Equivalência semântica da versão brasileira do instrumento Patient Satisfaction Questionnaire

Abstract

The evaluation of patient satisfaction with healthcare services has historical roots in social movements, associated with interests in marketing, economics, psychology, sociology, and health services organization. Over the years, patient satisfaction research has become increasingly widespread. There is interest in the evaluation of healthcare quality, efficacy, patient adherence to treatment, and, recently, as an outcome measure in clinical trials. In Orthodontics, objective criteria have been used extensively, and efforts to improve the evaluation of the patient's perspective are warranted. Adolescence is marked by different emotions and personal changes, with adolescents facing health and behavioral challenges that require attention from professionals and managers. Malocclusion stands out as one oral health condition relevant to adolescents. The Patient Satisfaction Questionnaire (PSQ) is a condition- specific self-reported instrument that assesses the satisfaction of adolescent patients with orthodontic treatment. At first, a 38-item instrument initially developed in the United States was subsequently adapted in the Netherlands when 20 items were added. As the instrument was developed in another language and culture, before its use in Brazil, a previous process of cross-cultural adaptation is necessary to obtain a valid and reliable instrument for this specific culture. According to a universalist approach, six steps must be tested in the evaluation of equivalence: semantic, conceptual, operational, item, measurement, and functional. Semantic equivalence is one of the steps in this process and evaluates the transfer of meaning between languages, seeking to achieve a similar effect in populations from different origins. The present study aimed to translate the PSQ into Brazilian Portuguese and cross-culturally adapt it for use in Brazil, assessing the semantic, conceptual, operational, and item equivalence between the original version of the instrument and the Brazilian version (B-PSQ). The PSQ has 58 items, distributed in 6 dimensions: doctor-patient relationship, situational aspects of the clinic, dentofacial improvement, psychosocial improvement, dental function, and a residual category. The following methods was used: 1) two independent translations into Brazilian Portuguese were carried out by two translators, both native in Brazilian Portuguese and fluent in English; 2) draft of the first summarized version in Portuguese by a committee of experts; 3) two independent back-translations into English by two translators, both native in English and fluent in Portuguese; 4) review by the expert committee; 5) draft of a summarized version of the back-translations by the committee; 6) draft of the second summarized version in Portuguese by the committee of experts; 7) pre-test of the instrument, carried out in two stages, including a cross-sectional study and a subsequent qualitative stage, using individual semi-structured interviews with 10 adolescents; 8) review and final version of the B-PSQ. Semantic, conceptual, operational, and item equivalence between the original version and the B-PSQ were achieved through careful and rigorous methods, with effective translation and expert evaluation, incorporating the views of the target population.