Folia Medica 2014; 56(2): 116-125

Copyright 2014 Medical University, Plovdiv

doi: 10.2478/folmed-2014-0017

Public Health Care

VALIDATING A SHORT BULGARIAN VERSION OF A PSYCHOMETRIC INSTRUMENT FOR

MULTIDIMENSIONAL NOISE SENSITIVITY ASSESSMENT
Angel M. Dzhambov1*, Donka D. Dimitrova2
1Faculty of Medicine, 2Department of Health Care Management, Health Economics and Primary Care,
Faculty of Public Health, Medical University Plovdiv, Bulgaria



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ABSTRACT
BACKGROUND: Noise sensitivity (NS) is a key construct in the fields of hygiene, planning and occupational medi-
cine. It refers to a personality trait representing the reactivity to noise and is associated with various psycho-phys-
iological health outcomes. AIM: This study aimed to develop a shorter version of the original Noise Sensitivity
Questionnaire (NoiSeQ), retaining its dimensions and assess its validity and reliability. METHODS: A test-retest
study was carried out in a convenience sample of 56 participants. A short 15-item form of the original NoiSeQ
(NoiSeQSF) questionnaire was developed and then administered. All major analyses were based on the coeffi-
cient of equivalence and stability, the generalizability theory and linear regression. RESULTS: Relative ( = 0.83)
and absolute ( = 0.80) G coefficients for global NS exceeded the lower reliability limit according to G- and D-
studies. Sleep subscale can readily be used to assess sleep-related NS ( = 0.76/ = 0.75). Moreover, NoiSeQSF
predicted some cardiac symptoms (with age of participants as a moderator factor), which demonstrated nomo-
logical validity. CONCLUSION: NoiSeQSF is a reliable estimate for global NS and NS related to sleep quality. It
might prove useful to experts in environmental hygiene, urban planning and occupational diseases when dealing
with noise-impaired occupational, social or psycho-physiological functioning.
Key words: noise sensitivity, cardiac symptoms, instrument validation, generalizability theory
Folia Medica 2014; 56(2): 116-125
Copyright 2014 Medical University, Plovdiv

: ,
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NoiSeQ - NoiSeQSF, 15 . Gene-
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Generalizability Theory
Folia Medica 2014; 56(2): 116-125
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Articles history: Received: 07 February 2014; Received in a revised form: 06 March 2014; Accepted: 26 March 2014
*Correspondence and reprint request to: A. Dzhambov, Faculty of Medicine, Medical University, Plovdiv;
E-mail: angelleloti@gmail.com; Mob.: +359 89 795 0802
116 15A Vassil Aprilov St., 4002 Plovdiv, Bulgaria
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 Validating a Short Bulgarian Version of a Psychometric Instrument for Multidimensional Noise Sensitivity Assessment
INTRODUCTION
Environmental noise costs society an estimated
0.2% to 2% of the Gross Domestic Product and at
least one million healthy life years are lost every
year due to traffic-related noise in the western part
of Europe.1,2 Noise pollution is associated with in-
creased incidence of cardiovascular diseases (such as
stenocardia and hypertension)3-6, noise annoyance,
sleep disturbance and impaired quality of life7,8.
According to the Noise Observation and Infor-
mation Service for Europe, in 2012 over 35% of
Plovdivs residents were exposed to environmental
noise exceeding 65 dB, a noise level that is higher
than that for almost all European agglomerations
and comparable to that measured in Hong Kong,
which is particularly alarming.9
Societies with traditions in noise pollution stud-
ies use an interdisciplinary approach, and noise
sensitivity (NS) is a key construct in the research
of experts on environmental hygiene, urban plan-
ning, occupational and public health. It refers to a
personality trait with sufficient power and gener-
alizability representing the reactivity to noise.10,11
Thus, a clear distinction between hearing sensitivity
and noise sensitivity is made. While the former
has otoneurological substrate, the latter should
be a psychological phenomenon. In fact, NS has
a stronger correlation with noise annoyance than
with noise exposure.12 It is also associated with
hypertension13,14, heart rate15, sleep quality16,17 and
various psychological and psychiatric disorders18,19.
Heinonen-Guzejevs in-depth analysis found that NS
was associated with emphysema, stress, hostility,
smoking and the use of psychoactive medications.20
It is widely accepted that NS acts as a modi-
fier of the effect of noise exposure on annoyance
and sleep quality, meaning that the nature of the
relationship noise exposure health outcomes
depends on individuals NS.17,21,22 Many authors
have recognized the importance of assessing NS.
If we are to understand how urban environment
alters the impact of noise on health, we have to
turn to psychoacoustics and conceptualize a more
complex and tangible model than simply evaluat-
ing the effect of noise exposure on quality of life.
This is particularly valid for a country with a low
socio-economic standard and limited effectiveness
of the healthcare system like Bulgaria. According
to Heinonen-Guzejev, NS should be considered
when assessing traffic noise risk, when establish-
ing cut-off noise levels and in noise mapping.20
To our knowledge, there are no validated multi-
item psychometric instruments for NS assessment
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available to Bulgarian researchers. Different Bul-
garian studies have reported results based on NS
assessment with single-item instruments, but being
single item instruments they cannot benefit from
the principle of aggregation in psychobiological
research. Most of the Bulgarian research in this
field has been discussed by Tzvetkov & Angelova.23
Another 10-point single-item scale has been recom-
mended by the Bulgarian noise control legislation
(cf. Appendix 4, article 7, Regulation 6/2006,
Ministry of Health and Ministry of Environment
and Water). The golden standard in measuring NS
is the Weinstein Noise Sensitivity Scale.10 There
are other derivate questionnaires, but just like
Weinsteins scale they operationalize only global
noise sensitivity. Hence, the Noise Sensitivity Ques-
tionnaire (NoiSeQ) was developed to quantify NS
related to different daily situations leisure, work,
habitation, communication and sleep. It consists of
five subscales and 35 items in total.24 However,
there are several unresolved problems with its facto-
rial structure and generalizability at subscale level
in cross-cultural context25, and more importantly,
as noise studies are primarily field-studies, they
require shorter psychometric instruments in order
to ensure high response rate26,27.
Therefore, the present study aimed to develop
a shorter Bulgarian version of NoiSeQ, retaining
its dimensions and to assess the validity and reli-
ability of the new tool.
MATERIALS AND METHODS
DESIGN AND SAMPLE
A test-retest study was carried out between October
13 and December 8, 2013. A convenience sample
of 56 participants was surveyed. The study was
methodological, socio-medical, voluntary and anony-
mous, conducted after obtaining informed consent
from participants and therefore not subjected to
ethical evaluation by the university committee. The
policy of tacit approval under these circumstances
has been partly adopted from the dissertation of
Radeva-Dafinova.28 In a pilot run with 30 participants
using the formula n = Z2a*S2/B2 and adjusting for
point-in-time parameter estimates, the maximum
needed number of participants to determine the
mean NS scores in the population was calculated
to be 29. Sixty eight people were contacted and
56 participated (82.35%). Exclusion criteria were
self-reported physician-diagnosed hearing impair-
ment or being under 18 years of age. The sample
size was relatively small, but the development and
cross-cultural validation of the original NoiSeQ also
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A. Dzhambov et al
used relatively small samples, especially given that
NoiSeQ has twice as many items as our version.23,29
Our sample was twice as large as that used in the
G- and D-studies of Nubaum30, published in a
renowned journal, so 56 participants were consid-
ered satisfactory. As Norman argues, the Gener-
alizability Theory is based on ANOVA, therefore
any concern about the sample size is irrelevant.31
Moreover, as evident from the Results section, the
estimated generalizability coefficients suggested a
sufficient sample size. Participants were recruited
from a circle of acquaintances of the authors and
the questionnaires were distributed either in person
or via e-mail. The shorter Bulgarian version of
NoiSeQ was administered twice in approximately
four week interval. The mean age was 46.61 years
(SEM = 1.89, SD = 14.16): 12.50% (n = 7) were
under 25 years; 7.14% (n = 4) were in the range of
26 to 35 years; 26.79% (n = 15) were 36-45 years
; 26.79% (n = 15) were 46-55; 19.64% (n = 11)
were 56-65 and 7.14% (n = 4) were > 65 years of
age. Women were 53.57% (n = 30). The majority
of the participants were from the lower or middle
socio-economic class (87.50%, n = 44) and had
master and bachelor educational degrees (67.86%,
n = 42). The sample was mostly representative of
the studied population with skew towards people
from the middle socio-economic class.
QUESTIONNAIRES
After personal correspondence, the English version
of NoiSeQ was provided by M. Schtte. It was
translated mostly adhering to the established pro-
cedures in cross-cultural research: the first author
translated it to Bulgarian, the second author back-
translated it to English and both translators inde-
pendently appraised the initial and back-translated
versions of NoiSeQ for suitability.32,33 A short form
of NoiSeQ (NoiSeQSF) comprising 15 items was
administered (cf. Appendix). This version was ar-
rived at after eliminating all items that represented
non-generalizable situations and after rescaling the
remaining ones on 5-point scales. For example,
items asking about NS in reference to childrens
play, music, going to a cinema, TV, radio, etc. are
somewhat connotative and thus may heavily rely
on the particular experiences of the individual with
his/her living and social environment. Each of the
authors separately selected the items that according
to their judgment needed to be included in the final
version of the instrument. In the shortest possible
version at least three items from each dimension
had to be retained in order to maintain factorability.
118
The degree of inter-rater agreement was assessed
with Krippendorffs alpha.34 Krippendorffs alpha
defines inter-rater agreement, controlling for the ex-
pected agreement based on chance alone, on a scale
where 1.00 represents perfect agreement and 0.00
the absence of agreement. It also allows estimation
of agreement between multiple sources and operates
with interval data unlike Cohens Kappa. At the first
step it was 0.43. After discussion the discrepancies
were resolved unanimously. The revised version has
five subscales with three items in each, measured
on 5-point bipolar Likert scales (strongly agree
to strongly disagree) where higher values indicate
higher NS. Four items are reverse-coded.
Socio-demographic characteristics were assessed
as well. Perceived health was measured as an in-
tegrative measure of multiple health indicators on
6-point Likert scale (very poor to very good).35
The incidence of cardiac symptoms (palpitations,
tachycardia, oppression and pain) was measured on
6-point Likert scale (never to very often). The
questions concerning perceived health and cardiac
symptoms were administered during the test study.
All questions referred to the past six months.
DATA ANALYTIC STRATEGY
First, missing values (< 1.8% of any given variable)
were replaced using automatic multiple imputation
technique (imputed values were manually aggregated
for some of the analyses which were conducted with
SPSS macros). Then the data were screened for
multivariate normality and outliers using a variant
of Smalls omnibus test of multivariate normality,
Mahalanobis distances and graphical analysis.36 In
the test study NoiSeQSFs items were multivariate
normal VQ3 (30) = 19.41, p = 0.931. Likert scale
variables were treated like interval to allow the use
of common parametric tests, because they satisfied
the minimum of having at least five categories.31,37
The composite scores for NoiSeQSF presented in this
paper are unit-weighted and divided by the number
of items in order to be measured and interpreted
on the same 5-point scale as the individual items.
The validity of the instrument was assessed using
Cronbachs alpha, the coefficient of equivalence and
stability (CES), calculated according to Schmidt et
al.38 and the Generalizability theory (G-Theory) ac-
cording to Mushquash & OConnor and using the
program G1-sps39. In short, the G-Theory provides
assortment of useful individual methods for assessing
reliability combing the different reliability estimates
of the Classical Theory, thus permitting all-at-once
comparison of error sources (or facets) in a common
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 Validating a Short Bulgarian Version of a Psychometric Instrument for Multidimensional Noise Sensitivity Assessment
metric and giving information about the variance
contributed by each source and by their interaction.
It also gives insight into the true or universal
score of the participants. A G coefficient (0.00 to
1.00) indicates increment in the generalizability of
the observed results as it approximates 1.00 (for
details see references 39 and 40). Specifications of
the analysis were: two-facet fully-crossed data set
with 56 respondents, two occasions of measure-
ment and 15 items. The occasions and items were
considered fixed facets. The described G-study was
followed by a decision study (D-study), performed
to forecast the changes in G coefficients that would
result from changing the number of items and oc-
casions. The criterion for significance level of p <
0.05 (two-tailed) was used.
Results are presented as number, percentage,
mean (M), standard error of the mean (SEM) and
standard deviation (SD). All statistical data were
analysed with SPSS v.19.
RESULTS
TEST STUDY
Table 1 presents the descriptive statistics and reli-
ability estimates for NoiSeQSF.
The participants are generally not very noise
sensitive referring to global NS (Table 1). All
alpha coefficients exceeded the 0.70 criterion rec-
ommended for new instruments and the inter-item
correlations were satisfactory. Significant positive
correlation was found only between age and Sleep
subscale (r(54) = 0.39, p = 0.003) indicating higher
NS at night in older people. People 36-55 years
of age had a significantly higher NS than the rest
of the sample (t(54) = 3.90, p < 0.001). Global NS
was moderately associated with higher incidence
of cardiac symptoms (r(54) = 0.34, p = 0.011). In
Table 1. Descriptive statistics and reliability for NoiSeQSF
Observed range
Subscale Mean SEM SD
(min max)
Sleep 3.01 0.12 0.92
Habitation 3.02 0.11 0.84
Leisure 3.28 0.10 0.76
Communication 2.42 0.09 0.71
Work 3.16 0.08 0.61
Total NoiSeQSF 2.98 0.08 0.58
Note. *Cronbachs alpha for NoiSeQSF is calculated based on the subscale scores in order to minimize the effect of the tau-
equivalence assumption.
Folia Medica 2014; 56(2): 116-125
2014 Medical University, Plovdiv
fact, Sleep subscale was the strongest correlate of
cardiac symptoms (r(54) = 0.37, p = 0.005). This
fact suggests nomological validity of NoiSeQSF41,
which might be antecedent variable to several
cardiovascular conditions. In a multiple regression
analysis, controlling for age, sex, socio-economic
class and perceived health, NS did not significantly
predict cardiac symptoms, but when an interaction
term (Age*NoiSeQSF) was added in the predictor
list to represent the possible moderating role of age
over NS, it was revealed that the ability of NS to
predict cardiac symptoms, previously found in the
literature, depended on the age of the individual
(Table 2).
RETEST STUDY
The test-retest correlations of the items were in the
range 0.62 0.83 implying good temporal stability.
However, CES is highly superior to the test-retest cor-
relations and Cronbachs alpha internal consistency
estimate, as it takes into account random response,
transient and specific factor error process. On the
contrary, Cronbachs alpha is limited by its inability
to assess transient error and might be considered
indirect validity estimate. CES was calculated by
splitting NoiSeQSF post-hoc into two halves (odds
vs. even) in order to obtain two halves from the
test - (At and Bt) and two from the retest study (Ar
and Br). Then the pairs At Br and Bt Ar were
correlated and the average of these two correlations
(0.739) was considered for the formula of Schmidt
et al.38 Secondly, we needed to average the two
Cronbachs alpha coefficients for NoiSeQSF in the
test and the retest study. The mean Cronbachs alpha
was 0.795. Finally, CES was calculated: 2*0.739/
(1 + 0.795) = 0.82, which suggested completely
satisfactory reliability of NoiSeQSF.
Inter-item Cronbachs
correlations alpha*
1.00 4.67 0.65 0.77 0.87
1.33 4.67 0.59 0.73 0.84
1.33 5.00 0.42 0.70 0.81
1.00 4.00 0.55 0.66 0.82
2.00 4.33 0.41 0.61 0.76
1.73 4.07 0.09 0.77 0.80*
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A. Dzhambov et al

Table 3 presents the descriptive statistics and a
correlation matrix of NoiSeQSFs items.
G-theory study was conducted using G1.sps
program (Table 4). The variance component for
respondents (P) was small so averaging over
items and occasions, they did not differ sub-
stantially in their NS. For items the variance
component (F1) was also small, indicating that all
items assessed NS to a similar degree. The negligible
variance component for occasions (F2) indicates

Table 2. Regression coefficients for multiple regression model with cardiac symptoms as dependent variable, age,
sex socio-economic class and perceived health as control variables, NoiSeQSF as main predictor of interest and
an interaction Age*NoiSeQSF

Non-standardized Standardized
Predictor Coefficients Coefficients t p
B SE
Perceived physical health -0.23 0.20 -0.15 -1.13 0.264
Age -0.11 0.06 -0.98 -1.74 0.088
NoiSeQSF -2.13 1.05 -0.80 -2.03 0.048
Age*NoiSeQSF 0.06 0.02 1.97 2.57 0.013
Sex -0.03 0.34 -0.01 -0.73 0.943
Middle socio-economic class 0.25 0.49 0.08 0.52 0.608
Upper socio-economic class -0.37 0.64 -0.08 -0.58 0.568
Note. Adjusted R2 = 0.45, F(7, 48) = 7.39, p < 0.001; Observed power is 1.00 suggesting adequacy of the sample size;
Age*NoiSeQSF interaction-term suggesting moderating role of age; middle and upper socio-economic classes are coded
with reference category lower socio-economic class; NoiSeQSFs coefficient does not reflect the actual positive association
with the outcome, due to the presence of Age*NoiSeQSF

Table 3. Correlation-matrix and descriptive statistics for the subscale items of NoiSeQSF (retest study estimates)

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. M SD

1. H1R 1.00 2.88 1.01
2. H2R .66** 1.00 3.02 0.80
3. H3R .64** .59** 1.00 3.25 0.84
4. S1R .72** .63** .49** 1.00 3.11 1.04
5. S2R .52** .35** .35** .66** 1.00 3.02 1.04
6. S3R .61** .55** .38** .73** .74** 1.00 3.13 1.11
7. L1R .49** .50** .41** .54** .40** .45** 1.00 3.13 0.92
8. L2R .34* .31* .31* .32* .32* .33* .61** 1.00 3.57 0.85
9. L3R .42** .45** .37** .49** .42** .40** .61** .35** 1.00 3.27 0.94
10. C1R .39** .19 .27* .30* .31* .36** .48** .40** .51** 1.00 2.48 0.89
11. C2R .21 .16 .01 .13 .12 .20 .24 .09 .37** .52** 1.00 2.25 1.00
12. C3R .27* .21 .22 .26* .39** .34* .43** .33* .46** .57** .51** 1.00 2.91 0.90
13. W1R .19 .27* .19 .18 .12 .11 .31* .17 .42** .20 .28* .26 1.00 3.64 0.80
14. W2R .09 .23 .04 .29* .39** .34** .31* .16 .46** .28* .35** .29* .41** 1.00 2.82 0.92
15. W3R .16 .27* .04 .22 .16 .16 .25 .26 .27* .12 .16 .01 .46** .60** 1.00 3.25 0.74

Note. 1r-3r - items included in the subscales: H habitation, S sleep, L leisure, C communication, W work; M mean,
SD standard deviation; NoiSeQSF Noise Sensitivity Questionnaire Short Form; **correlation is significant at p < 0.01,
*correlation is significant at p < 0.05.

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 Validating a Short Bulgarian Version of a Psychometric Instrument for Multidimensional Noise Sensitivity Assessment
that NoiSeQSF scores, averaged across persons
and items, remained consistent across the two
occasions of measurement. The rank ordering of
persons differed slightly across the items (P*F1),
but not across occasions (P*F2). The variance
component of the three-way interaction P*F1*F2 is
the residual and suggests that no important facets
were omitted from the model.
The relative ( = 0.83) and absolute ( =
0.80) G coefficients exceed the lower limit of
at least 0.70 required for orientation purposes as
recommended by ISO 10075-3, (cited by Schutte
et al.25) and the difference between respondents
scores and their universe scores were negligible
(absolute error variance of 0.06). For the subscales
the G coefficients were: Habituation ( = 0.76/
= 0.75), Sleep ( = 0.82/ = 0.82), Work ( =
0.68/ = 0.61), Leisure ( = 0.73/ = 0.70) and
Communication ( = 0.79/ = 0.73).
Finally, a D-study revealed that for NoiSeQSF
for one occasion of measurement the relative G
coefficient would be 0.76 and the absolute would
be 0.74 which is still above the lower limit and
this is important because NoiSeQSF will usually
be administered once in a sample (Fig. 1).
According to individual D-studies, the relative
and absolute G coefficients for the subscales at
one occasion of measurement would be as follows:
Habituation ( = 0.69/ = 0.68), Sleep ( = 0.76/
= 0.75), Work ( = 0.60/ = 0.54), Leisure
( = 0.66/ = 0.63) and Communication ( = 0.73/
= 0.68).
DISCUSSION
KEY FINDINGS
Overall, our findings suggest that NoiSeQSF is
Table 4. ANOVA for the G-study, representing the sources of error variance.
Facet DF SS
P 55 509.03
F1 14 215.89
F2 1 2.14
P*F1 770 709.85
P*F2 55 44.72
F1*F2 14 2.30
P*F1*F2 770 107.83
Note. P persons (respondents); F1 items; F2 occasions (measurements, test and retest).
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2014 Medical University, Plovdiv
very reliable according to the Classical Theory
(test-retest, equivalence and stability coefficient,
internal consistency). The results from the ques-
tionnaire may also be generalized to the popula-
tion of interest when the aim is to assess global
NS. Moreover, Sleep subscale can readily be used
to assess sleep-related NS, which is of particular
importance, as sleep disturbance is one of the key
health outcomes of noise pollution.8 In fact, Sleep
subscale had the highest Cronbachs alpha and inter-
item correlations and was the strongest correlate of
cardiac symptoms. The subscales Communication
and Habituation were marginally meeting the 0.70
criterion of the G-Theory, so further refinement of
the questionnaire might improve their performance.
We were able to confirm the association of NS
with some cardiological symptoms,13-15 suggesting
nomological validity. Nomological validity entails
the evaluation of a psychometric construct within
a broader theoretical framework describing the
causal sequences and antecedents of the construct
and how they relate to one another.42,43 It is more
of a philosophical approach towards construct
validity and might yield some justification of the
psychometric instrument if factor analysis is not
applicable. The association of age with NS found
by other authors was not linear10,20,22; however,
middle-aged people tended to be significantly
more noise sensitive than the rest. They have been
speculated to suffer higher noise annoyance due to
their personal characteristics and more responsibil-
ity for their families.44
In comparison to the original NoiSeQ, NoiSeQSF
had lower G coefficient for global NS, but still
satisfactory given its reduced length.24 In our study
Work subscale performed poorly, while in the study
of Schutte et al. the item Leisure was the poorest
MS Variance Proportion
9.26 0.26 0.27
15.42 0.12 0.13
2.14 0.002 0.002
0.92 0.39 0.41
0.81 0.05 0.05
0.17 < 0.001 < 0.001
0.14 0.14 0.15
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A. Dzhambov et al
fitting construct.24 NoiSeQSF as a global measure
and Sleep subscale independently might be read-
ily used in future field studies. We used 5-point
scales in contrast to the 4-point scales of NoiSeQ.
The other subscales need further assessment. How-
ever, it is noteworthy that in the development and
validation of NoiSeQ the G- and D-studies were
performed using separate ANOVAs, while we used
specialized computational program, which might
explain some of the discrepancies. Moreover, in
their validation the authors of NoiSeQ did not
seem to include occasions of measurement as error
sources, while we did not include age and gender
for simplicity purposes.
Figure 1. D-study-predicted change in the mean G coef-
ficient depending on the number of items and occasions
of measurement.
STRENGTHS AND LIMITATIONS
To our knowledge, this study is the first to introduce
NoiSeQ in Bulgarian. According to the estimates of
reliability widely accepted in Bulgaria, NoiSeQSF
has high psychometric properties. Nevertheless, we
went further and conducted G-Theory conceptual-
ized validation protocol so that our version can
be comparable to the original. Main limitation of
the study is the relatively small sample because of
which the estimates of variance components might
be assumed to be unstable. For this reason we were
unable to perform factor analysis which should
be addressed in future research. However, power
analysis and post-hoc statistical power justified the
sample size for the regression model. Additionally,
the G coefficients suggested adequacy of the sample
size for the generalization of total and sleep-related
NS scores.
122
In future, convergent and discriminant validity
will have to be confirmed with relevant variables
such as noise exposure (both occupational and
residential), noise annoyance, neuroticism, etc. in
order to complement the nomological network of
NoiSeQSF. This study implemented quantitative
psychology approach, based solely on statistical
inference, rather than on psychophysical experiment.
Hence, using functional neuroimaging techniques
to study the neuronal activity associated with indi-
vidual differences in NS would be interesting and
helpful in regards to further tune the precision of
existing NS scales and to tackle some effective
strategies to buffer NS.
It was beyond the scope of the present study to
identify systematic methodology to assess psycho-
metric validity of NoiSeQSF. Based on the D-study,
20-item version might yield higher G coefficients,
remaining at the same time considerably shorter
than the original. Another limitation is the non-
random sampling, which is, however, common in
questionnaire development.27 On the other hand,
the sample was only a little representative of the
studied population given that minors were not
involved and it was skewed towards people with
higher socio-economic status and educational degree.
CONCLUSIONS
The shorter Bulgarian version of NoiSeQ is a reli-
able estimate for global noise sensitivity and noise
sensitivity related to sleep quality. As currently it
has no published alternative in Bulgarian, it might
prove especially useful to experts in environmental
hygiene, exposure medicine and occupational dis-
eases when dealing with noise-impaired occupational,
social or psycho-physiological functioning. Bulgar-
ian researchers lag years behind their European
counterparts in understanding the complexity of
noise exposure. Dealing with its purely acoustical
dimensions hinders the efficacy of management
and urban planning decisions. Scholars should
be given the proper research tools to address the
multi-dimensional phenomenon of noise exposure.
They have to take advantage of every opportunity
to improve the well-being of the population by
uncovering individual differences and relevant con-
structs which make people react a certain way to
their immediate environment. Finally, as the public
health aspect of noise exposure is still underexplored
in Bulgaria, it presents an excellent opportunity for
scientific research.
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 Validating a Short Bulgarian Version of a Psychometric Instrument for Multidimensional Noise Sensitivity Assessment
CONFLICT OF INTEREST STATEMENT
The authors declare that the research was conducted
in the absence of any relationships that could be
construed as a potential conflict of interest.
ACKNOWLEDGEMENTS
Many thanks to our friends, relatives and colleagues
who helped make this study possible.
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Appendix
NoiSeQSF is freely available for academic and non-profit use.

Bulgarian version of NoiSeQSF with instructions: English version of NoiSeQSF with instructions
In the following section we ask you to make statements concern-
. , ing different noises. Please go through the statements and do not
. leave out a statement. Please try to put yourself in the respective
, situation and answer spontaneously without much thinking about
. it. Please, mark as you see fit the rating category which applies
. best. Please tick only one rating category per statement. We are
. , interested in your individual view concerning the statements,
. hence there are no correct or incorrect responses
, If you feel uncertain which of the rating categories applies best
, - . to you, mark the category which best fits your personal view.

50%

Agree

Mostly agree

Mostly disagree

Disagree
50% Agree

SS* Statements SS*

I find it hard to
1 L 1 relax in a noisy L
environment

- I need peace and
2 , W 2 quiet to do dif- W
ficult work

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2014 Medical University, Plovdiv
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 Validating a Short Bulgarian Version of a Psychometric Instrument for Multidimensional Noise Sensitivity Assessment

For a quiet place

to live I would
3 , H 3 H
accept other dis-
,
advantages

I find it hard to
4 , - C 4 communicate C
while it is noisy
- When I am ab-
- sorbed in a con-
5 , C 5 versation I do not C
notice whether it
is noisy around me
I can fall asleep
6 S 6 even when it is S
noisy
-- Even the slightest
noise can prevent
7 S 7 S
me from falling
asleep
- It would not both-
8 H 8 er me to live in a H
noisy street
At weekends I
9 L 9 prefer quiet sur- L
roundings
I wake up at the
10 S 10 S
- slightest noise
I avoid leisure
11 L 11 activities which L
are loud
- I dont like noisy
12 H 12 activities in my H
residential area
High noise levels
- make it hard for
13 C 13 me to concentrate C
, on my conversa-
tion
I have no prob-
lems to do routine
14 W 14 W
work in a noisy
environment

I need quiet sur-
,
roundings to be
15 - W 15 W
able to work on

new tasks

Note. SS subscale, H habitation, S sleep, L leisure, C Note. SS subscale, H habitation, S sleep, L leisure, C
communication, W work; *this column was not included in the communication, W work; *this column was not included in the
questionnaire questionnaire

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