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. 2021 Jul-Aug;25(4):460-470.
doi: 10.1016/j.bjpt.2021.01.002. Epub 2021 Feb 3.

Assessing health empowerment - Brazilian cross-cultural adaptation and validity testing of the health education impact questionnaire (heiQ) among people with chronic low back pain

Aline Mendonça Turci  1 , Camila Gorla Nogueira  1 , Richard Osborne  2 , Anamaria Siriani de Oliveira  3 , Thais Cristina Chaves  4
Affiliations

Assessing health empowerment - Brazilian cross-cultural adaptation and validity testing of the health education impact questionnaire (heiQ) among people with chronic low back pain

Aline Mendonça Turci et al. Braz J Phys Ther. 2021 Jul-Aug.

Abstract

Background: There is no patient reported outcome measure available in Brazilian Portuguese to comprehensively assess outcomes following administration of patient education programs for people with chronic conditions.

Objective: To describe the cross-cultural adaptation and measurement properties of the Brazilian Portuguese version of the Health Education Impact Questionnaire (heiQ), a multidimensional questionnaire designed for the evaluation of patient education programs, which was tested in people with chronic low back pain (LBP).

Methods: One hundred thirty-seven individuals with non-specific chronic LBP (age: 38.7 ± 13.2) were enrolled in the study. The translation was performed according to international standards. Intraclass correlation coefficient (ICC) was used to assess test-retest reliability, Cronbach's α to assess internal consistency, Pearson rank correlation to compare the heiQ scales with comparator scales, and confirmatory factor analysis (CFA) for structural validity.

Results: The test-retest analysis yielded ICC values ranging from 0.75 to 0.91. Cronbach's alphas for the seven scales ranged from 0.70 to 0.89. Significant correlations between affective and general health constructs and the heiQ scales (72%) were observed. For the majority of the scales, the CFA fit statistics showed to be good to excellent.

Conclusion: Overall, the Brazilian Portuguese version of the heiQ showed acceptable reliability, internal consistency, construct validity, and structural validity in individuals with chronic LBP. The heiQ scales may serve as direct outcomes to assess education and self-management programs for the Brazilian Portuguese speaker population.

Keywords: Chronic low back pain; Cross-cultural adaptation; Health education; Questionnaire; Rehabilitation; Validation.

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Figures

Figure 1
Figure 1
Step 1: Process of cross-cultural adaptation of the heiQ into Brazilian Portuguese. The heiQ was forward translated from English into Brazilian Portuguese by two translators fluent in both languages, with Brazilian Portuguese as their mother language; one was naive, and one was an expert on Rehabilitation for chronic conditions. Step 2: The two Brazilian Portuguese versions were compared and synthesized (T1 + T2 = T12, the synthesis document originated from the two forward translations). Step 3: The Brazilian Portuguese synthesis was then backward translated into English by two new translators (English natives fluent in Portuguese), creating two new backward translation versions: BT1 and BT2. Step 4: Group Cognitive Interview - A committee of translators and researchers (n = 11) comprised of researchers working with chronic conditions, the translators, and the author of the original tool (Prof. Richard Osborne) worked together by videoconference to harmonize all versions of the heiQ. The committee gathered two researchers working with chronic pain conditions, one international researcher with expertise in public health, 3 professional translators (two English native speakers) and four health professionals and PhD students. The meaning of each item in the questionnaire was discussed among committee members and all versions of the questionnaire were compared to validate each item and make corrections when needed. Ultimately the 1st version of the heiQ was submitted to a pre-final testing in which individual cognitive interviews were used to assess the comprehension and meaning of the questionnaire by patients. From this process, emerged the final version of the questionnaire. T = Forward Translation, BT = Back Translation
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