Translation, Cross-Cultural Adaptation, and Psychometric Validation of Hindi Versions of The Fagerström Test For Nicotine Dependence For Smoking and Smokeless Tobacco

Abstract

Statement of Problem: Culturally adapted and psychometrically validated Hindi instruments are needed for assessing nicotine dependence among smoking and smokeless tobacco users.

Purpose: To translate, culturally adapt, and validate Hindi versions of the Fagerström Test for Nicotine Dependence for Smoking (FTND-Smoking) and Smokeless Tobacco (FTND-ST).

Material and Methods: This methodological cross-sectional study included 360 Hindi-speaking adults (180 smokers and 180 smokeless tobacco users). Both instruments underwent forward–backward translation, expert review, cognitive interviewing, and pilot testing. Psychometric evaluation included content validity, internal consistency, test–retest reliability, exploratory factor analysis, convergent validity, known-groups validity, and floor and ceiling effects. Test–retest reliability was assessed in 40 participants per group after 7–14 days. Cotinine concentrations were evaluated in subsamples.

Results: Both instruments demonstrated excellent content validity (S-CVI/Ave: 0.979 and 1.000, respectively). Cronbach’s alpha values were 0.601 and 0.372, McDonald’s omega values were 0.619 and 0.403, and intraclass correlation coefficients were 0.967 and 0.968, respectively. Factor analysis supported a single-factor structure for FTND-Smoking (KMO=0.682), whereas FTND-ST exhibited marginal sampling adequacy (KMO=0.579) and a three-factor structure. Scores correlated significantly with daily tobacco consumption (ρ=0.79 and 0.62) and cotinine concentrations (ρ=0.93 and 0.92; all p<escape><</escape>0.001). Participants with previous failed quit attempts demonstrated higher dependence scores. No significant floor or ceiling effects were observed.

Conclusions: Hindi FTND-Smoking demonstrated satisfactory overall psychometric performance despite moderate internal consistency. Hindi FTND-ST exhibited excellent temporal stability but limited internal consistency, warranting further refinement and multicentric validation.