Abstract
BackgroundA rigorous cross-cultural adaptation process of an existing instrument could be the best option for measuring health in different cultures, instead of developing a new tool, and prior to psychometric and validation testing. The Dental Discomfort Questionnaire (DDQ), a validated instrument for assessing toothache in young children, has not been cross-culturally adapted so far. This study aimed to explore the detailed phases of the cross-cultural adaptation process of a pain assessment tool, presenting the example of the DDQ Brazilian-Portuguese adapted version.MethodsThe study design was based on the universalist approach, which consists of a sequential analysis to assess the relevant phases of a cross-cultural process before testing the measures of the instrument: conceptual, item, semantic, and operational equivalences. Systematic information was gathered from the literature, expert discussions, translations, and pre-testing through cognitive interviews with Brazilian population.ResultsDetailed description of the three major phases for a cross-cultural adaptation process was given. Notes of the changes done in the structure of the presented instrument (DDQ) were specifically pointed out at each phase. Conceptual and item analyses showed that there are similarities in the DDQ construct between the original and Brazilian cultures that require minor modifications. Translations and back-translations allowed the development of the preliminary Brazilian-Portuguese version of the DDQ, which was tested and underwent other minor changes to improve its comprehensibility.ConclusionsDescribing the phases was important to show how changes are made in a cross-cultural adaptation process of an instrument. This also could help researchers in adapting similar pediatric pain assessment tools to different cultures. A Brazilian-Portuguese version of the DDQ was presented.Electronic supplementary materialThe online version of this article (doi:10.1186/1756-0500-7-897) contains supplementary material, which is available to authorized users.
Highlights
A rigorous cross-cultural adaptation process of an existing instrument could be the best option for measuring health in different cultures, instead of developing a new tool, and prior to psychometric and validation testing
Part of the definition of pain by the International Association for the Study of Pain (IASP) summarizes pain’s relief relevance for health professionals, mainly those caring for children: “The inability to communicate verbally does not negate the possibility that an individual is experiencing pain and is in need of appropriate pain
Self-report is considered to be the gold standard for assessing pain [3], immaturity in communication in young children could be a barrier to understanding their feelings or how they can express their pain [3,4]; validated observational tools are recommended as more reliable than self-reports for facilitating pain assessment in young children [5,6]
Summary
A rigorous cross-cultural adaptation process of an existing instrument could be the best option for measuring health in different cultures, instead of developing a new tool, and prior to psychometric and validation testing. The Dental Discomfort Questionnaire (DDQ), a validated instrument for assessing toothache in young children, has not been cross-culturally adapted so far. To the best of our knowledge, the Dental Discomfort Questionnaire (DDQ) is the only published validated observational tool for assessing exclusively dental pain in children under the age of five [7]. Because child health care is influenced by language and cultural issues [14], for the assessment of pain in children [15], exploring the original DDQ across different cultures is important before its extensive use in different communities. Our hypothesis was that cross-cultural adapting the DDQ could possible discharge the need of the whole process of developing a new instrument
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