Abstract:
Background: Patients in sub-Saharan Africa commonly experience pain, which often is un-assessed and
undertreated. One hindrance to routine pain assessment in these settings is the lack of a single-item pain rating
scale validated for the particular context. The goal of this study was to examine the face validity and cultural
acceptability of two single-item pain scales, the Numerical Rating Scale (NRS) and the Faces Pain Scale-Revised
(FPS-R), in a population of patients on the medical, surgical, and pediatric wards of Moi Teaching and Referral
Hospital in Kenya.
Methods: Swahili versions of the NRS and FPS-R were developed by standard translation and back-translation.
Cognitive interviews were performed with 15 patients at Moi Teaching and Referral Hospital in Eldoret, Kenya.
Interview transcripts were analyzed on a question-by-question basis to identify major themes revealed through the
cognitive interviewing process and to uncover any significant problems participants encountered with
understanding and using the pain scales.
Results: Cognitive interview analysis demonstrated that participants had good comprehension of both the NRS
and the FPS-R and showed rational decision-making processes in choosing their responses. Participants felt that
both scales were easy to use. The FPS-R was preferred almost unanimously to the NRS.
Conclusions: The face validity and acceptability of the Swahili versions of the NRS and FPS-R has been
demonstrated for use in Kenyan patients. The broader application of these scales should be evaluated and may
benefit patients who currently suffer from pain.