Cross-Cultural Translation into Brazilian Portuguese and Validation of the Oral Anticoagulation Knowledge Tool (AKT-Br)

ABSTRACT Introduction: Oral anticoagulants are the treatment of choice for diverse types of coagulation disorders. Warfarin is widely used by the Brazilian population, possibly due to its lower cost than other oral anticoagulants. However, it has a high risk of serious adverse effects if used incorrectly. The Anticoagulation Knowledge Tool (AKT) can assess a patient's knowledge about her/his oral anticoagulant therapy and can assist health professionals in identifying patients with difficulties in adherence. This study aimed to translate, culturally adapt, and validate the AKT into Brazilian Portuguese. Methods: After a standard forward-backward procedure to translate the AKT into Brazilian Portuguese (AKT-Br), a version of the instrument was applied in three groups (patients, pharmacists, and the general population). The reliability of the AKT-Br was tested using an internal consistency measure and test-retest. The validity of the instrument was confirmed with data from the contrasted groups. All statistical analyses were performed with RStudio. Results: The median scores obtained with the AKT-Br were 29.0, 17.0, and 7.5 for pharmacists, patients, and the general population, respectively (maximum score of 35 points). There was moderate internal consistency for the instrument and test-retest reliability was satisfactory. Analysis of variance for validity of the groups revealed a significant relationship between the total score and the evaluated groups. Conclusion: The ATK-Br is a reliable and valid tool to assess knowledge about oral anticoagulants. AKT-Br can be used in clinical practice as an auxiliary tool to improve patient care through personalised educational interventions.

Validação do mini-questionário de qualidade de vida em hipertensão arterial (MINICHAL) para o português (Brasil) / Validation of the short form of the spanish hypertension quality of life questionnaire (MINICHAL) for portuguese (Brazil)

FUNDAMENTO: A avaliação da qualidade de vida tem sido considerada um parâmetro fundamental na compreensão do impacto causado pela hipertensão arterial. OBJETIVO: Traduzir, adaptar culturalmente e validar para a língua portuguesa o questionário específico para avaliação de qualidade de vida em hipertensão denominado "Mini-Cuestionario de Calidad de Vida em Hipertensión Arterial" (MINICHAL). MÉTODOS: Foram realizadas duas traduções independentes do MINICHAL para o português do Brasil. Posteriormente, as duas traduções foram harmonizadas gerando uma versão que foi retrotraduzida. Essa versão foi revisada por um comitê de juízes e a versão gerada foi testada em um ensaio piloto. Após a adaptação transcultural, a versão final do instrumento foi aplicada em uma amostra de 300 pacientes. Foram analisadas as propriedades psicométricas do questionário, como confiabilidade e validade de constructo. A consistência interna do instrumento foi verificada pelo coeficiente Alpha de Cronbach. RESULTADOS: A versão brasileira do MINICHAL apresentou na análise da consistência interna valores de Alpha de Cronbach de 0,88 para o domínio Estado Mental e 0,86 para Manifestações Somáticas. Na análise de validade de conteúdo a avaliação dos juízes apresentou alto índice de concordância (75,44 por cento). A análise fatorial confirmou os dois fatores, com diferenças em um item, o qual foi incluído no fator 2. O grupo controle apresentou diferenças significativas com relação aos hipertensos t=4,86, gl=276,8, p<0,001. CONCLUSÃO: A versão brasileira do MINICHAL foi validada com sucesso e representa um instrumento útil para avaliação da qualidade de vida de pacientes hipertensos brasileiros.

BACKGRAOUND: The assessment of quality of life has been considered an essential parameter in understanding the impact of arterial hypertension. OBJECTIVE: To translate into portuguese, cross-culturally adapt and validate the questionnaire specific for the assessment of quality of life known as "Mini Cuestionario de Calidad de Vida en Hipertensión Arterial" (MINICHAL). METHODS: Two independent translations of MINICHAL were made into brazilian portuguese. Later, these two translations were harmonized yielding a version that was back-translated into the source language. This version was revised by a committee of judges and the new version was tested in a pilot study. After the cross-cultural adaptation, the final version of the instrument was administered to a sample of 300 patients. The psychometric properties of the questionnaire such as reliability and construct validity were analyzed. The internal consistency of the instrument was measured by Cronbach’s alpha coefficient. RESULTS: In the brazilian version of MINICHAL, Cronbach’s alpha coefficients of internal consistency reliability were 0.88 for the Mental Status domain and 0.85 for the Somatic Manifestations domain. As to content validity, the judges’ assessment attained a high level of agreement (75.44 percent). The factor analysis confirmed both domains, with differences in one item which was included in factor 2. The control group presented significant differences relative to hypertensive patients (t=4.86, gl=276.8, p< 0.001). CONCLUSION: The brazilian version of MINICHAL was successfully validated and represents a useful and reliable instrument for assessing the quality of life of brazilian hypertensive patients.