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    Symptom Status Questionnaire - Heart Failure – versão brasileira: adaptação transcultural e validação de conteúdo
    (Universidade Federal de São Paulo (UNIFESP), 2020-10-29) Santos, Gabriela Nunes Dos [UNIFESP]; Lopes, Camila Takao [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Assessment of common physical symptoms in patients with heart failure (HF) is necessary so that the factors related to these findings are identified and better managed. For that purpose, reliable and valid instruments are needed. In Brazil, however, there are no instruments available to specifically assess the physical symptoms of HF. The Symptom Status Questionnaire-Heart Failure (SSQ-HF), an American instrument, assesses the presence, frequency, severity and distress related to seven common physical HF symptoms and has adequate evidence of internal consistency and construct validity. Objective: To adapt the SSQ-HF to Brazilian Portuguese and estimate evidence of content validity of the adapted version. Methods: A psychometric cross-cultural adaptation study and a content validation study of an instrument, conducted after obtaining authorization from the instrument's author. The cross-cultural adaptation was organized in five phases: 1.1) Translation by two independent translators. 1.2) Synthesis of translations. 1.3) Back-translation by two independent translators. 1.4) Review of back-translations by the author of the original instrument. 1.5) Evaluation of the translated version for semantic, idiomatic, cultural and conceptual equivalences (-1: not equivalent, 0: undecided, +1: equivalent) by nine specialist healthcare professionals (n=9). The agreement considered acceptable was ≥80%. The content validation was performed both by specialist professionals and by patients with HF, in two phases: 2.1). The content was evaluated by nine specialist professionals for clarity, theoretical relevance and practical pertinence, on a 4-poin Likert-type scale (1: no, 2: little; 3: quite; 4: very clear/relevant/pertinent). Items with a content validity coefficient (CVC) ≥0.70 were considered acceptable. 2.2) Content assessment by 40 outpatient HF patients, who evaluated the visual appearance of the instrument and understanding of the instructions and items. The need for adjustments was assessed qualitatively by the researchers. Evaluation rounds using the Delphi technique were carried out until the appropriate validity measures were reached. Results: After translation and back-translation, a conceptual discrepancy was identified and corrected in the translation of the item Did you have shortness of breath during day time?. In the first round of equivalence assessment, the agreement between experts was 100%, except for the item Did you have shortness of breath during day time?, which obtained 55.6% agreement regarding cultural equivalence and 77.8% as to conceptual equivalence. The translation of the item was changed to “Did you have shortness of breath during the period of the morning or afternoon?”, Which obtained 100% agreement in the second round of evaluation. In the content validation by the professionals, only one round was necessary and the total CVC of the instrument was 0.99. In the content validation by patients, all understood the items and adjustments were made to the font size and formatting, as suggested. Conclusion: The SSQ-HF – Versão Brasileira is equivalent to the original version and has satisfactory evidence of content validity. Additional psychometric tests are necessary to enable an accurate assessment of the prevalence, frequency, severity and distress associated with HF symptoms in Brazil.