Arabic translation, cross-cultural adaptation, feasibility, acceptability, and initial psychometric evaluation of the hot flushes diary and the hot flush rating scale and diary interference scale (HFRDIS) in young breast cancer survivors

Abstract

Abstract Background Hot flushes (HF) are a highly prevalent and distressing vasomotor symptom among young breast cancer survivors receiving endocrine therapy, yet validated Arabic patient-reported instruments are limited for quantifying daily symptoms and their interference with functioning. Methods The 3-Category Hot Flushes Diary and the Hot Flash Related Daily Interference Scale (HFRDIS) were translated using forward–back translation and culturally adapted into Arabic. A total of 37 premenopausal women aged ≤ 45 years with breast cancer receiving adjuvant endocrine therapy were prospectively enrolled at the National Cancer Institute, Cairo University. Participants completed the Arabic HFRDIS once (reflecting the preceding week). Then they completed the Arabic diary for seven consecutive days, recording daily hot-flash frequency and maximum daily severity. Internal consistency was assessed using Cronbach’s α (acceptability ≥0.70). Descriptive statistics summarized symptom frequency/severity and HFRDIS interference scores. Feasibility was assessed using completion rate and participant feedback on clarity and cultural appropriateness. Results Participants had a mean age of 38.5 ± 4.7 years; most were receiving tamoxifen (94.6%) and goserelin (73.0%). The Arabic diary demonstrated excellent internal consistency (Cronbach’s α = 0.933), with stable item-deletion α values (0.924–0.933). Median daily HF frequency was 2 episodes/day (range 0–9), with mean daily frequency ranging from 2.2 to 2.6 episodes/day across the week. Moderate-to-severe symptoms were frequently observed. The Arabic version of the HFRDIS exhibited high reliability, with a Cronbach’s alpha of 0.908. and indicated the greatest interference in mood (mean 8.0), sleep (mean 7.5), and concentration (mean 6.9), with notable interference in work, leisure activities, and overall quality of life. The sexuality item had fewer responses than other domains. All participants judged the instruments clear and culturally appropriate, and completion of the diary was 100%. Conclusions The Arabic 3-Category Hot Flushes Diary and Arabic HFRDIS demonstrated strong internal consistency and feasibility in this initial evaluation and appear suitable for use in Egyptian populations. These tools may support standardized symptom assessment and clinical decision-making in similar settings. Future studies should evaluate test–retest reliability and responsiveness in larger and more diverse Arabic-speaking populations.