Translation and validation of Warmometer, a tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese

Brooke, Marieta Sodré; Nakamura, Mary Uchiyama; Hosomi, Jorge Kioshi; Ribeiro, Meireluci Costa; Sass, Nelson

doi:10.1590/1516-3180.2018.0035160318

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Sao Paulo Medical Journal

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Original Article • Sao Paulo Med. J. 136 (03) • May-Jun 2018 • https://doi.org/10.1590/1516-3180.2018.0035160318 copy

Translation and validation of Warmometer, a tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

BACKGROUND:

Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese.

DESIGN AND SETTING:

Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil.

METHODS:

The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI).

RESULTS:

The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105).

CONCLUSIONS:

Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

KEY WORDS:
Empathy; Physician-patient relations; Survey and questionnaires; Psychometrics

	Probe questions
1	What characteristics and type of behavior demonstrated by your physician is your assessment based on? (see Figure 1, presenting an illustration of the Warmometer)
2	How did you arrive at your answer on the thermometer?
3	How do you perceive the way in which the physician talks to you?
4	What do the gestures of your physician mean to you (e.g. whether your physician shakes your hand to welcome you)?
5	Has your assessment of your physician changed since your first contact with him/her?
6	What do you think about the thermometer as a response format? Would you change anything?
7	Can you please repeat the first question in your own words? What is this question about, in your view?
8	Was the question easy for you to understand? Would you change anything?
9	Please indicate how much warmth your ideal physician would show towards you by placing an ‘‘X’’ directly on the thermometer to the left.
10	What characteristics and type of behavior of an ideal physician is your answer based on?
11	Please imagine a person from your personal environment (e.g. family, friends, neighbors or colleagues) who shows great warmth towards you. Indicate how much warmth this person shows to you by placing an ‘‘X’’ directly on the thermometer to the left.
12	What characteristics and type of behavior is your assessment based on?
13	Please imagine a person from your personal environment (e.g. family, friends, neighbors or colleagues) who shows an average amount of warmth towards you. Indicate how much warmth this person shows you by placing an ‘‘X’’ directly on the thermometer to the left.
14	What characteristics and type of behavior is your assessment based on?
15	Please imagine a person from your personal environment (e.g. family, friends, neighbors or colleagues) who shows coldness towards you. Indicate how much coldness this person shows you by placing an ‘‘X’’ directly on the thermometer to the left.
16	What characteristics and type of behavior is your assessment based on?
17	Do you have any other comments on the issue of human warmth in the patient-provider relationship? Or, is there anything else I should know?

	Mean temperature
	1^st interview^a	2^nd interview^b	3^rd interview^c
Physician warmth	25.5 ± 5.6	25.0 ± 5.9	25.4 ± 5.5
Ideal physician warmth	27.3 ± 3.8	26.4 ± 3.8	25.6 ± 4.5
Person of great warmth	28.1 ± 3.2	25.8 ± 4.1	26.5 ± 3.9
Person of average warmth	18.8 ± 6.6	16.9 ± 6.8	16.8 ± 6.8
Cold person	3.8 ± 5.7	7.9 ± 8.3	6.7 ± 7.2

Warmometer Temperatures	Intraclass correlation			Interclass correlation
Warmometer Temperatures	ICC	95% CI	P-value	ICC	95% CI	P-value
Physician warmth	0.224	-0.589-0.621	0.242	0.952	0.902-0.977	< 0.001
Ideal physician warmth	0.584	0.147-0.797	0.009	0.856	0.705-0.930	< 0.001
Person with great warmth	0.424	-0.180-0.719	0.065	0.908	0.812-0.955	< 0.001
Person of average warmth	-0.136	-1.328-0.445	0.638	0.777	0.543-0.891	< 0.001
Cold person	0.205	-0.629-0.612	0.263	0.727	0.440-0.866	< 0.001

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[1] Address for correspondence: Marieta Sodré Brooke Rua Napoleão de Barros, 875 Vila Clementino - São Paulo (SP) - Brasil CEP 04024-002 Tel. (+55 11) 5081-7279 E-mail: sodremarieta@gmail.com