Research Article: Psychometric properties of the acceptance and action questionnaire (AAQ II) Malay version in cancer patients

Date Published: February 26, 2019

Publisher: Public Library of Science

Author(s): Nurul Izzah Shari, Nor Zuraida Zainal, Ng Chong Guan, Zuraida Ahmad Sabki, Nor Aziyan Yahaya, Chung-Ying Lin.


Psychological inflexibility has been found as one of the predictor to psychopathology in cancer patient. Cancer patients tend to experience psychological inflexibility as a reaction to cancer diagnosis, prognosis and treatment. Therefore, there is a need to identify psychological inflexibility due to its impact on quality of life among cancer patients.

Partial Text

Acceptance and action questionnaire (AAQ II) is an instrument to assess experiential avoidance and psychological inflexibility. Experiential avoidance can be defined as an attempt to avoid or neglect unpleasant thought, unpleasant feelings, bitter memories, uncomfortable physical sensations, and consequently lead to an action that is against one’s values and causing long-term harm [1]. Empirical evidence has found contribution of experiential avoidance on psychopathology in cancer patients [2,3]. Cancer patients commonly experienced experiential avoidance as a reaction to cancer diagnosis, prognosis and treatment [4]. Experiential avoidance is found to be one of the coping strategies among cancer patients and become a predictor to psychosocial problem such as depression, anxiety and distress [5,6]. The attempts to avoid the unpleasant thought, feeling and memories related to cancer elevate their discomfort and lead to the lack of involvement in their valued activities and life. As a result, this circumstance becomes the source of psychosocial and emotional issues such as distress, anxiety and depression [7]. Hence, it affects their quality of life [2,3], perceived health, psychosocial life [2] and career [8].

Table 1 shows demographic information across respondents with cancer and without cancer. 101 respondents with cancer (14.9% male and 85.1% female) and 100 respondents without cancer (31% male and 69% female) were recruited. Mean age for cancer respondents is 48.32 and mean age for non-cancer respondents is 43.44. Only age has significant mean difference with total scores of AAQ II Malay version.

The purposes of this study were to translate, adapt and validate the AAQ II Malay version. The first objective was to evaluate the content validity index of AAQ II Malay version. Content validity implied the robustness of the interpretation of the items in the instrument to reflect and represent the construct. In this context, the results of this current study were determined by CVI and modified Kappa coefficient. The findings reveal that all items scored I-CVI equal to 0.83 and above. According to Polit & Beck [29], the I-CVI scores that fall above 0.79 are considered as excellent and appropriate. The S-CVI for both relevance and clarity that exceed 0.9 indicate as appropriate and excellent. The results from modified kappa statistic demonstrated the index of agreement between subject matter experts in AAQ II items that were relevant and cleared, were 82% and reached excellent level. Based on the results, all items in the instrument AAQ II were validated.

In spite of these limitations, the AAQ II Malay version demonstrated acceptable and promising psychometric properties of AAQ II Malay version. The results in term of dimensionality, reliability and validity were consistent with previous studies [9,15,16]. In addition, the current study also provided the empirical evidence on sensitivity and specificity of AAQ II Malay version in cancer patients that is devoted to Malaysian population.