Translating and Adapting the Patient Perception of Integrated Care Survey to Evaluate Integrated Care in Brazil: Preliminary Results

Abstract

Introduction: the increase in initiatives to improve integration of care for patients with chronic illness has risen on all over the world. This context claims the need for instruments able to evaluate the integrated care as perceived by patients across different cultural context. This abstract aims to describe the preliminary results forward translation and the expert panel of translation and cultural adaptation of the Patient Perception of Integrated Care PPIC survey to measure integrated care in Brazil. Methods: the PPIC survey version 2.1 served as basis for this methodological study after authorization granted by the original authors. For the process of translation and adaptation, we used the World Health Organization WHO guideline, including, sequentially, forward translation, expert panel, back-translation and pre-testing with cognitive interviewing. After expert panel, Content Validity Index CVI was calculated for each item for measuring the proportion of members in agreement with the translation proposed in first step. Beyond to analyzing each item individually, the instrument was evaluated as a whole. CVI ≥ 0.80 was adopted as indicator of adequacy of the translation to the original text. Results: the forward translation and the expert panel produced a Portuguese initial version of the PPIC survey with important adaptations. These adaptations resulted from differences relate to the context of Brazilian healthcare system Sistema Unico de Saude and are cultural/structural nature. The bilingual English and Portuguese expert panel, was composed by 5 members including experts in health, experts in linguistic as well as experts with experiences in instrument development and translation. The panel assess 76 items, being 64 questions e others 12 items related instructions and session titles. The mean CVI was 0.98 and all the suggestions made by the panel' members were discussed until to obtain the consensual version. Discussion: the WHO guideline is being very useful in guiding this process. Our partial results show that forward translation and expert panel are fundamental steps of translation and adaptation of instruments that need to be conducted carefully. This two steps showed that choosing words or expressions is a delicate procedure and need a rigorous examination. To ensure that questions content was not affected by adaptations, in the next steps, we will check for conceptual equivalence with the backward translation. Conclusions: the results of the two initial steps of the process of translation and adaptation of PPIC survey are promising for its adoption in Brazilian context for evaluate integrated care. Lessons learned: the results reached till the moment has shown that to focus on cross-cultural and conceptual, rather than on linguistic or literal equivalence, is the key point of these initial steps to achieve different language versions of the original instrument. Limitations: the forward translation and the expert panel were very important to produce a comprehensive starting version equivalent to the original instrument. However, it needs additional steps to successfully transfer the PPIC survey to Brazilian context. Suggestions for future research: after the final version, it will be necessary to determine the validity of the Brazilian PPIC survey through psychometric testing.