Development And Validation Of An Ayurvedic Hindi Questionnaire For Assessment And Classification Of Mṛdu, Madhyama, And Krūra Kostha In Clinical Practice

Abstract

Background

Kostha is an important Ayurvedic clinical concept that reflects an individual’s bowel pattern, gastrointestinal responsiveness, digestive behaviour, and the interaction of Agni and Doṣa. Assessment of Kostha is essential in Ayurvedic diagnosis, therapeutic planning, dose selection, and Panchakarma procedures, especially Snehana and Virecana. Classical Ayurvedic texts classify Kostha mainly into Mṛdu Kostha, Madhyama Kostha, and Krūra Kostha. However, in routine clinical practice, Kostha assessment largely depends on physician interpretation, which may lead to inter-observer variability and reduced reproducibility. Although an English Kostha assessment tool was previously validated after item analysis and Cronbach’s alpha reliability testing by Dr. Parameswarappa S. Byadgi and Dr. Neera Saini, there is a need for a culturally appropriate, standardized, and validated Hindi questionnaire for objective Kostha assessment among Hindi-speaking individuals.

Aim

To develop and validate a Hindi Kostha Assessment Questionnaire based on the already validated English Kostha assessment tool prepared after item analysis and Cronbach’s alpha reliability testing by Dr. Parameswarappa S. Byadgi and Dr. Neera Saini, for objective assessment of bowel pattern and classification of Mṛdu Kostha, Madhyama Kostha, and Krūra Kostha from an Ayurvedic perspective.

Materials and Methods

A methodological questionnaire development and validation design was adopted. The study involved translation and linguistic adaptation of selected validated English Kostha questionnaire items into Hindi, followed by expert review, content validation, pilot testing, field administration, and psychometric evaluation. The questionnaire items were designed to assess bowel frequency, stool consistency, ease of evacuation, straining during defecation, time required for bowel clearance, post-defecation satisfaction, need for laxatives, and response to specific dietary substances such as jaggery, raisins, sugarcane juice, milk, curd, and ghee. The refined Hindi questionnaire was administered to sixty healthy Hindi-speaking adults aged 18–60 years. Questionnaire-based Kostha assessment was compared with independent physician-based Kostha assessment. Statistical analysis was performed using IBM SPSS. Reliability and validity were assessed using Cronbach’s alpha, split-half reliability, intra-class correlation coefficient, Cohen’s kappa, content validity indices, item-total correlation, factor analysis, discriminant validity, and criterion validity.

Results

The final nine-item Hindi Kostha Assessment Questionnaire demonstrated excellent internal consistency with Cronbach’s alpha of 0.919. Test–retest reliability showed good stability with an intra-class correlation coefficient of 0.82. Inter-rater reliability between questionnaire-based classification and physician assessment showed substantial agreement with Cohen’s kappa of 0.76. Content validity was high with S-CVI of 0.89. Factor analysis supported a single-factor structure representing the core construct of Kostha. Independent samples t-test showed significant item-wise discriminatory capacity with p < 0.001. Criterion validity showed strong correlation with clinician evaluation, with r = 0.71. Based on response-code classification, individuals were classified as Mṛdu Kostha when the predominant response pattern was A, Madhyama Kostha when the predominant response pattern was B, and Krūra Kostha when the predominant response pattern was C.

Conclusion

The Hindi Kostha Assessment Questionnaire developed in this study is a reliable, valid, standardized, culturally appropriate, and clinically useful tool for objective assessment of Mṛdu, Madhyama, and Krūra Kostha among Hindi-speaking individuals. It bridges classical Ayurvedic diagnostic principles with contemporary psychometric methodology and may improve reproducibility, clinical decision-making, Panchakarma planning, academic teaching, and research in Ayurveda. Further validation in larger and disease-specific populations is recommended.