Evaluation of the psychometric properties of the UBACC questionnaire in a multi-country psychiatric study in Africa.

BACKGROUND: The University of California, San Diego Brief Assessment of Capacity to Consent (UBACC) is a tool to assess the capacity of participants to consent in psychiatric research. However, little is known about the psychometric properties in low and middle-income countries. This study aimed to examine the psychometric properties of the UBACC. METHODS: We examined the reliability, latent factor structure, and item response of the first attempt of the UBACC items in a sample of 32,208 adults (16,467 individuals with psychosis and 15,741 controls) in Ethiopia, Kenya, South Africa, and Uganda; exploring these properties in the full sample and stratified by country, diagnostic status, sex, and ethnolinguistic language groups. RESULTS: Exploratory factor analysis (EFA) suggested a two-factor model for the overall sample. However, a three-factor model was more appropriate when examining the latent structure across country, language, and sex. Confirmatory factor analyses (CFA) revealed an adequately fitting three-factor model for the full sample and across country, sex, and language. A two-factor model, however, was more appropriate for English and Amharic languages. Across all groups, the internal consistency of the UBACC was low, indicating below-threshold reliability (Cronbach's α (95 % CI = 0.58 (0.57-0.59). Using a multidimensional item-response theory framework for the full sample revealed that UBACC item 8, measuring understanding of the benefits of study participation, was the most discriminating item. Many of the other items had below-threshold discriminating characteristics. CONCLUSION: EFA and CFA converged towards a two and three-dimensional structure for the UBACC, in line with the developers of the original scale. The differences in properties between populations and language groups, low internal consistency, and below-threshold item functioning suggest that investigations into the cultural and linguistic nuances are still warranted. Understanding the utility of consent tools, such as the UBACC, in underrepresented populations will be a part of the larger process which ensures that research participants are adequately protected.

Risk management in a developing country context: improving decisions about point-of-use water treatment among the rural poor in Africa.

More than 1 billion people, the vast majority of which live in the developing world, lack basic access to clean water for domestic use. For this reason, finding and promoting effective and sustainable solutions for the provision of reliable clean water in developing nations has become a focus of several public health and international development efforts. Even though several means of providing centrally located sources of clean water in developing communities exist, the severity and widespread nature of the water problem has led most development agencies and sanitation experts to strongly advocate the use of point-of-use treatment systems alongside whatever source of water people regularly use. In doing so, however, development practitioners have been careful to point out that any interventions or infrastructure regarding water safety and human health must also adhere to one of the central principles of international development: to facilitate more democratic and participatory models of decision making and governance. To this end, the research reported here focused on the development of a deliberative risk management framework for involving affected stakeholders in decisions about POU water treatment systems. This research, which was grounded in previous studies of structured decision making, took place in two rural villages in the East African nation of Tanzania.