Cultural adaptation and validation of an instrument on barriers for the use of research results 1

ABSTRACT Objective: to culturally adapt The Barriers to Research Utilization Scale and to analyze the metric validity and reliability properties of its Brazilian Portuguese version. Method: methodological research conducted by means of the cultural adaptation process (translation and back-translation), face and content validity, construct validity (dimensionality and known groups) and reliability analysis (internal consistency and test-retest). The sample consisted of 335 nurses, of whom 43 participated in the retest phase. Results: the validity of the adapted version of the instrument was confirmed. The scale investigates the barriers for the use of the research results in clinical practice. Confirmatory factorial analysis demonstrated that the Brazilian Portuguese version of the instrument is adequately adjusted to the dimensional structure the scale authors originally proposed. Statistically significant differences were observed among the nurses holding a Master's or Doctoral degree, with characteristics favorable to Evidence-Based Practice, and working at an institution with an organizational cultural that targets this approach. The reliability showed a strong correlation (r ranging between 0.77 and 0.84, p<0.001) and the internal consistency was adequate (Cronbach's alpha ranging between 0.77 and 0.82). Conclusion: the Brazilian Portuguese version of The Barriers Scale was valid and reliable in the group studied.


Introduction
The growing demand to improve the quality of health services implies nursing's search for actions to implement Evidence-Based Practice (EBP), aiming to promote the increased quality of nurses' care and professional growth. In addition, the traditionalist and ritualistic practice of the profession is currently inadmissible (1) .
EBP is a problem-solving approach to deliver health care that integrates the best evidence originating in well-designed studies and care data, in combination with the patient's preferences and values and the health professional's expertise (2) .
Hence, the implementation of EBP can offer benefits for the patient, health service and professionals working in the area, including the nurse. This approach increases the patient's access to information on effective treatments and can improve the institution, facilitating decision making consistently and at a lower cost. In addition, through information, it helps the nurse to make decisions, recycling these professionals by means of technologies and enhancing their efficiency (3) .
The use of research results in clinical practice is one of the components of EBP. Despite the increased volume of nursing research in many countries, transferring knowledge to practice remains a challenge.
One of the actions that could minimize the gap between the knowledge produced and its application is the identification of barriers that impede the interdependence between research and practice (4) . consisting of six items, including the lack of readability and clarity of the study's implications for the practice (5) .

The Barriers to Research Utilization
For each scale item, the respondent marks one out of five options on a Likert scale, in which scores 1 to 4 indicate the increase of the perceived barrier, and 5 that the participants does not opine. Thus, higher scores indicate greater barriers for the use of research results in practice. It is highlighted that item 27 in the scale is not scored, as it was not included in any of the factors. Nevertheless, the authors of the original instrument maintained this item based on the experts' assessments (5) .
The use of the scale can permit the identification of area lacking intervention, enhance the usage process of research results in practice, guide the development of educative programs, support dialogues among clinicians, researchers and administrators with a view to reducing gaps between research and its application (5) .
Due to the lack of research in the Brazilian literature on a measure to investigate the barriers for the use of research results in clinical practice, this study was intended to develop the cultural adaptation of the instrument The Barriers to Research Utilization Scale, as well as to analyze the metric properties of validity and reliability of its version for Brazilian Portuguese.

Method
A methodological research was started after getting agreement from the main author of the instrument The Barriers to Research Utilization Scale.
The Barriers Scale was submitted to the cultural adaptation process proposed by experts on the procedure (21) , changing the order of the back-translation phase, which took place after the expert committee phase (22) . This change is justified, as it maintains the objective of the backtranslation, which is to observe possible errors of meaning between the adapted version and the original version. That would not be the case if the adapted version were further modified by the expert committee (22) . documented need to change the"; from "finds" to "has access to"). The changes the experts suggested resulted in the Brazilian Portuguese version of the instrument The Barriers Scale, which two independent translators translated to English: during a consensus meeting, the single version was formulated, which was then forwarded to the main author of the original version for evaluation, who answered that he had no contributions to add. For the sample size, the literature recommendations for confirmatory factor analysis were considered, that is, superior to at least 200 participants (23) and appropriate balancing of the sample between both hospital. Hence, it was determined that at least 300 nurses should participate. All nurses at hospital A who complied with the criteria were invited to participate in the study.
At hospital B, a draw was held but, due to the low adherence, we decided to invite everyone until reaching In the data analysis, descriptive analyses were developed of the instrument items, identifying central trend and dispersion measures. The dimensional construct validity was assessed by means of the confirmatory factorial analysis, and the construct validity by means of known groups was investigated using Student's t-test, predicting higher scores for the group of nurses with characteristics unfavorable to EBP and working at the hospital with an organizational culture that does not target that approach.
Cohen's d was also adopted to classify the magnitude of the difference between the mean scores of the groups or is insufficient time on the job to implement new ideas (24.6%). In the analysis of the average among the factors of the scale, Factor 2 also presented the highest mean score, and Factor 3 (research characteristics) the lowest.
In Figure 1, the results of the confirmatory factor analysis are presented to determine the dimensional construct validity of The Barriers Scale -Brazilian Portuguese version.   To understand the data presented in Table 2  though, which made discrimination power impossible for the qualification variable, which distinguished the participants' education in the lato sensu and stricto sensu modalities.
In Table 2

Discussion
The methodological research results on The Barriers Scale were similar to this study concerning the female sex and the age (5,7,(11)(12)(13)(14)(15)(16) . The habit of reading scientific articles and research development characterized most of the nurses in this study. Differently from a study involving Spanish nurses, whose results evidenced that the professionals possessed less than 40 hours of nonformal preparation for research (455; 69.15%), and had done their most recent scientific reading between the past month and more than one year earlier (15) .
Based on the analysis of the methodological studies identified in the literature, it can be affirmed that the main barriers the nurses reported were similar to the barriers reported in this study, in that they belonged to Factor 2 (organizational characteristics), more specifically items 6 and 13 (6)(7)(8)(10)(11)(12)(13)15) .
In a study developed in Turkey, involving 300 nurses from four hospitals, the results indicated the goodness of   (14) .
It is highlighted that, in the methodological studies, in which the authors developed exploratory factor analysis, the results evidenced factorial structures that differed from the original model (7)(8)(9)11,13) . p=0.001) (16) . No studies were identified in the literature whose authors assessed the reliability of the instrument using the test-retest phases, as executed in this study and in the original version of the scale (5) . In this research, the reliability of the instrument was assessed, using the analysis of the Intraclass Correlation Coefficient and of Pearson's Correlation Coefficient. The coefficients of the latter (between 0.77 and 0.84) were similar to the original study (between 0.68 and 0.83) (5) , indicating the temporal stability of the scale between two assessments.

Conclusions
The Barriers Scale -Brazilian Portuguese version is a valid and reliable tool that is easy to apply and can be used at health services.
The assessment of its use in practice depends on the development of new studies in different contexts.
Its application permits diagnosing the main barriers for nurses to use research results. The scale is a management tool that can further the understanding of the needs to promote the implementation of EBP, improving the quality of care, reducing health institutions' operating costs and benefiting nurses' evidence-based decision making process.