Cross-cultural adaptation of the Fresno Test for Turkish language

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Çakmakkaya Ö. S. , Batı A. H. , Kolodzie K.

PLOS ONE, vol.16, no.1, 2021 (Journal Indexed in SCI) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 16 Issue: 1
  • Publication Date: 2021
  • Doi Number: 10.1371/journal.pone.0245195
  • Title of Journal : PLOS ONE


National and international medical organizations and boards have recognized the impor-
tance of Evidence Based Medicine (EBM) and emphasized that EBM training should be
included in medical education programs. Although some Turkish medical schools have
developed and implemented EBM training programs, no validated Turkish language assess-
ment tool has been available to compare the effectiveness of these training programs to
national or international standards. The aim of this study is to cross-culturally adapt the
Fresno Test, which is a validated English language tool utilized worldwide in the assessment
of EBM training.
This study is a cross-sectional validation study, which was performed in two stages: Cross-
cultural adaptation of the Fresno Test into Turkish; and evaluation of the psychometric prop-
erties, validity, reliability and responsiveness, of the Turkish version of the Fresno Test.
The content validity of the test was evaluated by experienced physicians in the field of Evi-
dence-Based Medicine, and the content validity index was 1.00. The Cronbach α coefficient
was 0.78 on the post-test results. The intraclass correlation (ICC) coefficient and the kappa
analysis were calculated to evaluate inter-rater reliability. The ICC coefficients ranged from
0.66 to 0.97 for pre- and post-test results. The Kappa coefficients were 1.00 for all pre-test
and post-test questions except one post-test question which was 0.89.
The change score of the Fresno Test was used to evaluate responsiveness. The stu-
dents’ score of the Turkish Fresno Test was 49.9 ±18.2 pre-training and 118.9 ±26.3 post-
training with a change of 69 points (95% CI, 63.9–74.2). The Cohen’s effect size was 3.04
(95% CI, 2.6–3.5) indicating a very large change in scores