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      Cross-cultural adaptation and psychometric properties of the Brazilian-Portuguese version of the VSP-A (Vécu et Santé Perçue de l'Adolescent), a health-related quality of life (HRQoL) instrument for adolescents, in a healthy Brazilian population

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          Abstract

          Background

          Health-related quality of life (HRQoL) assessment, encompassing the adolescents' perceptions of their mental, physical, and social health and well-being is increasingly considered an important outcome to be used to identify population health needs and to provide targeted medical care. Although validated instruments are essential for accurately assessing HRQoL outcomes, there are few cross-culturally adapted tools for use in Brazil, and none designed exclusively for use among adolescents. The Vécu et Santé Perçue de l'Adolescent (VSP-A) is a generic, multidimensional self-reported instrument originally developed and validated in France that evaluates HRQoL of ill and healthy adolescents.

          Purpose

          To cross-culturally adapt and validate the Brazilian-Portuguese version of the VSP-A, a generic HRQoL measure for adolescents originally developed in France.

          Methods

          The VSP-A was translated following a well-validated forward-backward process leading to the Brazilian version. The psychometric evaluation was conducted in a sample of 446 adolescents (14-18 years) attending 2 public high schools of São Gonçalo City. The adolescents self-reported the Brazilian VSP-A, the validated Psychosomatic Symptom Checklist and socio-demographic information. A retest evaluation was carried out on a sub-sample (n = 195) at a two-week interval.

          The internal construct validity was assessed through confirmatory factor analysis (CFA), multi-trait scaling analyses, Rasch analysis evaluating unidimensionality of each scale and Cronbach's alpha coefficients. The reproducibility was evaluated by intra-class correlation coefficients (ICC). Zumbo's ordinal logistic regression analysis was used to detect differential item functioning (DIF) between the Brazilian and the French items. External construct validity was investigated testing expected differences between groups using one-way analysis of variance (ANOVA), Mann-Whitney tests and the univariate general regression linear model.

          Results

          CFA showed an acceptable fit (RMSEA=0.05; CFI=0.93); 94% of scaling success was found for item-internal consistency and 98% for item discriminant validity. The items showed good fit to the Rasch model except 3 items with an INFIT at the upper threshold. Cronbach's Alpha ranged from 0.60 to 0.85. Test-retest reliability was moderate to good (ICC=0.55-0.82). DIF was evidenced in 4 out of 36 items. Expected patterns of differences were confirmed with significantly lower physical, psychological well being and vitality reported by symptomatic adolescents.

          Conclusions

          Although DIF in few items and responsiveness must be further explored, the Brazilian version of VSP-A demonstrated an acceptable validity and reliability in adolescents attending school and might serve as a starting point for more specific clinical investigations.

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          Most cited references37

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          The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups.

          The widespread use of standardized health surveys is predicated on the largely untested assumption that scales constructed from those surveys will satisfy minimum psychometric requirements across diverse population groups. Data from the Medical Outcomes Study (MOS) were used to evaluate data completeness and quality, test scaling assumptions, and estimate internal-consistency reliability for the eight scales constructed from the MOS SF-36 Health Survey. Analyses were conducted among 3,445 patients and were replicated across 24 subgroups differing in sociodemographic characteristics, diagnosis, and disease severity. For each scale, item-completion rates were high across all groups (88% to 95%), but tended to be somewhat lower among the elderly, those with less than a high school education, and those in poverty. On average, surveys were complete enough to compute scales scores for more than 96% of the sample. Across patient groups, all scales passed tests for item-internal consistency (97% passed) and item-discriminant validity (92% passed). Reliability coefficients ranged from a low of 0.65 to a high of 0.94 across scales (median = 0.85) and varied somewhat across patient subgroups. Floor effects were negligible except for the two role disability scales. Noteworthy ceiling effects were observed for both role disability scales and the social functioning scale. These findings support the use of the SF-36 survey across the diverse populations studied and identify population groups in which use of standardized health status measures may or may not be problematic.
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            A model of equivalence in the cultural adaptation of HRQoL instruments: the universalist approach.

            The health-related quality of life (HRQoL) literature presents a confused picture of what 'equivalence' in the cross-cultural use of HRQoL questionnaires means and how it can be assessed. Much of this confusion can be attributed to the 'absolutist' approach to the cross-cultural adaptation of HRQoL questionnaires. The purpose of this paper is to provide a model of equivalence from a universalist perspective and to link this to the translation and adaptation of HRQoL questionnaires. The model evolved from reviews of the HRQoL and other literatures, interviews and discussions with researchers working in HRQoL and related areas and practical experience in the adaptation and development of HRQoL instruments. The model incorporates six key types of equivalence. For each type of equivalence the paper provides a definition, proposes various strategies for examining whether and how types of equivalence can be achieved, illustrates the relationships between them and suggests the order in which they should be tested. The principal conclusions are: (1) that a universalist approach to the cross-cultural adaptation of HRQoL instruments requires that six types of equivalence be taken into account; (2) that these are sufficient to describe and explain the nature of the cross-cultural adaptation process; (3) that this approach requires careful qualitative research in target cultures, particularly in the assessment of conceptual equivalence; and (4) that this qualitative work will provide information which will be fundamental in deciding whether to adapt an existing instrument and which instrument to adapt. It should also result in a more sensitive adaptation of existing instruments and provide valuable information for interpreting the results obtained using HRQoL instruments in the target culture.
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              Body image dissatisfaction: gender differences in eating attitudes, self-esteem, and reasons for exercise.

              Two hundred and thirty-five adolescents completed a questionnaire on the subject of eating attitudes, self-esteem, reasons for exercise, and their ideal versus current body size and shape. As predicted, boys were as likely to want to be heavier as lighter, whereas very few girls desired to be heavier. Only girls associated body dissatisfaction with the concept of self-esteem. Male self-esteem was not affected by body dissatisfaction. Specific reasons for exercise were found to correlate with low self-esteem and disordered eating, regardless of sex. The results are discussed in relation to burgeoning published research in this area.
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                Author and article information

                Journal
                BMC Pediatr
                BMC Pediatrics
                BioMed Central
                1471-2431
                2011
                27 January 2011
                : 11
                : 8
                Affiliations
                [1 ]Service de Santé Publique - EA3279, Faculté de Médecine, Université de La Méditerranée, Marseille, France
                [2 ]Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
                [3 ]Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
                Article
                1471-2431-11-8
                10.1186/1471-2431-11-8
                3042386
                21272317
                d1fb9344-2045-4df1-bcca-c616d96f33d8
                Copyright ©2011 Aires et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 26 April 2010
                : 27 January 2011
                Categories
                Research Article

                Pediatrics
                Pediatrics

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