Cross-cultural Adaptation and Psychometric Validation of the Hindi version of Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) among Rural Older Adults in North India

<title>Abstract</title> <p>Background Multimorbidity is an increasing public health challenge among older adults and requires valid, reliable, and culturally appropriate instruments for its assessment. The Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) is a comprehensive instrument developed for use in primary care settings; however, a validated Hindi version, the majority language of Indians, has not previously been available. Methods A methodological validation study was conducted among 340 Hindi-speaking older adults (≥ 60 years) residing in rural Gorakhpur, Uttar Pradesh, North India. The original English MAQ-PC was translated and cross-culturally adapted using a standardized forward–backward translation process, followed by expert committee review and cognitive interviewing. Face and content validity were assessed through pilot testing and expert ratings. Internal consistency was evaluated using Cronbach’s alpha and item-rest correlations. Construct validity was examined using exploratory factor analysis (EFA) with maximum likelihood extraction and Promax. Results Face validity of the Hindi MAQ-PC was found to be good after minor wording modifications; content validity was excellent (scale-level content validity index average [S-CVI/Ave] = 0.93). Overall internal consistency was acceptable (Cronbach’s α = 0.612, 95% CI 0.548–0.670); the depression (α = 0.830, 95% CI 0.802–0.855) and health-related quality of life (α = 0.829, 95% CI 0.801–0.854) domains showed excellent reliability. Exploratory factor analysis supported construct validity: KMO = 0.730, Bartlett’s test χ²(1225) = 9026, p &lt; 0.001; an interpretable eight-factor structure explained 35.38% of total variance. Model fit was good (root mean square error of approximation [RMSEA] = 0.043, 90% CI 0.039–0.047; Tucker–Lewis Index [TLI] = 0.898). Conclusions The Hindi MAQ-PC demonstrated satisfactory face and content validity, acceptable internal consistency, and good construct validity among older adults from rural India.</p>