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Tradução, adaptação cultural e validação do questionário Primary Care Outcomes Questionnaire: versão portuguesa
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RESUMO - Introdução: As Patient-reported Outcomes Measures são medidas de resultados relatadas pelos pacientes, que sobressaem no âmbito dos modelos inovadores em Cuidados de Saúde Primários (CSP) e que promovem os cuidados centrados no utente. O Primary Care Outcomes Questionnaire (PCOQ) foi traduzido, adaptado culturalmente e avaliado psicometricamente numa amostra de utentes que recorreram aos CSP em Portugal.
Métodos: O processo de tradução e adaptação cultural de medidas de resultados autoreportados, seguiu as etapas preconizadas por Beaton et al. A versão em português foi preenchida, no ano de 2025, por 407 utentes com idade g 18 anos, que recorreram a uma Unidade de Saúde Familiar, dos Cuidados de Saúde Primários, da Grande Lisboa. Alguns questionários foram aplicados presencialmente e outros via on-line. Foram recolhidos dados sociodemográficos e clínicos dos participantes. A psicometria da versão portuguesa do PCOQ foi analisada pela avaliação da confiabilidade e validade de construto. Realizou-se análise fatorial confirmatória utilizando-se como índices e ajustamento o ó2/df, o Comparative Fit Index (CFI), o Tucker-Lewis Index (TLI), o Root Mean Square Error of Approximation (RMSEA) e o Standardized Root Mean Square Residual (SRMR). A validade convergente foi estimada pela variância extraída média (VEM) e pela confiabilidade composta (CC). Avaliou-se também a validade discriminante. A confiabilidade foi avaliada pelo grau de consistência interna, através do cálculo do coeficiente alfa de Cronbach, e da correlação item-escala.
Resultados: A estrutura tetra-fatorial do PCOQ-PT mostrou um bom ajuste do modelo e validade de construto, refletindo o referencial teórico. O ajustamento adequado refletiu-se nos seguintes valores: ó2/df = 4,131; CFI = 0,993; TLI = 0,992; RMSEA = 0,088; SRMR = 0,063. Observou-se adequada validade convergente (VEM = 0.635;0,859, CC = 0,932;0,964) e adequada validade discriminante, pois a :VEM > correlação máxima, em todos os construtos. A consistência interna foi excelente (ñ = 0,912). Foram encontrados efeitos de teto na maioria dos itens.
Conclusões: O modelo tetra-fatorial do PCOQ-PT ajustado à amostra estudada, é um instrumento culturalmente adequado, confiável e válido, para avaliar os outcomes autopercecionados dos utentes que recorrem às unidades dos CSP em Portugal. Esta é uma contribuição relevante para a literatura científica lusófona pois, que tenhamos conhecimento, é a primeira tradução, adaptação cultural e validação deste PROM, para português de Portugal. Contudo, o fato de ter sido um estudo unicêntrico, de se terem apurado efeitos teto e de não ter sido testada a sensibilidade à mudança, considera-se necessário explorar essas questões em estudos posteriores.
ABSTRACT - Introduction: Patient-reported Outcomes Measures (PROMs) stand out within innovative Primary Health Care (PHC) models and promote patient-centred care. The Primary Care Outcomes Questionnaire (PCOQ) was translated, culturally adapted, and psychometrically evaluated in a sample of PHC users in Portugal. Methods: The translation and cultural adaptation process of self-reported outcome measures followed the steps recommended by Beaton et al. The Portuguese version was completed in 2025, by 407 patients aged 18 years or older who attended a Family Health Unit (FHU) within the PHC in Greater Lisbon. Some questionnaires were administered in person and others online. Sociodemographic and clinical data were collected from participants. The psychometrics of the PCOQ-PT were analyzed by assessing reliability and construct validity. Confirmatory factor analysis was performed using ó2/df, the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA), and the Standardized Root Mean Square Residual (SRMR) as fit indices. Convergent validity was estimated by the average variance extracted (AVE) and composite reliability (CR). Discriminant validity was also assessed. Reliability was assessed by the degree of internal consistency, by calculating Cronbach’s alpha coefficient, and the item-scale correlation. Results: The four-factor structure of the PCOQ-PT showed good model fit and construct validity, reflecting the theoretical framework. Adequate fit was reflected in the following values: ó2/df = 4.131; CFI = 0.993; TLI = 0.992; RMSEA = 0.088; SRMR = 0.063). Adequate convergent validity (AVE = 0.635;0.859, CC = 0.932;0.964) and adequate discriminant validity were observed, as :VEM > maximum correlation, in all constructs. Internal consistency was excellent (ñ = 0,912). Ceiling effects were found for most items. Conclusions: The four-factor model of the PCOQ, adjusted for the study sample, is a culturally appropriate, reliable, and valid instrument for assessing the self-reported outcomes of people who use PHC units in Portugal. This work constitutes a significant contribution to the lusophone scientific literature, as it represents, to the best of our knowledge, the first translation, cultural adaptation, and validation of this PROM into European Portuguese. However, given that this was a single-center study, ceiling effects were found, and sensitivity to change was not tested, these issues need to be explored in future studies.
ABSTRACT - Introduction: Patient-reported Outcomes Measures (PROMs) stand out within innovative Primary Health Care (PHC) models and promote patient-centred care. The Primary Care Outcomes Questionnaire (PCOQ) was translated, culturally adapted, and psychometrically evaluated in a sample of PHC users in Portugal. Methods: The translation and cultural adaptation process of self-reported outcome measures followed the steps recommended by Beaton et al. The Portuguese version was completed in 2025, by 407 patients aged 18 years or older who attended a Family Health Unit (FHU) within the PHC in Greater Lisbon. Some questionnaires were administered in person and others online. Sociodemographic and clinical data were collected from participants. The psychometrics of the PCOQ-PT were analyzed by assessing reliability and construct validity. Confirmatory factor analysis was performed using ó2/df, the Comparative Fit Index (CFI), the Tucker-Lewis Index (TLI), the Root Mean Square Error of Approximation (RMSEA), and the Standardized Root Mean Square Residual (SRMR) as fit indices. Convergent validity was estimated by the average variance extracted (AVE) and composite reliability (CR). Discriminant validity was also assessed. Reliability was assessed by the degree of internal consistency, by calculating Cronbach’s alpha coefficient, and the item-scale correlation. Results: The four-factor structure of the PCOQ-PT showed good model fit and construct validity, reflecting the theoretical framework. Adequate fit was reflected in the following values: ó2/df = 4.131; CFI = 0.993; TLI = 0.992; RMSEA = 0.088; SRMR = 0.063). Adequate convergent validity (AVE = 0.635;0.859, CC = 0.932;0.964) and adequate discriminant validity were observed, as :VEM > maximum correlation, in all constructs. Internal consistency was excellent (ñ = 0,912). Ceiling effects were found for most items. Conclusions: The four-factor model of the PCOQ, adjusted for the study sample, is a culturally appropriate, reliable, and valid instrument for assessing the self-reported outcomes of people who use PHC units in Portugal. This work constitutes a significant contribution to the lusophone scientific literature, as it represents, to the best of our knowledge, the first translation, cultural adaptation, and validation of this PROM into European Portuguese. However, given that this was a single-center study, ceiling effects were found, and sensitivity to change was not tested, these issues need to be explored in future studies.
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Patient-reported outcomes measures Cuidados de Saúde Primários Outcomes relatados pelo utente Psicometria Portugal Primary Health Care Patient-reported outcomes Psychometrics