背景：
口咽性吞嚥困難（oropharyngeal dysphagia, OD）是社區居住老年人常見的老年症候群之一，並與多種嚴重健康後果相關，包括營養不良、脫水、吸入性肺炎以及生活品質下降。雖然透過篩檢進行早期辨識對於預防併發症至關重要，但在社區場域中常規吞嚥困難篩檢的實施仍相當有限。在印尼，目前尚無標準化的印尼語工具可用於識別老年人口中口咽性吞嚥困難的風險，特別是針對無神經肌肉、神經學或結構性病因的社區居住老年人。因此，本研究旨在進行文化調適並評估一項印尼版口咽性吞嚥困難篩檢工具於社區老年人中的心理計量特性。
方法：
本研究採用三階段方法學設計，共包含三個依序進行的階段。第一階段依據「健康測量工具選擇共識標準」（COSMIN）指引進行系統性文獻回顧，以識別並評估現有基於問卷的口咽性吞嚥困難篩檢工具，並嚴格評估其測量特性與方法學品質，以選擇最適合進行文化調適的工具。第二階段針對所選工具進行跨文化翻譯與調適，遵循標準程序，包括前向翻譯、整合、回譯、專家委員會審查及預試，以確保語意、概念與文化等價性。第三階段採橫斷式設計，於社區老年人中評估印尼版本的心理計量特性。透過因素分析檢驗結構效度，並以內部一致性、重測信度及效標關聯效度進行信度與效度評估。
結果：
結果顯示，本研究所發展之印尼版篩檢工具（源自葡萄牙語巴西版本之9題「Rastreamento de Disfagia Orofaríngea em Idosos, RaDI」）具有良好的心理計量特性。其因素結構顯示可接受的模型適配度（CFI：1.000；TLI：0.999；RMSEA：0.052；SRMR：0.017）。內部一致性達到良好水準（Cronbach’s α：0.961），重測結果顯示具高度穩定性（加權Kappa：0.812–1.000）。效標關聯效度分析顯示該工具能有效辨識口咽性吞嚥困難風險個案（AUC：0.969）。受試者亦回饋題項清晰且具文化適切性，顯示其適用於社區情境。
結論：
本研究成功發展一項經文化調適且具良好心理計量效度之印尼語口咽性吞嚥困難篩檢工具，適用於社區居住老年人。此工具之可用性有助於早期識別與及時轉介，支持預防性醫療策略，並改善社區護理實務。研究結果亦有助於強化吞嚥困難篩檢實務，並促進印尼高齡人口之健康老化。

Background: Oropharyngeal dysphagia (OD) is a common geriatric syndrome among community-dwelling older adults and is associated with serious health consequences, including malnutrition, dehydration, aspiration pneumonia, and reduced quality of life. Although early identification through screening is crucial to prevent complications, routine dysphagia screening in community settings remains limited. In Indonesia, there is no standardized Indonesian-language tool for identifying the risk of OD among older adults, particularly those living in the community without neuromuscular, neurological, or structural causes. Therefore, this study aimed to culturally adapt and evaluate the psychometric properties of the Indonesian version of an oropharyngeal dysphagia screening instrument for community-dwelling older adults.
Methods: This study employed a three-stage methodological design consisting of three sequential stages. In stage 1, a systematic review was conducted following the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines to identify and evaluate existing questionnaire-based OD screening tools. Measuring properties and methodological quality were critically assessed to determine the most appropriate instrument for adaptation. In stage 2, the selected instrument underwent cross-cultural translation and adaptation using standard procedures, including forward translation, synthesis, back translation, expert committee review, and pretesting to ensure semantic, conceptual, and cultural equivalence. In stage 3, the psychometric properties of the Indonesian version were evaluated among community-dwelling older adults using a cross-sectional design. Structural validity was examined through factor analysis, while reliability and validity were assessed using internal consistency, test-retest reliability, and criterion validity analyses.
Results: The results indicated that the Indonesian version of the screening instrument, the 9-item Rastreamento de Disfagia Orofaringea em Idosos (RaDI) in the Portuguese Brazil language, had satisfactory psychometric properties. The factor structure demonstrated acceptable model fit (CFI: 1.000; TLI: 0.999; RMSEA: 0.052; SRMR: 0.017), internal consistency demonstrated adequate reliability (Cronbach’s alpha: 0.961), and test-retest results confirmed measurement stability (weighted Kappa: 0.812 – 1.000). Criterion validity analysis supported the instrument's ability to accurately identify individuals at risk for oropharyngeal dysphagia (AUC: 0.969). Participants reported good clarity and cultural relevance of the adapted items, indicating feasibility for application in the community.
Conclusion: In conclusion, this study provides a culturally adapted and psychometrically valid Indonesian screening tool for detecting oropharyngeal dysphagia in community-dwelling older adults. The availability of this instrument facilitates early identification and timely referral, supports preventive healthcare strategies, and improves nursing practice in community settings. These findings contribute to strengthening dysphagia screening practices and promoting healthy aging among the Indonesian population.

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