Cultural adaptation and updating of the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire

Objective: to translate and culturally adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire to the Brazilian context and to develop and evaluate a sociodemographic and occupational characterization questionnaire to compose the adapted questionnaire. Method: five stages were conducted to adapt the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire, namely: translation, synthesis of the translations, evaluation by a committee of judges, back translation and pre-test. As for the complementary questionnaire, it was elaborated and evaluated by a committee of judges and a pre-test was carried out. Results: the questionnaires were validated and the pre-test stage was conducted with health workers and students. Conclusion: the final version adapted to the Brazilian context was called Questionário de avaliação de risco e gestão da exposição de trabalhadores e estudantes de saúde no contexto da covid-19 and is available for use, together with the final version of the Sociodemographic and occupational questionnaire: Risk assessment and management of exposure of health care workers and students in the context of covid-19. These questionnaires may assist in mitigating the risks of infection, illness and death of health workers and students due to covid-19.

into seven topics related to the worker's characterization data, contact history and interactions with patients with covid-19, activities performed, adherence to individual and collective protection procedures in the provision of health care, and accidents with biological material. At the end of these topics, the item called "Risk categorization of health workers exposed to covid-19 virus" shows the risk classification of the health workers exposed to the new coronavirus. Subsequently, there is another section entitled "Management of health workers exposed to covid-19 virus applies only to exposure in health care settings" with the objective of instructing the workers about the main actions to be taken regarding exposure to patients with covid-19, based on the prior identification of risk and case management actions to the health managers (14) .

Procedures
The process of cultural adaptation of this questionnaire to the Brazilian context followed the recommendations of the WHO Translation Protocol (14,(17)(18)(19)(20)(21)(22) : 1) translation; 2) synthesis of the translations; 3) evaluation by the Committee of Judges; 4) back translation; 5) pre-test and elaboration of the final version.
In the translation stage, two independent translations into the target language are recommended, made by two different and qualified translators, preferably native speakers. This action aims at the perception of the discrepancies that may reflect a text with more than one With these three versions in hand, the evaluation by the committee of judges was carried out to analyze the idiomatic (analysis of the meaning of idioms), semantic (interpretation of the meaning of words, concepts and expressions), cultural (adaptation of words, concepts and expressions to the cultural reality in which the questionnaire will be used) and conceptual (correspondence of the original concepts to those culturally accepted in the context to be studied) equivalences of the questionnaire items, verifying the need for adaptations (15)(16)22) . The committee of judges was composed of nine health professionals, bilingual, with experience in the subject matter under study and/ or working in services aimed at assisting patients with covid-19 during the pandemic, selected by inviting the groups of health professionals from the social networks.

Data analysis
To analyze the adequacy of both tools (the Risk assessment and management of exposure of health care workers in the context of covid-19 questionnaire and the Rev. Latino-Am. Enfermagem 2021;29:e3490. sociodemographic and occupational questionnaire), the Content Validity Index (CVI) was used, which measures the proportion or percentage of the judges' answers that are in agreement with certain aspects of the questionnaire items (27) . To assess relevance and representativeness, the answers can include the following: 1 = not relevant or not representative; 2 = the item needs major review to be representative; 3 = the item needs minor review to be representative; and 4 = relevant or representative item.
The index score is calculated by adding up the items that received "3" or "4" answers by the evaluators. The items that scored "1" or "2" must be reviewed or deleted. To be considered valid, the CVI of the questionnaire must be greater than 0.78 (27-28) . Thus, items rated 1 or 2 were reviewed or deleted and received no score; and those rated 3 or 4 were considered as valid answers, reviewed (if necessary) and received a score of 1. The valid answers were added up and divided by the total number of nine judges, characterizing the CVI of the items (Formula 1).
The CVI of the questionnaire was calculated from the product of the sum of the items' CVI and the total number of items in the questionnaire (Formula 2) (29) :

Ethical aspects
The study was approved by the Research Ethics with the objective of evaluating the post-contact risk of nurses who provided assistance to patients diagnosed with covid-19 (36) . The questionnaire was applied to a sample of 80 nurses working in hospitals located in the North of the country, and it was identified that 8.8% of the workers had a high risk of failure in the removal and exchange of the PPE; that 6.3% had a high risk of not performing hand hygiene before and after touching patients with covid-19; and that 5% did not follow the recommended guidelines for hand hygiene after touching the patients' surroundings. In addition to that, 3.8% of the participants suffered accidents related to biological material, such as biological fluid splashes (in the eyes) and were classified as at high risk for infection by the covid-19 virus.
In Bangladesh, the WHO questionnaire was used to