Translation and socio-linguistic adaptation of the Maltese version of the decision regret scale

Background and aim: Decision regret (DR) is critical in patient-centred care, especially among individuals with chronic diseases who face complex healthcare decisions. Despite growing interest in DR as a measurable construct, no validated instrument exists in the Maltese language. This study aimed to trans- late the 5-item Decision Regret Scale (DRS) into Maltese and to evaluate its content validity, following a structured methodological approach. Methods: The study adopted a two-phase methodological design. In Phase One, the DRS was translated into Maltese using a collaborative and iterative model, as described by Douglas and Craig, which involved forward translation, synthesis, expert adjudication, and back-translation. Phase Two evaluated both quantitative and qualitative content validity. A panel of eight experts assessed the relevance and clarity of each item using the Content Validity Ratio (CVR), Item- and Scale-level Content Validity Indexes (I-CVI and S-CVI). Qualitative feedback was also collected to explore face validity and se- mantic nuances. Results: All items demonstrated acceptable CVR, I-CVI, and S-CVI values after two rounds of expert review. Items 3 and 5 required further discussion due to initial concerns about semantic overlap, resulting in the revision of item 3. Additionally, minor changes were introduced to enhance conceptual clar- ity. Final indices confirmed the content validity of all five items. Conclusions: The Maltese version of the DRS was found to be culturally appropriate, linguistically accurate, and content-valid. Further psychometric studies are recommended to assess construct validity, reliability, and responsiveness in clinical populations. (www.actabiomedica.it)