# The Holm and Cordoba Urinary Tract Infection Score: Translation, Linguistic and Content Validation of the German Version of a Patient‐Reported Outcome Measure to Assess Symptoms, Bothersomeness and Impact of Uncomplicated Urinary Tract Infections in Women

## TL;DR

This study translated and validated a German version of a questionnaire to assess the symptoms and impact of urinary tract infections in women.

## Contribution

The study provides a linguistically validated German version of the HCUTI for use in future research on urinary tract infections.

## Key findings

- The German version of HCUTI was found to be easy to understand and relevant by lay participants.
- One item was removed and several items were reformulated to improve clarity and comprehensiveness.
- The final version includes 18 symptom items, 18 bothersomeness items, and six impact items.

## Abstract

The Danish Holm and Cordoba Urinary Tract Infection Score (HCUTI) assessing symptom severity, bothersomeness and impact of uncomplicated urinary tract infections (uUTIs) on daily activities in women is a promising patient‐reported outcome measure (PROM) for use in future research. For potential application in Germany, the present study aimed (i) to perform translation and linguistic validation of the HCUTI, and (ii) to assess content validity of the German version of the HCUTI.

Translation and linguistic validation was performed using the dual‐panel method. A bilingual panel of nonprofessional Danish‐German speaking persons translated the HCUTI, and the translated version was evaluated regarding comprehensibility by a lay panel of native German‐speaking women with past uUTI. Content validity of the German version of the HCUTI was assessed according to the criteria of the COnsensus‐based Standards for the selection of health Measurement INstruments (COSMIN) methodology. In individual cognitive interviews, women with a history of uUTI and experts from different medical fields rated the instructions, items, response options and recall period of the HCUTI in terms of relevance, comprehensiveness and comprehensibility.

Translation and linguistic validation resulted in a German version of the HCUTI which lay persons considered easy to understand. In content validity assessments, participants rated the questionnaire as generally relevant and comprehensive. One item was removed due to lack of relevance. The response options were linguistically modified, and a dichotomous scale was introduced for 10 items on symptoms. To enhance comprehensibility, eight items on symptoms and bothersomeness, and one item on daily activities were slightly reformulated. After modification, the German version of the HCUTI includes 18 items on symptoms, 18 items on bothersomeness, and six items on impact on daily activities. The study team reviewed and linguistically standardized the final version of the questionnaire to ensure consistency in wording and sentence structure across all items.

The German version of the HCUTI is a suitable tool to assess symptoms, bothersomeness and impact of uUTIs in women. Data on psychometric properties of the instrument will be collected in a subsequent survey among women with uUTIs.