Cross-cultural adaptation and preliminary psychometric evaluation of the Malayalam version of the Revised Hearing Handicap Inventory

Patient-reported outcome measures capture the psychosocial impact of hearing loss more comprehensively than audiometric testing alone, yet no validated instrument exists for Malayalam speakers, a Dravidian-language population of roughly 38 million in Kerala, India. This study translated and culturally adapted the Revised Hearing Handicap Inventory (RHHI) into Malayalam and evaluated its internal consistency reliability. A prospective cross-cultural translation and adaptation study following international guidelines (forward translation, back translation, expert committee review, field testing), followed by a cross-sectional reliability evaluation. Forty adults aged 45 years or older, with varying hearing impairment and Malayalam as primary language, recruited by purposive sampling from three private audiology clinics in Kerala, India. Adaptation required substantive revisions to five items to resolve semantic drift, politically connotative borrowed vocabulary, and stigmatizing disability terminology, plus recalibration of emotional-intensity descriptors. All 40 participants completed the questionnaire. The adapted instrument (RHHI-M) showed excellent internal consistency (Cronbach's α = .953; standardized α = .955), with corrected item-total correlations of .469–.853; no item's removal would meaningfully improve reliability. A linguistically accurate, culturally appropriate Malayalam RHHI was developed, with reliability comparable to the original and other adaptations, filling a key gap in hearing healthcare assessment and supporting further validation.