PROPOSAL FOR CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE INSTRUMENT PROPOSTA DE ADAPTAÇÃO TRANSCULTURAL E VALIDAÇÃO DE UM INSTRUMENTO PROPUESTA DE ADAPTACIÓN TRANSCULTURAL Y VALIDACIÓN DE UN INSTRUMENTO

Objective: to present the proposal of protocol for Cross-cultural adaptation and validation of the instrument The Assessment of Strategies in Families-Effectiveness to the Brazilian Portuguese language, and validate it for use with Brazilian families. Method: this is a quantitative, cross-sectional study. For the development of the transcultural adaptation process, the methodological standards recommended for use in another cultural context were followed. This study will be carried out in Basic Health Units that have a Family Health Strategy in Brazil. The participants will be recruited by the community health agents in a home visit: The initial validation steps include: a) Qualitatively evaluate the instrument properties with 15 participants; b) Perform the initial pre-test of the instrument with 30 participants and c) comple thevalidation of the instrument with 200 participants. Two instruments in total will be used: a form for the sociodemographic characterization and the instrument that will evaluate family effectiveness. Exploratory factor analysis and the reliability test using "Cronbach Alpha coefficients" will be applied. The theoretical model employed is the Framework of Systemic Organization to interpret the results. Results expects: the adapted instrument is expected to have internal consistency (at least 0.70) both among the items and domains. Descriptors: Family Nursing; Nursing Assessment; Self-Efficacy; Cross-Cultural Comparison; Transcultural Nursing; Nursing Theory. RESUMO Objetivos: apresentar uma proposta de um protocolo para a adaptação transcultural do instrumento The Assessment of Strategies in Families-Effectiveness (ASF-E) para o idioma português do Brasil e validar para uso com famílias brasileiras. Método: estudo quantitativo, transversal. Para o desenvolvimento do processo de adaptação transcultural serão seguidos os padrões metodológicos recomendados para uso em outro contexto cultural. Este estudo será realizado em Unidades Básicas de Saúde, que serão selecionados os participantes por indicação dos agentes comunitários de saúde para em visita domiciliar: a) Avaliação qualitativa do instrumento com 15 participantes; b) Realizar o pré-teste do instrumento com 30 participantes e c) Validar o instrumento com 200 participantes. Serão utilizados dois instrumentos, um formulário para caracterização sociodemográfica e instrumento que avaliará a eficácia familiar. Para a análise dos dados será utilizado o programa Statistical Package Social Science. Para a análise do teste de confiabilidade serão aplicados os "coeficientes de Alpha Cronbach”. O modelo teórico da organização sistêmica para entender a partir desta perspectiva a eficácia familiar. Resultados esperados: O instrumento adaptado apresentará consistência interna alta (0,70) tanto entre os itens quanto entre os itens e os domínios. Descritores: Enfermagem familiar; Avaliação de Enfermagem; Autoeficácia; Comparação transcultural; Enfermagem transcultural; Teoria de Enfermagem RESUMEN Objetivo: presentar una propuesta de protocolo para la adaptación transcultural del instrumento La Evaluación de las Estrategias de familias con Eficacia (ASF-E) a la lengua portuguesa en Brasil y validados para el uso con las familias brasileñas. Método: estudio cuantitativo, transversal. Para el desarrollo del proceso de adaptación transcultural se seguirán los patrones metodológicos recomendados para el uso en otro contexto cultural. Este estudio se realizará en Unidades Básicas de Salud, que serán seleccionados los participantes por indicación de los agentes comunitarios de salud para en visita domiciliar: a) evaluación cualitativa del instrumento con 15 participantes; b) Realizar el pre-test del instrumento con 30 participantes y, c) Validar el instrumento con 200 participantes. Se utilizarán dos instrumentos, un formulario para caracterización sociodemográfica e instrumento que evaluará la eficacia familiar. Para el análisis de los datos se utilizará el programa Statistical Package Social Science. Para el análisis de la prueba de confiabilidad se aplicarán los "coeficientes de Alpha Cronbach". El modelo teórico de la organización sistémica para entender a partir de esta perspectiva la eficacia familiar. Resultados esperados: el instrumento adaptado presentará consistencia interna alta (0,70) tanto entre los ítems como entre los ítems y los dominios.Descriptores: Enfermería de la Familia; Evaluación en Enfermería; Comparación Transcultural; Enfermería transcultural; Teoria de Enfermería. PhD student at the Post-Graduate Program in Nursing at UFPel. Universidade Federal de Pelotas/UFPel. Pelotas (RS), Brazil. E-mail: fernandalise@gmail.com https://orcid.org/0000-0002-1677-6140; PhD in Nursing. CNPQ scholarship holder. Universidade Federal de Pelotas/UFPel. Pelotas (RS), Brazil. E-mail: E-mail: eschwartz@terra.com.br https://orcid.org/0000-0002-5823-7858; PhD in Nursing. Florida International University/FIU. Miami (FL), United States of America. E-mail: friedemm@fiu.edu https://orcid.org/0000-0003-35189192; PhD in Nursing. Georgia Southern University/GSU. Statesboro (GA), United States of America. E-mail: khanderson@georgiasouthern.edu https://orcid.org/0000-0002-0081-1247 NOTE PREVIEW ARTICLE Lise F, Schwartz E, Friedemann ML et al. Proposal for cross-cultural adaptation... English/Portuguese J Nurs UFPE on line., Recife, 12(3):808-11, Mar., 2018 809 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i3a230765p808-811-2018 The family is a system composed of members who have decided to socialize and interact emotionally, with the main objective of supporting each other and to fulfill certain roles that contribute to family effectiveness, as a total unit and of constant exchange with the environment. In this way, family effectiveness refers to the interpersonal relationships that occur in each family and give the family its own identity. Because the family is a dynamic and complex system, it requires that those who work with families have dynamic forms of evaluation and intervention with families to enhance functioning and effectiveness. Thus, the use of family effectiveness assessment instruments can best define the functional structure of families, thereby allowing more effective and efficient interventions by health professionals. This thesis project proposes to test the cross-cultural adaptation of the instrument The Assessment of Strategies in FamilyEffectiveness (ASF-E) for the Brazilian Portuguese language, and its validation for use with Brazilian families. This instrument was developed and validated by Prof. Dr. Marie-Luise Friedemann, to be used with families in general and in different settings across many countries. This study will be the first to present the adaptation and validation in Brazil, as well as the Framework of the Systemic Organization developed by the same author. This instrument evaluates family effectiveness and family processes and is measured by 20 items, each one with three choices with choice 1 signifying low effectiveness, 2 medium effectiveness and 3 high effectiveness. The 20 questions assess 4 family life domains, coherence five questions); changes in the system (six questions); individualization (three questions) and maintenance of the system (six questions). The total value of the instrument is 60 points, being defined, as families with high family effectiveness measured at 54-60 points. Below this score of 54, families are considered with low family effectiveness. The Framework of Systemic Organization, that aims to achieve goals for the maintenance of family health will be used as the theoretical framework for the study. Friedemann developed this instrument, which allows us to measure how the family organizes itself to function effectively as a system and to respond to the requirements of needs of each member. This effective functioning allows the realization of the four universal goals, called stability, growth, control and spirituality, which are maintained by values and beliefs developed in the family processes of coherence, maintenance of the system, individualization and change of the system. ● To present the proposal of protocol for Cross-cultural adaptation and validation of the instrument The Assessment of Strategies in Families-Effectiveness to the Brazilian Portuguese language, and validate it for use with Brazilian families. It is a quantitative, cross-sectional study. The process of cross-cultural adaptation goes beyond the translation of the instrument to consider the cultural, idiomatic, linguistic and contextual aspects related to its translation. This study followed the model that proposes the methodological sequence described in figure 1. OBJETIVES


NOTE PREVIEW ARTICLE
Lise F, Schwartz E, Friedemann ML et al.
Proposal for cross-cultural adaptation... English/Portuguese J Nurs UFPE on line., Recife, 12(3):808-11, Mar., 2018  809 The family is a system composed of members who have decided to socialize and interact emotionally, with the main objective of supporting each other and to fulfill certain roles that contribute to family effectiveness, as a total unit and of constant exchange with the environment.In this way, family effectiveness refers to the interpersonal relationships that occur in each family and give the family its own identity. 1cause the family is a dynamic and complex system, it requires that those who work with families have dynamic forms of evaluation and intervention with families to enhance functioning and effectiveness. This thesis project proposes to test the cross-cultural adaptation of the instrument The Assessment of Strategies in Family-Effectiveness (ASF-E) for the Brazilian Portuguese language, and its validation for use with Brazilian families.This instrument was developed and validated by Prof. Dr. Marie-Luise Friedemann, to be used with families in general and in different settings across many countries.This study will be the first to present the adaptation and validation in Brazil, as well as the Framework of the Systemic Organization developed by the same author.
This instrument evaluates family effectiveness and family processes and is measured by 20 items, each one with three choices with choice 1 signifying low effectiveness, 2 medium effectiveness and 3 high effectiveness.The 20 questions assess 4 family life domains, coherence five questions); changes in the system (six questions); individualization (three questions) and maintenance of the system (six questions).The total value of the instrument is 60 points, being defined, as families with high family effectiveness measured at 54-60 points.Below this score of 54, families are considered with low family effectiveness. 4e Framework of Systemic Organization, that aims to achieve goals for the maintenance of family health will be used as the theoretical framework for the study.Friedemann developed this instrument, which allows us to measure how the family organizes itself to function effectively as a system and to respond to the requirements of needs of each member.This effective functioning allows the realization of the four universal goals, called stability, growth, control and spirituality, which are maintained by values and beliefs developed in the family processes of coherence, maintenance of the system, individualization and change of the system. 1 • To present the proposal of protocol for Cross-cultural adaptation and validation of the instrument The Assessment of Strategies in Families-Effectiveness to the Brazilian Portuguese language, and validate it for use with Brazilian families.
It is a quantitative, cross-sectional study. 5,6e process of cross-cultural adaptation goes beyond the translation of the instrument to consider the cultural, idiomatic, linguistic and contextual aspects related to its translation. 7This study followed the model that proposes the methodological sequence described in figure 1 This study will be carried out in three Basic Health Units (BHU) that have Family Health Strategies (FHS) in the municipality of Pelotas, Rio Grande do Sul, Brazil.In these sites, the participants will be selected, by appointment of the CHA for a home visit to: a) Evaluate the instrument with 15 participants; b) Perform the pre-test of the instrument with 30 participants and c) Validate the instrument with larger sample of 200 participants (100 families).Participants will be people over 18, who are part of the area covered by Health Units with FHS, living in the urban area.
The criteria for the exclusion include: not being able to read and communicate verbally to answer the questions; have already answered the questionnaire at another opportunity, and do not agree to participate.Data collection will begin after the transcultural adaptation stage.The data will be collected using two instruments: the first, measuring sociodemographic characterization; the second The Assessment of Strategies in Family-Effectiveness (ASF-E). 4 the analysis of the data, the program SPSS (Statistical Package Social Science) will be used to analyze the demographics and to describe the family variables, using frequencies and proportions.A component exploratory factor analysis using varimax rotation will be employed, a method used in order to obtain a simple structure by maximizing the highest saturations and reducing the lowest saturations of the instrument items.In this way, by minimizing the number of items that show saturation in a factor, this technique will facilitate their interpretation in theoretical terms. 8For the reliability test, the "Cronbach Alpha coefficients" will be applied, to allow the determination of the internal consistency of the total instrument and its subscales. 9,10The theoretical model "the Framework of Systemic Organization" is a model of analysis used to interpret the meaning of family effectiveness from the theoretical systemic perspective. 1is project was sent to the Brazil Platform and received the approval of the Research Ethics Committee number 2,088,369.The precepts of Resolution 466/12 of the National Health Council, which regulates research involving human beings, will be respected. 11e Brazilian Portuguese version, of the adapted instrument will have internal consistency (at least 0.70) both among items, and domains.After testing of the validity and reliability of the tool, it will be ready for use to assess the family effectiveness of Brazilian families by nurses and other health care providers to direct care and improve family effectiveness and the health of the family.
1. Friedemann ML.The framework of systemic organization: a conceptual approach to families and nursing.

Figure 1 .
Figure 1.Adaptation of the representation of the stages of the cross-cultural adaptation process and validation of a measuring instrument. 8