Valmi D. Sousa

Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline

RATIONALE, AIMS AND OBJECTIVES The diversity of the population worldwide suggests a great need for cross-culturally validated research instruments or scales. Researchers and clinicians must have access to reliable and valid measures of concepts of interest in their own cultures and languages to conduct cross-cultural research and/or provide quality patient care. Although there are well-established methodological approaches for translating, adapting and validating instruments or scales for use in cross-cultural health care research, a great variation in the use of these approaches continues to prevail in the health care literature. Therefore, the objectives of this scholarly paper were to review published recommendations of cross-cultural validation of instruments and scales, and to propose and present a clear and user-friendly guideline for the translation, adaptation and validation of instruments or scales for cross-cultural health care research. METHODS A review of highly recommended methodological approaches to translation, adaptation and cross-cultural validation of research instruments or scales was performed. Recommendations were summarized and incorporated into a seven-step guideline. Each one of the steps was described and key points were highlighted. Example of a project using the proposed steps of the guideline was fully described. CONCLUSIONS Translation, adaptation and validation of instruments or scales for cross-cultural research is very time-consuming and requires careful planning and the adoption of rigorous methodological approaches to derive a reliable and valid measure of the concept of interest in the target population.

Outcomes of family involvement in care intervention for caregivers of individuals with dementia

Health concerns and management strategies among families of young and middle-age adults with Huntington’s disease (HD) are unknown. This study developed and tested psychometric properties of the Huntington Disease Family Concerns and Strategies Survey (HDFCSS). Focus group data from 91 adult family members were used to develop content. Content analysis yielded four domains that were transferred into Personal, Person With HD, Community Health Care Services, and Strategies scales. Focus group data, expert validation, and cognitive interviews demonstrated survey content validity. Cronbach’s alpha internal consistency coefficients for the scales were 0.83 or above. The measure can be used to generate reliable and valid data to identify adult family members’ health-related concerns and management strategies for themselves and persons with HD.

Perceptions of breastfeeding and planned return to work or school among low-income pregnant women in the USA

AIMS AND OBJECTIVES To describe the perceptions of breastfeeding in low-income pregnant women to understand their needs better as they plan to return to work or school. BACKGROUND Maternal employment has a negative impact on breastfeeding duration. Yet there is insufficient research on challenges and facilitators regarding breastfeeding and employment issue among low-income women in the USA. Knowing the perceptions of breastfeeding among low-income pregnant women and their plan to return to work or school may have implications for nurses and midwives in providing quality care. DESIGN Qualitative study using focus group interviews. METHODS The research setting consisted of three Women, Infants and Children clinics (WIC) in a midwestern city of the USA. Seventeen pregnant women (aged 19-35) participated in focus group interviews. Data were coded and analysed for themes and patterns using the QSR software - NVivo 6. RESULTS Eleven participants were single. Ten women were primigravida, and seven were multipara. The following five themes were identified: (1) perceived benefits of breastfeeding; (2) general perceptions of breastfeeding; (3) maternal concerns; (4) having the right support; and (5) anticipated challenges of combining breastfeeding and work. Conclusions.  Low-income women anticipated substantial barriers for breastfeeding when they planned to combine breastfeeding and work or school. The results of this study have many implications for public health practice, research and policy. Educating employers and the public at large about the health and economic benefits derived from long-term breastfeeding could help promote breastfeeding awareness. RELEVANCE TO CLINICAL PRACTICE Strategies supporting breastfeeding among low-income working women must be provided at multiple levels to help overcome the barriers they concern. Health care providers should help women gain confidence by minimising their uncertainties and fears about breastfeeding to prepare them to continue breastfeeding successfully after returning to work.

Knowledge and attitude: important components in diabetes education

This descriptive cross-sectional study was conducted from March to November 2007 at a research and community services center of a Brazilian university. It aimed to explore the knowledge and attitude of people with diabetes mellitus who were attending a diabetes self-care education program. The sample was composed of 82 adults with diabetes mellitus. Data were collected through the Portuguese versions of the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). Results revealed that 78.05% of the participants obtained scores higher than eight on knowledge about diabetes, which indicates they have knowledge and understand the disease. Scores on attitude ranged from 25 to 71 suggesting difficulty in coping with the disease. We conclude that although participants obtained a good score on knowledge, their attitude did not change so as to more adequately cope with the disease.Estudio transversal, realizado en un centro de investigacion y extension universitaria brasileno, en el periodo de marzo a noviembre de 2007. El objetivo fue verificar conocimientos y actitudes de personas con diabetes mellitus que participaban de un programa de educacion en el auto cuidado en diabetes. Como metodo se uso una muestra constituida por 82 adultos con diabetes mellitus. Para recoleccion de los datos fueron utilizadas versiones portuguesas de los cuestionarios Diabetes Knowledge Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Los resultados mostraron que 78,05% tuvieron puntajes superiores a 8 en relacion al conocimiento en diabetes, indicando conocimiento y comprension acerca de la enfermedad. En cuanto a la actitud, los puntajes variaron entre 25 y 71 puntos, sugiriendo dificultad en el enfrentamiento de la enfermedad. Se concluye que, a pesar que los participantes obtuvieron un buen puntaje en el conocimiento, todavia asi no modificaron la actitud para el enfrentamiento mas adecuado de la enfermedad.

Reliability, validity and factor structure of the Appraisal of Self‐Care Agency Scale – Revised (ASAS‐R)

RATIONALE, AIMS AND OBJECTIVES Self-care agency is a fundamental concept in nursing and health care research. Having self-care agency enhances an individuals health-promoting behaviours and/or specific capabilities for chronic disease self-management. The purpose of this study was to continue the development and psychometric testing of the Appraisal of Self-Care Agency - Revised (ASAS-R). METHODS A cross-sectional methodological design was used to examine the reliability, validity and factor structure of the ASAS-R among individuals from the general population. The sample consisted of 629 adults who were randomly selected to conduct an exploratory factor analysis (EFA; n=240) and a confirmatory factor analysis (CFA; n=389) of the scale. A demographic questionnaire, the ASAS-R and the Health-Promoting Lifestyle Profile (HPLP-II) were the measures used to collect the data. RESULTS The final 15-item three-factor ASAS-R had an overall Cronbachs alpha (α) of 0.89. The three factors extracted, rotated and scored in this study were labelled: having power for self-care, developing power for self-care and lacking power for self-care. All inter-items and item-to-total correlations met recommended criteria of r=0.30 to r=0.70, except for one of the items that had an item-to-total correlation of 0.71, slightly exceeding the maximum recommended item-to-total correlation. The three factors had Cronbachs alphas of 0.86, 0.83 and 0.79, respectively. The three factors together explained 61.7% of the scale items variance. Each item of the scale had a strong factor loading ranging from 0.52 to 0.81. All measures of model fit exceeded the recommended criteria, indicating that the 15-item ASAS-R had a very good fit (χ(2) /d.f.=1.97, GFI=0.94, AGFI=0.92, CFI=0.96, TLI=0.95, RMSEA=0.05, RMR=0.05 and the PCLOSE=0.48). CONCLUSIONS The 15-item three-factor ASAS-R is a short, reliable and valid instrument to measure self-care agency among individuals from the general population, but further psychometric evaluation is needed among individuals with chronic diseases, especially those with diabetes mellitus.

FactOr Analysis Of the Appraisal Of Self-care Agency Scale in American Adults With Diabetes Mellitus:

PURPOSE The purpose of this methodological secondary data analysis study is to examine the reliability, construct validity, and dimensionality of the Appraisal of Self-care Agency Scale (ASAS) in an American sample of adults with diabetes mellitus. METHODS The sample consisted of 141 insulin-requiring adults with diabetes mellitus recruited from a Diabetes Care Center in the southern United States. The ASAS, along with Hurleys Insulin Management Diabetes Self-efficacy and Insulin Management Diabetes Self-care Scales, was used in the study to determine convergent validity, thus contributing to the construct validity of the ASAS. Other data analysis consisted of internal consistency estimates of reliability, Pearson correlations, and factor analysis. RESULTS The findings suggest that the ASAS consists of a single substantive dimension and has adequate construct validity and reliability. CONCLUSION Revision of certain items and conducting further analysis of the scale, prior to its adoption in clinical practice, should be considered.

Conhecimento e atitudes: componentes para a educação em diabetes

This descriptive cross-sectional study was conducted from March to November 2007 at a research and community services center of a Brazilian university. It aimed to explore the knowledge and attitude of people with diabetes mellitus who were attending a diabetes self-care education program. The sample was composed of 82 adults with diabetes mellitus. Data were collected through the Portuguese versions of the Diabetes Knowledge Questionnaire (DKN-A) and the Diabetes Attitude Questionnaire (ATT-19). Results revealed that 78.05% of the participants obtained scores higher than eight on knowledge about diabetes, which indicates they have knowledge and understand the disease. Scores on attitude ranged from 25 to 71 suggesting difficulty in coping with the disease. We conclude that although participants obtained a good score on knowledge, their attitude did not change so as to more adequately cope with the disease.Estudio transversal, realizado en un centro de investigacion y extension universitaria brasileno, en el periodo de marzo a noviembre de 2007. El objetivo fue verificar conocimientos y actitudes de personas con diabetes mellitus que participaban de un programa de educacion en el auto cuidado en diabetes. Como metodo se uso una muestra constituida por 82 adultos con diabetes mellitus. Para recoleccion de los datos fueron utilizadas versiones portuguesas de los cuestionarios Diabetes Knowledge Questionnaire (DKN-A) y Diabetes Attitude Questionnaire (ATT-19). Los resultados mostraron que 78,05% tuvieron puntajes superiores a 8 en relacion al conocimiento en diabetes, indicando conocimiento y comprension acerca de la enfermedad. En cuanto a la actitud, los puntajes variaron entre 25 y 71 puntos, sugiriendo dificultad en el enfrentamiento de la enfermedad. Se concluye que, a pesar que los participantes obtuvieron un buen puntaje en el conocimiento, todavia asi no modificaron la actitud para el enfrentamiento mas adecuado de la enfermedad.

Psychometric Properties of the Portuguese Version of the Depressive Cognition Scale in Brazilian Adults with Diabetes Mellitus

Identifying depressive cognitions in Brazilians with diabetes can be important step to prevent the development of clinical depression, which is negatively associated with diabetes self-management. This study focused on the psychometric testing of the Portuguese version of the Depressive Cognition Scale, the Escala Cognitiva de Depressão (ECD), among 82 Brazilian adults with diabetes mellitus. The questionnaire was assessed for internal consistency, homogeneity, and construct validity using factor analysis and convergent validity assessment with the Portuguese version of the Beck Depression Inventory, the Inventário de Depressão Beck (IDB). Cronbach’s alpha for the ECD was .88. The homogeneity of the instrument was supported by item-to-total correlations between .30 and .70. Factor extraction generated only one factor with eigenvalues greater than 1, which is consistent with the English version. The ECD’s total score had a weak but significant correlation with the IDB’s total score (r = .24, p < .05), indicating convergent validity. Evidence for the reliability and construct validity of the ECD was provided by this study. This scale has the potential to become a useful screening tool for depressive cognitions among Brazilians with diabetes.

An overview of research designs relevant to nursing: Part 3: Mixed and multiple methods

Este tercero articulo de la serie “Revision de los Disenos de Investigacion Relevantes para la Enfermeria”presenta el uso de los metodos mixtos o multiples en la investigacion en enfermeria. El uso de metodos mixtoso multiples es una tendencia creciente que ofrece una alternativa a los investigadores en la aproximacion deproblemas complejos de la salud enfrentados actualmente en la enfermeria. Entender todos los metodos ytodas las combinaciones de metodos facilita la conduccion y diseminacion de la investigacion para servir a lapractica de la enfermeria.DESCRIPTORES: investigacion en enfermeria; analisis cualitativo; metodologia; enfermeria

Revisão dos desenhos de pesquisa relevantes para enfermagem: Parte 3: Métodos mistos e múltiplos

Este tercero articulo de la serie “Revision de los Disenos de Investigacion Relevantes para la Enfermeria”presenta el uso de los metodos mixtos o multiples en la investigacion en enfermeria. El uso de metodos mixtoso multiples es una tendencia creciente que ofrece una alternativa a los investigadores en la aproximacion deproblemas complejos de la salud enfrentados actualmente en la enfermeria. Entender todos los metodos ytodas las combinaciones de metodos facilita la conduccion y diseminacion de la investigacion para servir a lapractica de la enfermeria.DESCRIPTORES: investigacion en enfermeria; analisis cualitativo; metodologia; enfermeria