RAMB - Maio / Junho 2016

oárez

240

ssoc

ras

2016; 62(3):236-242

tion should be understood by at least 90% of individuals.

Questions with an understanding below 90% would be

automatically identified and subject to revision.

In Pretesting 1, 8 of the 100 questions were below the

minimum level of understanding of 90%, and were sub-

jected to the revision process.

The discussion held with individuals after filling out

the questionnaire provided very useful data for explain-

ing why these 8 questions had not been understood.

The first major difficulty faced by individuals repre-

senting the health insurance operators was to understand

which health promotion program they were evaluating:

Health promotion programs from the health insurance

plans offered to beneficiaries in their portfolios or health

promotion programs available to their own employees.

Some individuals had difficulty in understanding

specific words, for example, “self-management programs”,

and found that some activities did not make sense in the

Brazilian context, such as “feira livre” (used for the trans-

lation of “farmers’ Market”), and “dial to stop smoking”.

The explanations of certain questions were considered

confusing and hindered answering.

The majority of the individuals considered the ques-

tionnaire very useful to determine the scope of the exist-

ing health promotion programs and to point out areas

that could be developed and/or improved in the current

programs.

Revision by the Expert Committee

The questions identified as having an understanding be-

low 90% were discussed by the expert committee.

The emerging points detailed in the specific form

were transformed into the summary file, where the ques-

tions that were not understood were quantified and spec-

ified. This summary was fundamental for emphasizing

the words not understood, misinterpretations, or instruc-

tions that were not sufficiently clear. The expert commit-

tee evaluated these words and replaced them with others

with the same idea but more easily understood, includ-

ing suggestions from the individuals themselves, seeking

to change the structure and evaluation properties of such

questions. Some verb tenses and sentences in Portuguese

were rewritten until a consensus was reached. Versions

no. 5 in Portuguese was thereby created.

Evaluation of cultural adaptation (Pretesting 2)

This step is designed to evaluate the degree of understand-

ing of the questions again, and to identify if the problems

related to the formulation or content of the questions iden-

tified in the previous version remained in the current one.

In the same manner as Pretesting 1, the participants

received an explanation of the objectives and methodol-

ogy of the study. We asked for permission to use their re-

sponses, assuring that the data would be always displayed

in aggregated form and that the confidentiality of the in-

dividuals would be maintained.

Version no. 5 was applied to another group of 13 in-

dividuals, responsible for the health promotion programs

of their organizations. A paper copy of version no. 5 and

the form were delivered, as described earlier.

The participants took approximately 60 minutes to

answer the questionnaire and fill out the form. Upon

completion, the questions asked in Pretesting 1 were re-

peated, and the queries, comments and suggestions of

the participants were discussed and noted in a specific

form by one of the researchers.

In Pretesting 2, only 6 of the 100 questions did not

present adequate understanding. As expected, in this

group made up of managers or administrators of health

promotion programs at companies, the general under-

standing was better than that of the previous group, com-

posed of managers or administrators of health insurance

operators, given that the HSC was developed for applica-

tion in companies.

In this second application the individuals had diffi-

culty understanding some specific expressions, for exam-

ple: how many classes would “a series of classes” exactly

mean? 3, 6 or 10 classes? They indicated the almost non-

existence of vending machines in their companies and

suggested including the dining areas next to cafeterias

and snack bars in these questions. Another difficulty en-

countered was related to the subsidies mentioned in sev-

eral questions. Some argued whether these issues were

applicable to our area, because subsidies are not a com-

mon form of benefits offered to employees locally.

In the same way as in the pretesting 1, individuals con-

sidered the questionnaire very useful for evaluating the ex-

isting health promotion programs and suggesting areas

that have not yet been developed in current programs.

The questions that presented problems of understand-

ing were rewritten. The researcher responsible and a revis-

er checked the final translation and corrected spelling,

grammatical, typographical or other remaining typing mis-

takes. Version no. 6 in Portuguese was thereby created.

Revision by the Expert Committee

After Pretesting 2, another summary file was created, where

the questions not understood were quantified and spec-

ified. The expert committee reviewed this detailed sum-

mary of the words and phrases not understood and the