Adaptação transcultural e avaliação das propriedades psicométricas da versão brasileira do pediatric rating of chronic illness self-efficacy (PRCISE-BR) para crianças e adolescentes com condições respiratórias crônicas

Abstract

Introduction: Self-efficacy is an important concept associated with positive health outcomes in pediatric chronic respiratory conditions. However, to date, there is no validated generic instrument for the Brazilian population to estimate self-efficacy in various chronic respiratory conditions in childhood and adolescence. Objective: To cross-culturally adapt and evaluate the psychometric properties of the Brazilian version of the Pediatric Rating of Chronic Illness SelfEfficacy (PRCISE-Br) for children and adolescents with chronic respiratory conditions. Methods: Exploratory methodological study approved by the Research Ethics Committee of the Health Sciences Faculty of Trairi (FACISA) at the Federal University of Rio Grande do Norte (UFRN), under opinion number 6,061,966. The cross-cultural adaptation protocol involved 6 stages: translation, synthesis of translations, back-translation, expert committee, pretest, and submission of documents to the original author. In-depth interviews were conducted during the pre-test to help assess the level of understanding of the target population. Psychometric properties were assessed in a sample of children and adolescents of both sexes, aged 7 to 18 years, with a clinical diagnosis of asthma, cystic fibrosis, or other isolated chronic respiratory conditions. Psychometric tests were used to assess content validity, construct validity (structural, convergent, divergent, and discriminant validity), reliability (internal consistency and test-retest reliability), and interpretability (ceiling and floor effects). Results: The cross-cultural adaptation was conducted according to guidelines, involving the adaptation of items into statements instead of questions and the inclusion of filling instructions to facilitate understanding among the target population. The pre-test was carried out with a sample of 30 participants, aged 12.33 ± 2.87 years, diagnosed clinically with asthma (50.00%) and cystic fibrosis (50.00%). Among these individuals, 10 took part in the in-depth interviews. All items of the PRCISE-Br showed adequate comprehension and satisfactory content validity index (CVI ≥ 0.78). The sample in phase 2 consisted of 36 individuals, aged 11.00 [9.00 – 14.75] years, clinically diagnosed with cystic fibrosis (66.67%) and asthma (33.33%). In the exploratory factor analysis, the structure of PRCISE-Br was obtained by determining 1 fixed factor that explained 23.58% of the total variance. Fit indices achieved in the confirmatory factor analysis through SPSS Amos indicated that the model was not entirely adequate. Convergent validity was confirmed through moderate positive correlations with the Escala de Autoeficácia Geral Percebida (EAGP; r = 0.486; p = 0.003) and the Pediatric Quality of Life Inventory™ (PedsQL™ 4.0; r = 0.604; p < 0.001). Divergent validity could not be ensured due to the lack of correlation with the number of hospitalizations and emergency visits in the last 12 months (p > 0.05). PRCISE-Br did not correlate with age at diagnosis, confirming its discriminant validity. Reliability was adequate, with a Cronbach's alpha coefficient of 0.71 and an intraclass correlation coefficient of 0.613 (95% CI = -0.036 – 0.855; p = 0.029). Ceiling effect was observed in 41.67% of the evaluated sample, and no floor effect was found. Conclusion: The PRCISE-Br is cross-culturally adapted and is semantically equivalent to the original version. The psychometric properties demonstrate that the instrument can provide reliable and valid measures for children and adolescents with chronic respiratory conditions. Further studies with larger samples are needed to ensure the reliability of the psychometric properties and confirm the dimensionality of the instrument.