ArticlePloS one2026
Cross-cultural adaptation and psychometric validation of the Kannada version of the Extended Effort Assessment Scale (EEAS-K) in adults with hearing loss.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionThe Extended Effort Assessment Scale (EEAS) is a recently developed questionnaire for measuring listening effort, but a validated version for Kannada speakers is lacking. This study aimed to translate, culturally adapt, and psychometrically validate the EEAS for the Kannada-speaking adults with hearing loss.
methodThe EEAS was translated into Kannada (EEAS-K) following rigorous forward and back translation, expert committee review and cognitive debriefing. The final EEAS-K was then field-tested with 100 native Kannada-speaking adults with hearing loss (predominantly non-hearing aid users, 92%). Psychometric validation included assessing construct validity via exploratory factor analysis, Rasch analysis using item response theory (IRT), internal consistency (Cronbach's alpha), convergent validity via a Visual Analogue Scale (VAS), test-retest reliability with an Intraclass correlation coefficient (ICC) and Differential Item Functioning (DIF).
resultsAll 10 EEAS-K items demonstrated acceptable content validity (CVR = 1.00). EFA, guided by eigenvalues and the scree plot, provided initial support for a unidimensional structure, with a single factor accounting for 32.7% of the variance. Rasch analysis supported essential unidimensionality (first residual eigenvalue = 1.90). Nine of 10 items showed acceptable infit MNSQ values (0.64-1.34); Q8 (telephone) showed elevated infit (1.92) and outfit (1.83) values, indicating misfit, which may reflect the unique and multidimensional cognitive demands of technology-mediated communication in this population. Person-item targeting remained within acceptable clinical limits, though items were slightly easier for the average person's ability (person mean = 0.49 logits). The EEAS-K demonstrated excellent internal consistency (α = 0.886), moderate to strong convergent validity with the VAS (r = 0.611), and excellent test-reliability (ICC = 0.91). DIF analysis identified significant gender-based DIF for Q7 and age-based DIF for Q7 and Q8, suggesting raw scores for these specific items should be interpreted with caution across these demographics. No significant DIF was found for hearing-loss-severity.
conclusionThe EEAS-K is a reliable and valid tool for assessing listening effort in Kannada-speaking adults with hearing loss. The Wright map demonstrates adequate person-item targeting, and the dual-method psychometric approach provides satisfactory measurement evidence supporting clinical and research use.
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