PubMed  Google Scholar 

  69. Gillanders DT, Ferreira NB, Bose S, Esrich T (2013) The relationship between acceptance, catastrophizing and illness representations in chronic pain. Eur J Pain 17:893–902

    Article  CAS  PubMed  Google Scholar 

  70. Hirsh AT, George SZ, Riley JL III, Robinson ME (2007) An evaluation of the measurement of pain catastrophizing by the coping strategies questionnaire. Eur J Pain 11:75–81

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Not applicable.

Funding

Data collection for this study was funded by the Tertiary Education Trust Fund, Nigeria and the Schlumberger Foundation, The Netherlands. Both organizations had no influence on the study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the manuscript for publication.

Author information

Authors and Affiliations

Authors

Contributions

CNI-C conceived of this work, designed the study, collected data, conducted analyses, interpreted findings, and drafted the initial manuscript. ELG and IOS contributed to interpretation of findings and supervision of data collection. All authors read, provided feedback and approved the final version of the manuscript to be published.

Corresponding author

Correspondence to Chinonso Nwamaka Igwesi-Chidobe.

Ethics declarations

Ethics approval and consent to participate

King’s College London (Ref: BDM/13/14-99) and University of Nigeria Teaching Hospital (Ref: UNTH/CSA/329/Vol.5) gave ethical approvals.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1: Figs. S1–S7

. Bland–Altman test–retest agreement.

Additional file 2

. Coping strategies questionnaire (original and adaptation).

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Igwesi-Chidobe, C.N., Sorinola, I.O. & Godfrey, E.L. Only two subscales of the Coping Strategies Questionnaire are culturally relevant for people with chronic low back pain in Nigerian Igbo populations: a cross-cultural adaptation and validation study. J Patient Rep Outcomes 5, 85 (2021). https://doi.org/10.1186/s41687-021-00367-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s41687-021-00367-1

Keywords