Translation, Cultural Adaptation, and Content Validation of a Pleural Mesothelioma Questionnaire to Portuguese Context - A Key Tool for Epidemiological Surveillance

Our plain-English summary of Translation, Cultural Adaptation, and Content Validation of a Pleural Mesothelioma Questionnaire to Portuguese Context - A Key Tool for Epidemiological Surveillance, by C. Santos, E. Sacadura-Leite, S. Feijó, et al (Portuguese Journal of Public Health, 2024).

The study

• Authors: C. Santos, E. Sacadura-Leite, S. Feijó, M.D.A. Dixe, P. Astoul, A. Sousa-Uva
• Journal: Portuguese Journal of Public Health
• Published: 2024;42(2):101-110
• Read it: PubMed · Publisher · Free full text

Abstract

Objective: The main objective of this study was to describe the translation, cultural adaptation, and content validation process of the French National Surveillance Programme for Pleural Mesothelioma (FNSPPM) questionnaire for the Portuguese context.

Methods: A search was conducted in the PubMed database and Web of Science, in the period from January 1, 1960, to December 31, 2022, to select the questionnaire. Forward and reverse translations, calculation of the content validity index (CVI) by a panel of experts (n = 9), and cognitive interviewing with individuals with at least one exposure to asbestos (n = 10) were performed. Experts rated items on a Likert scale (1-4) based on their relevance. The item-level content validity index (I-CVI), scale-level content validity index based on the average method (S-CVI/Ave), and scale-level content validity index based on the universal agreement method (S-CVI/UA) were calculated.

Results: The final version of the FNSPPM questionnaire for the Portuguese context resulted from a translation and content validation process. The panel of experts considered the questionnaire relevant, with an I-CVI of up to 0.78 in 68 of 69 of the questions, an S-CVI/Ave of 0.98, and an S-CVI/UA of 0.90. The participants in the cognitive interviews reported an understanding of the questionnaire.

Conclusion: A validated FNSPPM questionnaire for the Portuguese context is now available to study individuals with pleural mesothelioma (PM) and asbestos exposure.

© 2024 The Author(s). Published by S. Karger AG, Basel on behalf of NOVA National School of Public Health.

In plain English

The authors translated a French questionnaire into Portuguese and checked its content for use in Portugal. The questionnaire comes from the French National Surveillance Programme for Pleural Mesothelioma. It had 69 questions covering personal details, occupational and nonoccupational asbestos exposure, habits and health. A literature search found questionnaires from six countries, and the authors reported that only the French one met their criteria. Separate translators put it into Portuguese and back into French. Addresses were removed for data protection, and the gender and schooling options were adapted. Nine health professionals rated how relevant each question was. In the authors' table of ratings, 68 of the 69 questions scored at least 0.78 on an item-level index (one of them exactly 0.78), and the overall scale scores were 0.98 and 0.90. Question 4, on place of birth (parish), scored 0.56 and was removed. Ten adults in Portugal with at least one known asbestos exposure went through the questionnaire in interviews and reported understanding it. The authors concluded that the Portuguese version had satisfactory content validity. They noted that they could not apply it to a larger sample of patients with pleural mesothelioma.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Questionnaire translation, cultural adaptation and content validation study, preceded by a database search to select the questionnaire
• Who was studied: A panel of 9 experts (nurses and physicians in occupational health, public health, pulmonology, epidemiology, oncology and anatomopathology) recruited in July 2023, and 10 adults of Portuguese nationality living in Portugal with at least one known asbestos exposure, interviewed in two rounds in August 2023
• Exposure: Occupational and/or nonoccupational asbestos exposure, which the questionnaire is designed to characterize. Interview participants had at least one known exposure. No fiber types are named.
• Main results:
  • The search gave 215 hits (PubMed 159, Web of Science 56) and 185 unique papers. Six questionnaires were found (Australia, France, Italy, Spain, South Korea, Turkey), and only the French questionnaire met all inclusion criteria.
  • The French questionnaire has 69 questions in two domains: 13 on the individual and the interview, and 56 on occupational and nonoccupational characterization, habits and health.
  • Cultural adaptation removed information considered sensitive for data protection (address) and adjusted the gender and schooling categories to the Portuguese context.
  • Expert panel (9 experts): the text reports 68 of 69 questions with an item-level content validity index above 0.78. Table 2 shows Q69 at exactly 0.78 and Q4 at 0.56, so 68 of 69 reached at least 0.78. The scale-level index was 0.98 by the average method and 0.90 by the universal agreement method. The authors interpreted this as relevant.
  • Question 4 (place of birth: parish) had an item-level index of 0.56 and was excluded because it could jeopardize participants' anonymization.
  • Question 10 was rewritten on the experts' suggestions so that activities and occupations are coded with Portuguese classification systems.
  • The 10 cognitive-interview participants reported understanding the questionnaire and its instructions, and no further changes were made.
• The authors' conclusion: The authors concluded that the Portuguese version of the questionnaire achieved a satisfactory level of content validity and could be used to study individuals with pleural mesothelioma and asbestos exposure in Portugal. They added that more work is needed to apply it to a significant sample of the Portuguese population and to create a specific registry.
• Limitations the authors state:
  • The search used to choose the questionnaire excluded publications not in English or French, although studies of interest in other languages were identified.
  • It was not possible to apply the questionnaire to a more substantial sample of patients with pleural mesothelioma.

Topics

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Asbestos Exposure.

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