Brazilian adaptation of the questionnaire to assess adherence to treatment for arterial hypertension

Matta, Samara Ramalho; Luiza, Vera Lucia; Azeredo, Thiago Botelho

doi:10.1590/S0034-8910.2013047003463

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Sumário

Original Articles • Rev. Saúde Públ. 47 (2) • June 2013 • https://doi.org/10.1590/S0034-8910.2013047003463 copy

Brazilian adaptation of the questionnaire to assess adherence to treatment for arterial hypertension

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To describe the cross-cultural adaptation of the questionnaire evaluating adhesion to treatment for arterial hypertension from its original Spanish version to a Portuguese version, to be applied in Brazil.

METHODS

In order to establish conceptual, semantic and operational equivalents of the items, two independent translations to Portuguese, and two back-translations into Spanish were performed. The translations and back-translations were assessed for changes in referential and general meanings. The synthesis of the translations was applied in pre-tests with patients with arterial hypertension and/or diabetes, which were important to identify different problems and confirm earlier decisions.

RESULTS

In general, the second translation and back translation were evaluated more positively because the translation process did not affect the meanings in five of the twelve items of the questionnaire. Operational changes were made and a vignette with response options and an example included in the instrument facilitated application in interviews.

CONCLUSIONS

The results obtained in the process of evaluating the items’ conceptual, semantic and operational equivalence allowed the construction of a Portuguese version of the MBG questionnaire to assess adherence to treatment which can be applied in the Brazilian context.

Hypertension, drug therapy ; Medication Adherence ; Translations ; Questionnaires ; Validation Studies

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E-mail: revsp@usp.br

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[1] The authors declare that there are no conflicts of interests.

Original instrument	Semantic evaluation^a (exponent)

	T1	R1	Ref	Ger	T2	R2	Ref	Ger

a) Toma los medicamentos en el horario establecido - take medication at the correct time	Toma as medicações no horário estabelecido	Tomar los medicamentos en el horário establecido	10	LA	No horário marcado toma os remédios	En el horario marcado toma los remedios	7	LA
b) Se toma todas las dosis indicadas - take all prescribed doses	Devem-se tomar todas as dosagens indicadas	Se deben de tomar todas las dosis indicadas	10	SA	Se tomam todas as doses indicadas	Se toma toda las dosis indicadas	5	SA
c) Cumple las indicaciones relacionadas con la dieta - follow recommendation on diet	Cumpre as indicações relacionadas com a dieta	Cumplir las indicaciones relacionadas con la dieta	10	LA	Segue as regras da dieta	Sigue las reglas de la dieta	10	UN
d) Asiste a las consultas de seguimiento programadas - attend all follow up appointments	Acompanha as consultas ambulatoriais programadas	Acompañar las citas programadas	3	CA	Vai a consultas periódicas	Asiste a consultas periódicas	10	UN
e) Realiza los ejercicios físicos indicados - Do recommended exercise	Realiza os exercícios físicos indicados	Realice los ejercicios físicos indicados	10	LA	Faz os exercícios físicos indicados	Hace los ejercicios médicos indicados	0	CA
f) Acomoda sus horarios de medicación, a las actividades de su vida diaria - Fit schedule for taking medicine in with day-to-day life	Adequa seus horários de tomada dos medicamentos às atividades de sua vida diária	Adaptar sus horários de la toma de sus medicamentos con los de sus actividades diárias	8	LA	Encaixa os horários do remédio no seu dia a dia	Los horarios de sus remédios encajan en su dia a dia	8	LA
g) Usted y su médico, deciden de manera conjunta, el tratamiento a seguir - You and your doctor made a joint decision as to what treatment to follow	O senhor e seu médico decidem de maneira conjunta o tratamento a ser seguido	Usted con su médico deciden como llevar a cabo su tratamiento	10	UN	Senhor/Senhora e seu médico decidem juntos o tratamento que vai fazer	Señor/Señora y su médico deciden juntos el tratamiento que va hacerce	8	UN
h) Cumple el tratamiento sin supervisión de su familia o amigos - Follow treatment without supervision by family or friends	Cumpre o tratamento sem supervisão de sua família ou amigos	Cumpla con el tratamiento sin la ayuda de familiares o amigos	10	SA	Cumpre o tratamento sem supervisão de sua família ou amigos	Cumple el tratamiento sin supervicion de sus familiares o amigos	10	UN
i) Lleva a cabo el tratamiento sin realizar grandes esfuerzos - Follow the treatment without major effort	Leva até o fim o tratamento sem realizar grandes esforços	Termine su tratamiento sin hacer mayores esfuerzos	10	LA	Leva o tratamento sem grandes esforços	Lleva el tratamiento sin grandes esfuerzos	9	UN
j) Utiliza recordatorios que faciliten la realización del tratamiento - Used reminders to make it easier to follow the treatment	Utiliza lembretes que facilitem a realização do tratamento	Utilice papelitos recordatorios para facilitar la realización de su tratamiento	8	SA	Faz uso de lembretes para realização do tratamento	Hace uso de recordatorios para la realizacion del tratamiento	10	UN
k) Usted y su médico analizan, cómo cumplir el tratamiento - You and your doctor analyzed how to follow the treatment	O senhor e seu médico analisam como cumprir o tratamento	Usted con su médico deciden como realizar su tratamiento	6	SA	Senhor/Senhora e seu médico analisam como cumprir o tratamento	Señor/Señora y su médico analizan como cumplir el tratamiento	8	LA
l) Tiene la posibilidad de manifestar su aceptación del tratamiento que ha prescripto su medico - You had the opportunity to show your agreement to the treatment your doctor prescribed	Tem a possibilidade de manifestar sua concordância com o tratamento prescrito pelo seu medico	Tiene la posibilidad de manifestar que está de acuerdo con el tratamiento que le dejó su médico	10	UN	Tem como dar a sua opinião no tratamento que o médico prescreveu	Tiene como dar su opinion en el tratamiento que le médico prescribio	10	UN

Item^a	Problem	Suggested solution

b	Some people did not understand the meaning of “dose of medicine.”	Introduced an explanation of the concept of doses in the fieldworker manual. Other proposed changes to this item were to conjugate the verb “take” instead of leaving it in the infinitive and replace “as stated” for “indicated.”
F	Understood by respondents as: “take medications on schedule.”	Added the term “activities” to the sentence.
i	The term “great efforts” was not clearly understood.	Replaced the term “great efforts” by “great difficulty.”
K	The term “analyze” in item k was understood by the respondent as clinical analysis of your health and not as establishing a partnership relationship with the doctor.	The term “analyze” was replaced by “discuss” the sentence of item (k).
g, k	Were understood the same way by the respondents, who even asked if it was a repeated question.	Although “discuss” is not a synonym for “analyze” in Portuguese, it emphasizes the active role of the patient in relation to the doctor more than the term “analyze”.
g, k, l	Nuanced understanding of items that comprise the same category.	The term “be able to give your opinion” replaced by “have the opportunity to give your opinion” in the sentence in item (l).
c, e	Did not apply to some patients because they received no recommendation on diet or physical exercise.	Insert a filter question into the questionnaire to identify whether the patient received recommendations on diet and exercise in the treatment of hypertension and / or diabetes.

Item^a	Synthesized version	Origin	Modifications after the first pre-test	Modifications after the second test

A	Toma as medicações no horário estabelecido - Take medication at the set time	T1	–	–
B	Tomar todas as doses dos medicamentos como indicado - Take all doses as indicated	T1 + T2 modificado	Toma todas as doses indicadas	–
C	Segue as regras da dieta - Follow a diet	T2	–	–
D	Vai a consultas marcadas - Attend appointments	T2 modificado	–	–
E	Realiza os exercícios físicos indicados - Do exercise as recommended	T1	–	–
F	Encaixa os horários do remédio no seu dia a dia - Fit schedule for taking medicine in with day-to-day life	T2	Encaixa os horários do remédio nas atividades do seu dia a dia	–
G	O senhor e seu médico decidem juntos o tratamento a ser seguido - You and your doctor made a joint decision as to what treatment to follow	T1 + T2	–	–
H	Cumpre o tratamento sem supervisão de sua família ou amigos - Follow treatment without supervision by family or friends	T1 = T2	–	–
I	Leva até o fim o tratamento sem realizar grandes esforços - Follow the treatment without major effort	T1	Leva até o fim o tratamento sem grandes dificuldades	Leva o tratamento sem grandes esforços
J	Faz uso de lembretes para realização do tratamento - Used reminders to make it easier to follow the treatment	T2	–	–
K	O/a senhor/senhora e seu médico analisam como cumprir o tratamento - You and your doctor analyzed how to follow the treatment	T1 = T2	O(a) senhor(a) e seu médico discutem como cumprir o tratamento	–
L	Tem como dar a sua opinião no tratamento que o médico prescreveu - You had the opportunity to show your agreement to the treatment your doctor prescribed	T2	–	Tem a possibilidade de dar a sua opinião no tratamento que o médico prescreveu

Item^a	Final version

A	Take medication at the set time
B	Take all doses as indicated
C	Follow a diet
D	Attend appointments
E	Do exercise as recommended
F	1.1.1 Fit schedule for taking medicine in with day-to-day life
1.1.2	1.1.3 You and your doctor made a joint decision as to what treatment to follow
1.1.4	1.1.5 Follow treatment without supervision by family or friends
1.1.6	1.1.7 Follow the treatment without major effort
1.1.8	1.1.9 Used reminders to make it easier to follow the treatment
1.1.10	1.1.11 You and your doctor analyzed how to follow the treatment
1.1.12	1.1.13 You had the opportunity to show your agreement to the treatment your doctor prescribed