Translation into Portuguese and content validation of the Social Rhythm Metric-17 (SRM-17)

Abstracts

OBJETIVOS: Traduzir para o português a Social Rhythm Metric-17 (SRM-17), escala que afere ritmo social, e realizar validação de conteúdo da versão produzida. MÉTODO: Foi utilizada uma adaptação do método para validação de instrumentos que compreendeu as seguintes etapas: preparação, tradução, conciliação, retrotradução, revisão da retrotradução, avaliação de clareza, revisão de resultados da avaliação de clareza e finalização, prova de leitura e relatório final. RESULTADOS: A versão final brasileira manteve uma equivalência de itens com relação à primeira versão em inglês do instrumento original, incorporando melhorias. A transposição do instrumento alternativo criado pelo grupo de Cronobiologia Humana do Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre (RS), para a SRM-17 não mostrou discrepâncias significativas e revelou que, embora essa escala seja um instrumento genérico, é sensível às diferenças individuais quanto à aferição de ritmo social. A versão avaliada demonstrou um grau satisfatório de clareza e equivalência semântica. CONCLUSÃO: Este trabalho apresenta uma versão adaptada à realidade brasileira de um instrumento específico para aferir ritmo social. O processo de adaptação transcultural deve efetivar-se com estudos de validação do instrumento final em uma amostra maior da população, nos quais também poderão ser avaliadas as equivalências operacional, de medida e funcional.

Social Rhythm Metric; zeitgeber; cronobiologia; ritmo biológico; transtorno mental

Translation into Portuguese and content validation of the Social Rhythm Metric-17 (SRM-17)

Regina Lopes Schimitt^I; Maria Paz Loayza Hidalgo^II

^ISpecialist, Clinical Psychology. Psychologist, Master's degree student, Medical Sciences, School of Medicine (FAMED), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil

^IIProfessor, Department of Psychiatry and Legal Medicine, FAMED, UFRGS, Porto Alegre, RS, Brazil. Chronobiology Laboratory, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil

Correspondence

ABSTRACT

OBJECTIVES: To translate the Social Rhythm Metric-17 (SRM-17), a scale that assesses social rhythm, into Portuguese and to validate the content of the Portuguese version.

METHODS: An adaptation of the method for validation of instruments was used and it included the following stages: preparation, translation, reconciliation, back translation, revision of back translation, comprehension assessment, review of the results of comprehension assessment and completion, proofreading, and final report.

RESULTS: The final Brazilian version has the same number of items as the first English version of the original instrument, and included some enhancements. The adaptation of the alternative instrument developed by the Human Chronobiology Group of Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil, to the SRM-17 did not show any significant discrepancies and revealed that, in spite of being a generic instrument, it is sensitive to the individual differences regarding the assessment of social rhythm. The Portuguese version showed a satisfactory level of understanding and semantic equivalence.

CONCLUSION: A version of an instrument to assess social rhythm adapted to the Brazilian reality is presented in this study. The cross-cultural adaptation process must be completed by validation studies of the final instrument in a larger population sample, which will also be able to evaluate the equivalences related to operation, measures, and functionality.

Keywords: Social rhythm metric, social Zeitgeber theory, chronobiology, biologic rhythm, mental disorder.

INTRODUCTION

The concept of social rhythm addressed in the present study is part of the theoretical field of chronobiology, which is the study of biological rhythms, and is closely related to behavioral psychology, since it is described as the rhythm defined by the individuals' social interactions or determined by social conventions.

Within the scope of chronobiology, the external synchronizing agents of biological rhythms are called zeitgebers. Thus, social rhythm is determined by social zeitgebers. The importance of studying such rhythm, which is not a biological rhythm even though it has an influence on the synchronization of biological rhythms, is related to the fact that it may play a role in the etiology of mood disorders.¹

The social rhythm metric was designed in 1990 by researchers of the University of Pittsburg,², Pittsburg, USA, with the purpose of studying the association between social rhythm disruption and onset of mood disorder episodes. Reestablishing the social rhythm of depressed people helps with their recovery, but the role played by social rhythm disruption in the etiology of mood disorders has not been thoroughly studied yet.

The social rhythm metric is a self-administered form consisting of a list of 15 fixed generic activities and two optional activities. The respondent must record at the end of the day, during a certain period of time, if these activities were performed or not, informing the time the activities were carried out and the quantity and quality of the intervening social interactions taking place during the activities.

The instrument investigates the most important indexes, the "hit" and the ALI (Activity Level Index), based on an algorithm.^3-5 If an activity is practiced more than three times a week at the same time of the day or within a time span ranging from 45 minutes before and 45 minutes after the usual time, it is considered a "hit." The amount of "hits" shows the regularity in the individual's life and it is the most important index of the instrument. The regularity score does not have a cutoff point, but it ranges from a minimum of 0 (no regularity) to a maximum score that depends on the number of days measured. For instance, if the period measured consists of 7 days, the maximum score is 7; if the period consists of 9 days, the maximum score is 9; and so on. The instrument was designed to assess the regularity during at least 1 week.

The ALI shows the volume of different activities performed during the period, being calculated by simply adding up every activity carried out on each day. According to Monk et al.,⁶ a score lower than 59 makes it impossible to assess regularity. Therefore, the ALI can range from 59 (little activity) to a maximum score that depends on the period measured. For instance, if the period measured includes 7 days and the individual performs all the 17 activities contained in the instrument, then the maximum score will be 119 (17 x 7).

The objective of the present study is to describe the process of translation and content validation of the Portuguese version of the Social Rhythm Metric-17 (SRM-17).

METHOD

Even though there is a large number of studies on this topic, consensus has not been reached on the translation process of instruments such as scales and questionnaires used in health research.^7-20 The equivalence model designed by Herdman et al.¹⁰ was used as a guideline with the purpose of obtaining an instrument equivalent to the original version in terms of concept, items, and semantics. In the present study, we used an adaptation of the method suggested by Wild et al.⁸ for validation of instruments, which included the following stages: 1) preparation; 2) translation; 3) reconciliation; 4) back translation; 5) revision of back translation; 6) comprehension assessment; 7) review of the results of comprehension assessment and completion; 8) proofreading; and 9) final report.

Preparation

During this stage, which included understanding the chronobiological concept of social rhythm in the Brazilian culture, establishing a relationship with the author of the instrument, and selecting the team members, we also tried to achieve conceptual equivalence. Such equivalence is not achieved only through the translation of the instrument, and it is important to investigate if the construct being analyzed has the same meaning in both cultures.

After receiving the author's authorization to translate the instrument and after establishing a relationship with him in order to clarify doubts, we tried to understand the chronobiological concept of social rhythm in the Brazilian culture by searching the literature about this concept in Portuguese and looking for Brazilian versions of psychometric instruments that measure the same construct. Such survey revealed that, in spite of being observed as a phenomenon, the concept had not received enough attention as a chronobiological variable. On the other hand, according to the anthropological and sociological points of view, it has emerged as an established concept.

Such interface with the social sciences showed that it was impossible to make a literal translation of the instrument, since defining social zeitgebers, which is one of the functions of the instrument, means to indicate how many and which are the cultural events that are able to interfere in the rhythm of biological events, which presents differences related to the peculiar characteristics of the culture concerned.

The absence of any psychometric instruments in Portuguese for the assessment of social rhythm led to the design of an alternative instrument aimed at measuring this variable with the purpose of defining categories of activities and, later, analyzing the equivalence of concepts.

This experimental instrument was called Temporal Map of Activities. The idea was discussed during the course of chronobiology offered by the Graduate Program in Medical Sciences of the School of Medicine of Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil. Ten members of the group of Human Chronobiology of HCPA, Porto Alegre, RS, Brazil, took this course. During 9 days, these people completed a daily spreadsheet of activities designed using Excel and including all the activities carried out during the day and their respective times. They also informed, using a pre-established sign, if there was social interaction during these activities. The results obtained by means of this spreadsheet were included in the first version of the SRM-17 to define which categories indicated in the instrument designed by the team were not included in the SRM-17 and which were the consequences of such ommissions.

Next, a discussion group was created including health professionals, antropologists and linguists, as well as students of health sciences.

Translation

For the translation process, we selected two English versions of the instrument, one was older and seemed to be more adequate considering the Brazilian reality, and the other was the most recent version designed by the author (Appendixes 1 and 2).³ For each one of these versions, two translations into Portuguese were made: one of them was carried out by a translator who was informed about the underlying concepts of the instrument, and the other translation was made by a professional translator defined as "naive", that is, not informed about the concepts and who was not a health professional. According to Beaton et al.,¹¹ it is important that one of the translators is "naive" so that he/she is less influenced by academic objectives and can offer a translation that is more closely related to the language actually used by the population. A third translation was made by a member of the team in charge of the project.

Reconciliation

The team reconciled these translations in order to achieve a single version for the back translation.

Back translation

The process of back translation into English was carried out by a professional translator who was also an English native speaker. This translator was not familiar with the original version of the instrument and was not informed about the concepts. Such process was useful to indicate the discrepancies between the original versions and the translations.

Revision of back translation

The discrepancies identified were discussed with the author of the instrument. We could not reconciliate our version with other versions in other languages because there are not other versions of the instrument according to the author.

Comprehension assessment and content validation

During this stage, we tried to achieve equivalence of item and semantic equivalence. Equivalence of item is related to the level of adequacy, relevance and acceptability of the items selected considering both cultures, the source culture (culture of the language used to write the original version of the instrument) and the target culture (the culture of the language to which the instrument is being adapted). Semantic equivalence is related to the preservation of the meaning in the translation to the other language. According to Herdman et al.,^10,16 there are seven types of meaning: 1) referential meaning: related to the ideas or objects to which a word or a set of words refer; 2) connotative meaning: related to the emotional response evoked by a word; 3) stylistic or social meaning: related to how much a word is appropriate in a specific context conditioned by geography, time, style, level of formality, sex, etc and inappropriate in another context; 4) affective meaning: related to the way words may reflect feelings and points of view; 5) reflected meaning: related to the possible interpretations of a word (how something may sound funny or offensive in different contexts); 6) collocative meaning: related to the way in which a word extracted from a foreign context may gain strength and extra meaning; and finally, 7) thematic meaning: related to the way in which a certain meaning is provided to a message by the manner the words are ordered in the sentence.

The validation of content is not statistically defined; instead, it is based on the analysis of representativeness of the items regarding the concepts and the relevance of objectives to be measured.²¹

The older version of the instrument, which was chosen by the team because it seemed more adequate for the Brazilian reality, was assessed by 25 researchers of chronobiology and five assessors of psychometry. These 30 professionals assessed the level of comprehension of each one of the 15 sentences of the version of the social rhythm metric translated and adapted to Brazilian Portuguese using a visual analogue scale (VAS) of 10 cm.^22,23 The instructions provided were: "Describe how comprehensible the question is by drawing a line vertically to the line below the question. Remember that 0 means 'incomprehensible' and 10 means 'absolutely clear'." We defined as indicator of lack of comprehension those values below the 25th percentile. The global comprehension of the instrument was defined as the arithmetic mean of the 15 objective questions included in the instrument (Table 1).

Review of the results of comprehension assessment and completion, proofreading and final report

Participants were also invited to take note of critical comments and suggestions that were taken into consideration before producing the definitive version of the instrument. In spite of being similar to the first English version of the instrument, the definitive version (Appendix 3) included some improvement from the most recent version. Finally, the instrument was proofread for correction of possible mistakes that had not been detected at some point of the process.

RESULTS AND DISCUSSION

In the present study we found that, in terms of conceptual equivalence, the meaning of social rhythm in the Brazilian population is equivalent to the comprehension of this concept in the culture of the original instrument, since the transposition of the alternative instrument designed by the group of Human Chronobiology of HCPA for the SRM-17 did not show significant discrepancies and revealed that, even though this scale is a generic instrument, it is sensitive to individual differences regarding the measurement of social rhythm. The discussion among health professionals and students engaged in the assessment of the instrument suggested the need of changing some items with the purpose of achieving conceptual equivalence.

With regard to the equivalence of item, the final Brazilian version preserved equivalence regarding the first English version of the original instrument, adding some improvements from the second version, as shown in Appendixes 1, 2 and 3.

Table 1 shows that the version assessed demonstrated a satisfactory level of comprehension and semantic equivalence. However, the level of dispersion revealed the need of better adapting the instrument to the comprehension of the Brazilian population.

The changes carried out based on the assessment procedures of conceptual equivalence, equivalence of items and semantic equivalence are listed below:

1. Verbs were conjugated in the past perfect tense because the instrument will be completed at the end of the day, when the actions will have been already performed. This helps the respondents to organize the events in terms of time.

2. Verbs were used in all sentences in order to preserve the coherence among the items.

3. Item 1, "saí da cama," was used according to both versions.

4. Item 2 was used according to the first version. We decided to use the sentence "falei pela primeira vez com outra pessoa (pessoalmente ou por telefone)" instead of "primeiro contato (first contact)" or " primeira communicação (first communication)."

5. Item 3 was used according to the first version. We decided to use the sentence "ouvi rádio ou assisti TV (em casa, no carro, no trabalho, ou em outro lugar)" as the possible translation for "first listen to TV or radio (in home, car, at work, wherever)" in order to make the actions related to each object more specific.

6. Item 4, "tomei café da manhã," was used according to both versions. The sentence "tomei café da manhã" replaces the phrases "have morning beverage" and "have breakfast" because it was considered more adequate to the Brazilian reality;

7. Item 5, "saí de casa pela primeira vez," was used according to the second version.

8. Item 6, "fiz exercício físico (caminhada, ginástica, dança, etc)," was used according to the first version. However, we added examples of activities according to the suggestion made by some people who assessed the comprehension of the instrument.

9. Item 7, "comecei o trabalho (ou a escola, o trabalho de casa, trabalho voluntário, cuidados com crianças ou outros membros da família, etc)": was the translation of the phrase "start work (or school, housework, volunteer activities, etc)" since we decided to use "comecei o trabalho" instead of "comecei a trabalhar" because it is closer to the original and does not hinder the comprehension. "Trabalho voluntário" was used instead of "atividade voluntária" because it is a term that specifically defines non-paid work instead of any type of volunteer activity.

10. Item 8, "almocei," was kept in this position according to the first version.

11. Item 9, "tirei uma soneca à tarde," was used according to the second version, but in the same position as in the first version.

12. In item 10, the sentence "comi ou bebi algo à tarde (marcar apenas a primeira vez)" was the translation for "have a snack" and "have an alcoholic drink," which were used in the first version, or "have an evening snack/drink," which was used in the second version. We decided to ask the respondents to record only the first time it happened because this is an activity that may take place many times during the day, and this was a problem pointed out by the assessors of the instrument.

13. Item 11, "cheguei em casa pela última vez," was used according to item 16 in the second version.

14. Item 12, "jantei," was used according to items 12 and 9 in the first and second version, respectively.

15. Item 13 was used according to the first version. We decided to use the sentence "fiz uma atividade de lazer (assisti TV, fui ao cinema, li, etc)" as a more adequate alternative for "engage in evening leisure activities (watch TV, go to the movies, read, etc)."

16. Item 14, "desliguei a TV ou o rádio pela última vez," was used according to the first version.

17. Items 15 and 16 were used according to the second version.

18. Item 17: We decided to use "foi para cama," instead of "deitou-se," because we believe that the first sentence describes the end of the day in a more appropriate manner.

CONCLUSIONS

In the present study, the content of the instrument was validated by highly qualified professionals of the fields of chronobiology and psychometry. This study presents a version of a specific instrument to measure the social rhythm adapted to the Brazilian reality, which is equivalent to the original version with regard to concept, items, and semantics. The lack of consensus on the transcultural adaptation of psychometric instruments makes it difficult to standardize the process. In order to investigate this matter, we decided to base our study mainly on the approaches suggested by Wild et al.⁸ and Herdman et al.¹⁰ due to the wide scope of their criteria. The transcultural adaptation process must become effective by means of further studies validating the final instrument using a larger population sample which also enable the assessment of operational, measurement and functional equivalences.

ACKNOWLEDGEMENTS

We would like to thank Dr. Thimoty Monk from the University of Pittsburg. We also would like to thank Professor Menna-Barreto of the group of Human Chronobiology of Universidade de São Paulo (USP), São Paulo (SP).

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Publication Dates

• Publication in this collection
  18 Mar 2010
• Date of issue
  2009