Adaptation and validation of the Inventory of Family Protective Factors for the Portuguese culture

OBJECTIVES: to adapt and validate the Inventory of Family Protective Factors (IFPF) for the Portuguese culture. This instrument assesses protective factors that contribute to family resilience. Studies addressing resilience are embedded within the salutogenic paradigm, i.e. it addresses protective factors of individuals or groups without underestimating risk factors or vulnerability. METHOD: in order to assess the IFPF's linguistic and conceptual equivalence, the instrument was translated, retro-translated and the think-aloud protocol was used. We then verified the instrument's sensitiveness, reliability and validity of results to assess its psychometric characteristics. A factor analysis was performed of the principal components with varimax rotation of the scale's items and Cronbach's alpha coefficient was calculated for each dimension. A total of 85 families with disabled children, selected through simple random sampling, self-administered the instrument. RESULTS: the IFPF presents psychometric characteristics that are appropriate for the Portuguese population (Cronbach's alpha = .90). CONCLUSION: the IFPF was adapted and validated for the Portuguese culture and is an instrument to be used in studies intended to assess protective factors of family resilience.


Introduction
One of the issues currently emerging within the scientific community, particularly among healthcare and education workers, is that certain families are not only able to respond positively to adversities and cope with them, but also to become stronger, optimistic and feel renewed and positively transformed by these situations.
Resilience is the ability to overcome a potentially traumatic situation and regain strength, which implies positive adaptation to hardships and normal development, despite risk factors, and self-control after a traumatic event (1) .
The first studies exploring the concept of resilience focused on individuals' personal characteristics and coping strategies (adult or child) used to face adversities.
One of the first studies addressing adaptive responses to adverse situations was developed in the 1970s with children at high risk. These children did not mirror the hardships they were subject to, but rather grew and became stronger than others in similar situations (1) .
Research on resilience was extended to different age groups and different types of diversities, such as poverty and violence (2) , maltreatment (3) , and chronic diseases (4) . One group of researchers also investigated the relationship of this concept with cultural and ethnic characteristics of American and Hawaiian Indians (5) .
These studies indicate a sense of resilience focused on personal attributes, such as autonomy and self-esteem.
Recently, some authors shifted the focus from personal resilience, previously based on individual resources, to a concept of family resilience, as a product of family relationships (6) . Family resilience is viewed as a family's ability to cultivate strengths that enable one to deal with changes in life. Underlying this concept are certain characteristics, dimensions and properties that ease adaptation of the family to change and crisis situations. This perspective acknowledges family strengths and dynamic relationships and considers that family stress and changes are not obstacles but an opportunity to grow (7) .
Families use coping strategies to deal with stressful situations in order to adapt. One has to consider the differences between resilience and coping. Resilience involves two processes: the first consists of resistance to stress and, therefore, ability to cope; and the second is more related to an ability to carry on with development and increase competences in an adverse situation (1) . Therefore, the focus of family resilience is on essential areas that enable family strengthening in the face of crisis situations, namely: (i) assigning a meaning to adversity; (ii) hope and optimism; (iii) spirituality, flexibility, cohesion, family communication, sharing leisure, routines and rituals; and (iv) support networks and family ability to maintain itself (7)(8) .

Instrument
Author individual or family as a whole and encourage an active process of restructuring and growth (6). This approach, which emphasizes family strengths rather than vulnerability and risk factors, is not apparent in most contexts of investigation and care practices. Hence, studies addressing family resilience are incipient, far from becoming strong studies with empirical evidence.
For this reason, this is a broad field of investigation (7).
There are some instruments that permit assessing families from the perspective of their strengths, such as the Family Inventory of Resources for Management (8) , Family Hardiness Index (9) , Family Resource Scale (10) , and Inventory of Family Protective Factors (11) . Figure 1 presents the main characteristics of these instruments with regard to the dimensions assessed, number of items, format and psychometric characteristics.
Some of these instruments are not frequently used by professionals, given their complexity and especially because of the time required for application.
We selected the Inventory of Family Protective Factors (IFPF) (11) for this study because it enables professionals to rapidly assess families' protective factors that contribute to family resilience. The IFPF was developed and validated by five American researchers from the Lehigh University, New Mexico State University and University of Wisconsin -River Falls based on the Family Adaptation Model (12) . In this context, protective factors are assessed as opposed to risk factors, meaning that certain families have some attributes and resources that enable them to overcome and take advantage of demands inherent to transition processes, whether these are developmental or situational processes (6) .
The Inventory of Family Protective Factors (IFPF) assesses four dimensions that influence family protection: fewer stressors, adaptive appraisal, social support, and compensating experiences, as described in becomes a multidimensional experience for both the child and family (13) .
Given the previous discussion, this study's objective was to adapt and validate the IFPF to the Portuguese Culture, considering the availability of a multidimensional instrument that permits assessing protective factors that contribute to family resilience and which can be used by nurses and other professionals in the fields of health and education.

Dimensions Description No. of items Cronbach's alpha
Fewer stressors It assesses whether the family has more positive or negative experiences in the sphere of health, finances, family and friends, and work/school.

.53
Adaptive appraisal It includes the family's perception with regard to self-esteem, optimism, creativity and self-reliance. 4 .83 Social Support It assesses the existence of good relationship with at least one supportive individual, one caring individual, one individual the family can trust, and one person interested in the family.

.94
Compensating experiences It assesses the family's experience with regard to their level of control in an adverse context that includes positive control in some challenging situations. 4 .82

Method
For the adaptation and validation process of the measurement instrument, we adopted a theoreticalmethodological framework (14) that comprises both a qualitative and quantitative analysis of items.
With regard to the qualitative analysis, we performed the procedures required for linguistic and conceptual equivalence. After contacting the instrument's authors, we learned that this instrument had never been used for the Portuguese population and were authorized to initiate the scale's validation process.
Linguistic equivalence was first achieved with translation

Results
The participant families had children between three months and 18 years old, with an average of 8 with marked dysfunction.
The Cronbach's alpha value found in this study for the instrument as a whole was .90, exceeding the original study, which found an alpha coefficient of .81 (11) . Figure   3 presents the Cronbach's alpha values by dimension and number of items.
The Cronbach's alpha values suggest good internal consistency in the IFPF's four dimensions (equal to or higher than .60), except for the dimension "Fewer stressors", which presented a low coefficient (.57), but which we considered since it was higher than the one observed in the original study (.53).   3. There have been more positive experiences than problems with work/school in the past three months 2.     can identify and advise the family to mobilize the resources necessary to the management of the adverse situation to which it is subject (16) .
Family resilience is a dynamic process: a family may mobilize resources to cope with a situation or adverse event and, in another situation, may not be able to cope mobilize such resources, which corroborates the opinion of authors who consider that the assessment of family resilience cannot be generalized over time (7) . Hence, we suggest that protective factors be monitored at different points in time and in different circumstances. The times of assessment among families with disabled children could coincide with developmental milestones, which may be delayed or never reached by these children, potentially generating anxiety in the parents.

Final considerations
The IFPF Portuguese version is an instrument that can be used by nurses in the context of primary healthcare to assess protective factors that contribute to family resilience. We suggest that family resilience is addressed at the beginning of the nursing program, when family health is taught, to enable more efficient nursing interventions in this domain.
One of the limitations of IFPF is related with low internal consistency of the "fewer stressors" dimension, a situation also observed by the authors of the original instrument and which may be explained by the fact that there is a temporal limitation (last three months). It is an aspect that should be taken into account when assessing these items in the future.
The IFPF version adapted to Portuguese showed to be a reliable instrument, valid and sensitive to assess protective factors of resilience among families with disabled children and, for this reason, we recommend its use.
In short, we believe this study and the validated instrument contribute to the adherence of professionals to family assessment, which can be accomplished in a brief but comprehensive and multidimensional manner, with emphasis on the resources and strengths of families.