Validation of the Moroccan Arabic version of the EORTC QLQ-CX24 questionnaire in cervical cancer patients: a North African psychometric and cultural adaptation study

Abstract Background Cervical cancer continues to exert a disproportionate impact on women in low- and middle-income countries (LMICs), where long-term treatment-related morbidity is increasingly shaping survivorship priorities. Patient-reported outcome measures (PROMs) are now central to quality-of-life assessment and treatment personalization. However, no validated version of the EORTC QLQ-CX24 module has previously existed in Moroccan Arabic. Objective To validate the Moroccan Arabic version of the EORTC QLQ-CX24 in cervical cancer patients and assess its structural validity, internal consistency, domain complementarity with QLQ-C30, and response behavior in a high-illiteracy LMIC oncology cohort. Methods A quantitative, cross-sectional psychometric validation study was conducted at the National Institute of Oncology, Rabat, Morocco (January–April 2024), including 303 women with biopsy-proven cervical cancer. The module was translated using the official EORTC forward–backward process. Structural validity was tested by confirmatory factor analysis (CFA), and internal consistency was assessed using Cronbach’s α for multi-item subscales. Pearson correlations evaluated convergent and divergent validity against QLQ-C30 domains. Scores were transformed to a 0–100 scale using the EORTC scoring manual. To ensure inclusivity, surveys were administered orally in a private setting. Results The 3-factor structure of CX24 was preserved, with all loadings significant ( p < 0.001; 0.32–0.77 for symptom experience; 0.88–0.89 for body image; 0.71–0.90 for sexual/vaginal functioning). Multi-item subscales demonstrated strong reliability (α = 0.83, 0.92, and 0.88, respectively). Model-fit indices showed average but conceptually stable behavior (CFI = 0.842; TLI = 0.817; RMSEA = 0.116 [0.108–0.125]; SRMR = 0.129), reflecting contextual covariance influence rather than structural invalidity. No patients refused participation (100% response), the proportion of blank responses was highest for items related to sexuality (> 45%), as these items were contingent on reported sexual activity during the previous four weeks. Convergent validity was generally supported by significant correlations between the dimensions of the QLQ-CX24 and the QLQ-C30 ( r = 0.254–0.599, p < 0.001), while the sexual dimensions showed weaker and sometimes negative associations. CX24 and QLQ-C30 measured complementary, non-redundant domains, supporting tandem use. Conclusion The Moroccan Arabic version of the EORTC QLQ-CX24 is reliable, multidimensional, culturally acceptable, and clinically complementary to QLQ-C30. In Morocco and comparable LMIC settings, PROM validation is not only a psychometric requirement it is a clinical instrument enabling women’s measurable voice, long-term sequelae quantification, and personalized therapeutic planning beyond survival outcomes alone.