Adapting the Kansas City Cardiomyopathy Questionnaire (KCCQ-12) for Moroccan Arabic Speakers: A Study on Translation, Cultural Relevance and Validation in Heart Failure Patients

Objectives: Heart failure is the final stage in the progression of all cardiac diseases, significantly modulating the quality of life and survival of patients. As a result, several means of assessing and predicting mortality have been developed, including the Kansas City cardiomyopathy Questionnaire (KCCQ). Aim: This study aimed to evaluate an Arab cultural adaptation of the KCCQ score, taking into account the increasing trend of heart failure in Morocco and the Arab world, With the KCCQ-12 score, a patient's heart failure profile is broken down into five domains: physical function (3 questions), symptom frequency (4 items), quality of life (2 items), and social limitations (3 things). These five subcategories are ranked from worst to best based on an average score that ranges from 0 to 100. The KCCQ-12 questionnaire was translated by a competent translator and a bilingual healthcare expert fluent in Arabic and English medical terminology. Methods: We conducted a prospective study involving patients consecutively presenting with chronic heart failure aimed to evaluate the cultural adaptation and validation of the Kansas City Cardiomyopathy Questionnaire (KCCQ-12 in Moroccan Arabic population, addressing the rising prevalence of heart failure in Morocco and the broader Arab region. The KCCQ-12 assesses patients' health status across four domains: physical limitation (3 items), symptom frequency (4 items), quality of life (2 items), and social limitation (3 items), generating a summary score from 0 to 100, with higher scores indicating better health status. This KCCQ-12 has undergone validation and exhibits excellent agreement with the major score, which consists of 23 items. For this adaptation, the questionnaire was translated into Moroccan Arabic by a professional translator and a bilingual healthcare expert proficient in both Arabic and English medical terminology, ensuring linguistic accuracy and cultural relevance. Results: 149 patients were included, and all of them were questioned with the translated KCCQ questionnaire. We conducted several statistical tests and correlations with a significant correlation between the KCCQ and our results. Each subgroup's set of questions underwent a reliability test. For each subgroup, the Cronbach's alpha coefficient was calculated, except the symptoms domain score all of which were greater than 0,70, which displays a strong internal reliability. We used the Spearman Correlation Coefficient to assess the convergence and divergence of construct validity between the KCCQ-12 and NYHA functional classification, with a great validity correlation. Conclusion: Our study demonstrated the feasibility and cultural appropriateness in Morocco of our translated version of KCCQ-12, Taking into account the cultural similarities between Morocco and the Arab world this questionnaire may be used with small modifications in the Arab countries. The QOL scores are generally Better than the NYHA classification. It may be beneficial to use this important tool in Moroccan and Arab’s cardiologist's daily routine.