Portuguese translation, cultural adaptation, and validation of the Person-Centred Practice Inventory - Staff (PCPI-S)

Ventura, Filipa; Costa, Paulo; Chaplin, John; Domingues, Inês; Ferreira, Ricardo Jorge de Oliveira; McCormack, Brendan; Parreira, Pedro; Sousa, Liliana B.

doi:10.1590/1413-812320232811.17072022

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FREE THEMES • Ciênc. saúde coletiva 28 (11) • Nov 2023 • https://doi.org/10.1590/1413-812320232811.17072022 copy

Portuguese translation, cultural adaptation, and validation of the Person-Centred Practice Inventory - Staff (PCPI-S)

Tradução, adaptação cultural e validação do Inventário da Prática Centrada na Pessoa, profissionais de saúde (PCPI-S)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Aiming to translate, culturally adapt, and psychometrically evaluate the Person-centred Practice Inventory - Staff (PCPI-S) for Portuguese healthcare professionals, this methodological study was conducted sequentially in two phases. Phase I followed the 10-steps recommendations from the ISPOR taskforce for translation and cultural adaptation of patient reported outcome measures. Phase II comprised a quantitative cross-sectional virtual survey of the translated PCPI-S with healthcare professionals, who were reached through snowball sampling from both primary and specialized care settings. The psychometric properties of the PCPI-S were determined by assessing reliability and construct validity. A sample of 304 healthcare professionals participated in Phase II. Ceiling effects were found. The overall internal consistency was excellent (> 0.9). The confirmatory factor analysis showed a good model fit after minor modifications, revealing construct validity, and supporting the theoretical framework. In conclusion, the three-factorial model of PCPI-S adjusted to the studied sample is a valid and reliable instrument to assess the perceptions of healthcare professionals on person-centred practice in various Portuguese clinical contexts. Considering the ceiling effects, the effect of social desirability should be explored.

Key words:
Patient-centered care; Psychometrics; Health personnel; Portugal

ISPOR recommendations	Procedures in the translation and cultural adaptation of the PCPI-S to European Portuguese.
1. Preparation	. Permission to use the PCPI-S in the Portuguese context was requested and received by the authors of the original version. . The concepts underpinning the instrument and reflected in the PcPF were translated to European Portuguese and discussed for consensus. . Definition of roles in the research process: project manager, key in-country consultant, in-country consultants, instrument developer, forward translators and back translator.
2. Forward translation	. Translation from English to European Portuguese by two independent translators.
3. Reconciliation	. Comparison and merging of the two forward translations into a single forward translation. . Consensus was reached through discussion with the key in-country consultant, in-country consultants and project manager.
4. Back translation	. Translation of the European Portuguese language version back into the original English by one native English speaker.
5. Back translation review	. Comparison of the back-translated versions of the instrument with the original to highlight and investigate discrepancies. . Consensus was reached through discussion with the key in-country consultant, in-country consultants, and project manager.
6. Harmonization	. Comparison of back translations with multiple language versions. . Consensus was reached through discussion between the key in-country consultant and the in-country consultants.
7. Cognitive debriefing	. Testing the instrument with healthcare professionals from both primary and specialized healthcare settings, reached by email through convenience sampling in a one-hour virtual interview with a ratio of 5:1.
8. Review of cognitive debriefing results	. Comparison of the respondents’ interpretation of the translation with the original version to highlight and amend discrepancies. . Consensus was reached through discussion between the key in-country consultant, the in-country consultants and project manager.
9. Proofreading	. Review to highlight and correct typographic, grammatical, or other errors.
10. Final report	. Report from phase I.

Culturally adapted version (Portuguese version)	Culturally adapted version (English version)	Original wording	Item
Na minha prática	In my practice	When I provide care (…)	2
Na minha prática	In my practice	I deliver care (…)	59
Contributo de todos os membros da equipa para o plano terapêutico	Contribution of all team members to the therapeutic plan	(…) contributions to care.	21
Tarefa imediata	Immediate task	(…) immediate physical task	2
a minha forma de comunicar	the way I communicate	Communication techniques	6
Diversidade de competências	Skill mix	(…) diversity of competencies (…)	20

Domains Domínios	Constructs and items Construtos e itens	Mean (SD)	Item-scale correlation	Standard error
Prerequisites Pre-requisitos (α = 0.89)	Professionally competent (α = 0.56)
	Competências profissionais	4,37 (.48)		,027
	1. I have the necessary skills to negotiate care options.
	Tenho as competências necessárias para negociar opções de cuidados.	4.14 (.67)	.451**	,038
	2. In my practice, I am attentive to more than just the immediate task.
	Na minha prática estou atento/a a mais do que apenas a tarefa imediata.	4.54 (.64)	.524**	,037
	3. I actively look for opportunities to expand my professional competence.
	Procuro ativamente oportunidades para melhorar a minha competência profissional.	4.42 (.66)	.544**	,038
	Developed interpersonal skills (α = 0.83)
	Competências interpessoais desenvolvidas	4,44 (.50)		,029
	4. I make sure that I hear and acknowledge the others perspectives.
	Certifico-me de que ouço e reconheço as perspectivas do outro.	4.43 (.61)	.624**	,035
	5. In my communication, I show respect towards others.
	Demonstro respeito pelo outro na minha comunicação.	4.57 (.55)	.586**	,032
	6. I adjust the way I communicate to find solutions by mutual agreement.
	Ajusto a minha forma de comunicar para encontrar soluções por mútuo acordo	4.47 (.60)	.665**	,034
	7. I am aware of the impact that my non-verbal communication has in my relationship with others.
	Estou atento/a ao impacto da minha comunicação não verbal no relacionamento com o outro.	4.29 (.69)	.666**	,040
	Being committed to the job (α = 0.84)
	Compromisso com o trabalho	4,43 (.50)		,028
	8. I strive to provide high quality care.
	Esforço-me por prestar cuidados de alta qualidade.	4.66 (.54)	.614**	,031
	9. I look for opportunities to get to know the person and his/her family, to perform holistic care.
	Procuro oportunidades para conhecer a pessoa e a sua família, de modo a prestar cuidados holísticos	4.32 (.71)	.696**	,041
	10. I strive to ensure that the time I spend with the person is of quality.
	Esforço-me para que o tempo que passo com a pessoa seja de qualidade.	4,44 (.61)	.704**	,035
	11. I strive to provide high-quality, evidence-based care.
	Esforço-me por prestar cuidados de alta qualidade e baseados na evidência.	4.42 (.59)	.632**	,034
	12. I constantly look for opportunities to improve the care experience.
	Procuro constantemente oportunidades para melhorar a experiência de cuidados.	4.30 (.66)	.675**	,038
Prerequisites Pre-requisitos (α = 0.89)	Knowing self (α = 0.83)
	Autoconhecimento	3,99 (.67)		,039
	13. I take time to explore the reasons why I react the way I do in certain situations.
	Dedico tempo a explorar as razões pelas quais reajo do modo como reajo em certas situações.	3.86 (.84)	.659**	,048
	14. I analyze if my actions correspond to my way of being.
	Analiso se as minhas ações correspondem à minha maneira de ser.	3.99 (.80)	.634**	,046
	15. I am aware of how my experiences influence my practice.
	Estou atento/a à forma como as minhas vivências influenciam a minha prática.	4.11 (.68)	.628**	,039
	Clarity of beliefs and values (α = 0.72)
	Clareza de crenças e valores	3,70 (.70)		,040
	16. I actively seek feedback from others about my practice.
	Procuro ativamente o feedback do outro sobre a minha prática.	3.77 (.88)	.609**	,050
	17. I question my colleagues when their practice does not reflect our team's values and beliefs.
	Questiono os meus colegas quando a sua prática não reflete os valores e crenças da nossa equipa.	3.54 (.91)^a	.484**	,052
	18. I encourage colleagues to develop their practice in line with the team's values and beliefs.
	Incentivo os colegas a desenvolverem a sua prática de acordo com os valores e crenças da equipa.	3.77 (.83)	.546**	,047
The care environment O ambiente de cuidados (α = 0.93)	Skill mix (α = 0.65)
	Diversidade de competências	4,08 (.60)		,034
	19. I recognize when there is a lack of knowledge and skills in the team and its impact on care delivery.
	Reconheço quando há um défice de conhecimento e competências na equipa e o seu impacto na prestação de cuidados.	3.96 (.80)	.199**	,046
	20. I am able to signal when the diversity of skills in the team is below acceptable levels.
	Sou capaz de sinalizar quando a diversidade de competências na equipa está abaixo dos níveis aceitáveis.	3.78 (.86)	.405**	,049
	21. I value the participation and contribution of all team members to the therapeutic plan.
	Valorizo a participação e o contributo de todos os membros da equipa para o plano terapêutico	4.49 (.61)	.456**	,035
	Shared Decision-Making Systems (α = 0.84)
	Sistemas de tomada de decisão partilhada	3,62 (0.91)		,052
	22. I actively participate in team meetings to support my decision making.
	Participo ativamente em reuniões de equipa para fundamentar a minha tomada de decisão.	4.01 (.88)	.543**	,051
The care environment O ambiente de cuidados (α = 0.93)	23. I participate in decision-making working groups at an institutional level with an impact on practice.
	Participo em grupos de trabalho de tomada de decisão a nível institucional com impacto na prática.	3.53 (1.15)	.579**	,066
	24. I have the opportunity to actively participate and influence decisions in my service.
	Tenho a oportunidade de participar ativamente e de influenciar decisões no meu serviço.	3.52 (1.16)	.709**	,067
	25. My opinion is requested in multidisciplinary therapeutic decision-making meetings (eg clinical service meeting, clinical case conferences, discharge planning).
	A minha opinião é requisitada em reuniões multidisciplinares de tomada de decisão terapêutica (por exemplo: reunião clínica do serviço, conferências clínicas de casos, planeamento da alta).	3.42 (1.19)	.689**	,068
	Effective staff relationships (α = 0.87)
	Relações eficazes entre profissionais	3,64 (.93)		,053
	26. I work in a team that values my contribution to person-centered care.
	Trabalho numa equipa que valoriza a minha contribuição para os cuidados centrados na pessoa.	3.72 (1.07)	.746**	,061
	27. I work in a team that encourages everyone to contribute to person-centred care.
	Trabalho numa equipa que encoraja a contribuição de todos para os cuidados centrados na pessoa	3.65 (1.06)	.767**	,061
	28. My colleagues set a good example of effective peer relationships.
	Os meus colegas dão um bom exemplo de relacionamentos eficazes entre pares.	3.55 (1.01)^a	.615**	,058
	Power sharing (α = 0.83)
	Partilha de poder	3,63 (.82)		,047
	29. The contribution of colleagues is recognized and valued.
	O contributo dos colegas é reconhecido e valorizado.	3.50 (1.03) ^a	.720**	,059
	30. . I actively contribute to the development of common goals.
	Contribuo ativamente para o desenvolvimento de objetivos comuns.	4.08 (.75)	.645**	,043
	31. The service coordinator promotes participation.
	O coordenador do serviço promove a participação.	3.54 (1.12)	.702**	,064
	32. They encourage and support me to lead improvements in practice.
	Encorajam-me e apoiam-me para liderar as melhorias na prática.	3.42 (1.11)	.763**	,064
	Potential for innovation and risk taking (α = 0.62)
	Potencial para inovação e tomada de riscos	3,69 (.68)		,039
	33. I feel supported when I do things differently to improve my practice.
	Sinto-me apoiado quando procedo de forma diferente para melhorar a minha prática	3.32 (1.10) ^a	.760**	,063
The care environment O ambiente de cuidados (α = 0.93)	34. I am able to maintain a balance between using evidence and taking risks.
	Sou capaz de manter o equilíbrio entre usar a evidência e correr riscos.	3.72 (.78) ^a	.496**	,045
	35. I am committed to improving the quality of care by challenging current practices.
	Estou comprometido/a em melhorar a qualidade dos cuidados desafiando práticas correntes	4.04 (.78)	.463**	,045
	The physical environment (α = 0.82)
	Ambiente físico	4,03 (.72)		,041
	36. I am aware of the impact of the physical environment on the dignity of the person.
	Estou atento/a ao impacto do ambiente físico na dignidade da pessoa.	4.29 (.71)	.462**	,041
	37. I encourage others to analyze the impact of the physical environment on the provision of person-centred care (eg noise, light, heat etc.).
	Encorajo os outros a analisar o impacto do ambiente físico na prestação de cuidados centrados na pessoa (por exemplo: ruído, luz, calor etc.).	4.02 (.86)	.484**	,050
	38. I look for creative ways to improve the physical environment.
	Procuro formas criativas de melhorar o ambiente físico.	3.78 (.93)	.469**	,053
	Supportive Organizational Systems (α = 0.86)
	Sistemas organizacionais facilitadores	3.15 (0.9)		,052
	39. In my team we make a point of celebrating our successes.
	Na minha equipa fazemos questão de celebrar os nossos sucessos.	3.36 (1.05) ^a	.651**	,060
	40. My organization recognizes and rewards success.
	A minha organização reconhece e recompensa o sucesso.	2.65 (1.19 ) ^a	.600**	,068
	41. I am recognized for providing a person with a positive care experience.
	Sou reconhecido por proporcionar à pessoa uma experiência de cuidados positiva.	3.43 (1.08) ^a	.648**	,062
	42. I'm encouraged to express concerns about aspects of care.
	Incentivam-me a expressar preocupações sobre aspetos dos cuidados.	3.22 (1.10) ^a	.750**	,063
	43. I have the opportunity to regularly discuss my practice and professional development.
Person-centered processes Processos de centralidade na pessoa (α = 0.95)	Tenho a oportunidade de discutir regularmente a minha prática e o meu desenvolvimento profissional	3.07 (1.17) ^a	.720**	,067
	Working with patients’ beliefs and values (α = 0.83)
	Considerar as crenças e os valores da pessoa	4,22 (.60)		,035
	44. I integrate my knowledge of the person into care delivery.
	Integro os meus conhecimentos sobre a pessoa na prestação de cuidados.	4.25 (.73)	.627**	,042
Person-centered processes Processos de centralidade na pessoa (α = 0.95)	45. I work with the person taking into account their family context and their caregivers.
	Trabalho com a pessoa tendo em conta o seu contexto familiar e os seus cuidadores.	4.17 (.79)	.735**	,045
	46. I try to get the person's perception of their care experience.
	Procuro obter a perceção da pessoa sobre a sua experiência de cuidados.	4.14 (.76)	.730**	,043
	47. I encourage the person to talk about what is important to them.
	Encorajo a pessoa a falar sobre o que lhes é importante.	4.33 (.69)	.803**	,039
	Shared decision-making (α = 0.81)
	Tomada de decisão partilhada	4,13 (.65)		,037
	48. I include the family in decisions about care when it is appropriate and/or in accordance with the person's wishes.
	Incluo a família nas decisões sobre os cuidados quando é apropriado e/ou de acordo com a vontade da pessoa.	4.13 (.78)	.696**	,045
	49. I work with the person to set future health goals.
	Trabalho com a pessoa para estabelecer objetivos de saúde futuros.	4.12 (.76)	.802**	,044
	50. I sensitize the person to obtain information about their care from other health professionals.
	Sensibilizo a pessoa para obter informações sobre os seus cuidados junto de outros profissionais de saúde.	4.16 (.74)	.705**	,042
	Engagement (α = 0.86)
	Envolvimento autêntico	4,33 (.58)		,033
	51. I try to understand the person's perspective.
	Tento compreender a perspectiva da pessoa.	4.44 (.62)	.799**	,036
	52. I try to reach consensus when my goals for the person differ from their perspective.
	Procuro chegar a um consenso quando os meus objetivos para a pessoa diferem da sua perspectiva.	4.18 (.69)	.796**	,039
	53. I involve the person in care processes when appropriate.
	Envolvo a pessoa nos processos de cuidados quando apropriado.	4.37 (.64)	.847**	,036
	Having solidary presence (α = 0.84)
	Estar presente em solidariedade	4,27 (.60)		,034
	54. I actively listen to the person to identify unmet needs.
	Escuto ativamente a pessoa no sentido de identificar as necessidades não satisfeitas.	4.38 (.66)	.836**	,038
	55. I gather additional information to help support the person.
	Recolho informação adicional para me ajudar no apoio à pessoa.	4.22 (.68)	.758**	,039
	56. I make sure I fully focus my attention on the person I'm with.
Person-centered processes Processos de centralidade na pessoa (α = 0.95)	Certifico-me que foco totalmente a minha atenção na pessoa com quem estou.	4.21 (.71)	.781**	,041
	Providing holistic care (α = 0.91)
	Trabalhar holisticamente	4,42 (.61)		,035
	57. I strive to understand the person as a whole.
	Esforço-me por compreender a pessoa como um todo.	4.44 (.67)	.821**	,038
	58. I assess the needs of the person, taking into account all aspects of life.
	Avalio as necessidades da pessoa, tendo em conta todos os seus aspetos de vida.	4.27 (.71)	.792**	,041
	59. In my practice I consider the person as a whole.
	Na minha prática considero a pessoa como um todo.	4.54 (.62)	.795**	,036

Models	X²/df	TLI	CFI	RMSEA	90% RMSEA	SRMR
Pre-requisites	1.929	0,938	.952	.055	0.044 - 0.066 (p = 0,199)	0.0478
Care environment	2.933	0,865	.887	.080	0.073 - 0.087 (p = 0.000)	0.0763
Person-centred processes	2.179	0,961	.969	.062	0.051 - 0.074 (p = 0,041)	0.0305

Domain	Construct	Items	Factor loading	CR	AVE
Prerequisite	Professionally competent	1. I have the necessary skills to negotiate care options.	.44	.66	.40
		2. In my practice, I am attentive to more than just the immediate task.	.59
		3. I actively look for opportunities to expand my professional competence.	.61
	Developed interpersonal skills	4. I make sure that I hear and acknowledge the others perspectives.	.69	.88	.66
		5. In my communication, I show respect towards others.	.69
		6. I adjust the way I communicate to find solutions by mutual agreement.	.81
		7. I am aware of the impact that my non-verbal communication has in my relationship with others.	.71
	Being committed to the job	8. I strive to provide high quality care.	.72	.85	.67
		9. I look for opportunities to get to know the person and his/her family, to perform holistic care.	.70
			.72
	Knowing self	13. I take time to explore the reasons why I react the way I do in certain situations.	.74	.90	.76
		14. I analyze if my actions correspond to my way of being.	.86
		15. I am aware of how my experiences influence my practice.	.80
	Clarity of beliefs and values	16. I actively seek feedback from others about my practice.	.83	.80	.48
		17. I question my colleagues when their practice does not reflect our team’s values and beliefs.	.56
		18. I encourage colleagues to develop their practice in line with the team’s values and beliefs.	.62
Care environment	Skill mix	19. I recognize when there is a lack of knowledge and skills in the team and its impact on care delivery.	.54	.76	.51
		20. I am able to signal when the diversity of skills in the team is below acceptable levels.	.68
		21. I value the participation and contribution of all team members to the therapeutic plan.	.65
	Shared decision-making systems	22. I actively participate in team meetings to support my decision making.	.69	.91	.71
		23. I participate in decision-making working groups at an institutional level with an impact on practice.	.71
		24. I have the opportunity to actively participate and influence decisions in my service.	.79
		25. My opinion is requested in multidisciplinary therapeutic decision-making meetings (eg clinical service meeting, clinical case conferences, discharge planning).	.85
	Effective staff relationships	26. I work in a team that values my contribution to person-centered care.	.88	.91	.81
		27. I work in a team that encourages everyone to contribute to person-centred care.	.93
		28. My colleagues set a good example of effective peer relationships.	.69
	Power sharing	29. The contribution of colleagues is recognized and valued.	.75	.88	.65
		30. I actively contribute to the development of common goals.	.60
		31. The service coordinator promotes participation.	.71
		32. They encourage and support me to lead improvements in practice.	.82
Care environment	Potential for innovation and risk taking	33. I feel supported when I do things differently to improve my practice.	.85	.66	.43
		34. I am able to maintain a balance between using evidence and taking risks.	.42
		35.I am committed to improving the quality of care by challenging current practices.	.36
	The Physical Environment	36. I am aware of the impact of the physical environment on the dignity of the person.	.74	.90	.75
		37. I encourage others to analyze the impact of the physical environment on the provision of person-centred care (eg noise, light, heat etc.).	.88
		38. I look for creative ways to improve the physical environment.	.74
	Supportive organizational systems	39. In my team we make a point of celebrating our successes.	.64	.91	.68
		40. My organization recognizes and rewards success.	.65
		41. I am recognized for providing a person with a positive care experience.	.70
		42. I’m encouraged to express concerns about aspects of care.	.87
		43. I have the opportunity to regularly discuss my practice and professional development.	.83
Person-centered processes	Working with patients’ beliefs and values	44. I integrate my knowledge of the person into care delivery.	.61	.91	.71
		45. I work with the person taking into account their family context and their caregivers.	.73
		46. I try to get the person’s perception of their care experience.	.76
		47. I encourage the person to talk about what is important to them.	.84
	Shared decision-making	48. I include the family in decisions about care when it is appropriate and/or in accordance with the person’s wishes.	.72	.84	.63
		49. I work with the person to set future health goals.	.86
		50. I sensitize the person to obtain information about their care from other health professionals.	.74
	Engagement	51. I try to understand the person’s perspective.	.80	.92	.79
		52. I try to reach consensus when my goals for the person differ from their perspective.	.79
		53. I involve the person in care processes when appropriate.	.85
	Having solidary presence	54. I actively listen to the person to identify unmet needs.	.86	.90	.75
		55. I gather additional information to help support the person.	.73
		56. I make sure I fully focus my attention on the person I’m with.	.79
	Providing holistic care	57. I strive to understand the person as a whole.	.92	.95	.86
		58. I assess the needs of the person, taking into account all aspects of life.	.85
		59. In my practice I consider the person as a whole.	.87

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[1] Chief editors:

Romeu Gomes, Antônio Augusto Moura da Silva