Confirmatory Factor Analysis and Reliability of the Burn Specific Health Scale-Revised in Brazilian Burned Patients.

BACKGROUND AND PURPOSE: The aim of the study was to analyze the factor structure and the reliability of the Brazilian-Portuguese version of the Burn Specific Health Scale-Revised (BSHS-R) in a sample of Brazilian burned adults. METHODS: This study was a cross-sectional study. The internal consistency was analyzed using Cronbach's α, considering coefficients ≥.70 as appropriate. We conducted confirmatory factor analysis (CFA) to test the hypothesis that the BSHS-R Brazilian-Portuguese version has a factor structure similar to the original. We assessed the factor structure of the BSHS-R Brazilian-Portuguese version by CFA, examining three models: three-factor, six-factor, and seven-factor structure. RESULTS: The participants were 299 burned adults. The CFA indicated good model fit indices for the seven-factor model (root mean square error of approximation = .062; goodness-of-fit index = .844; adjusted goodness-of-fit index = .809; Akaike information criterion = 1,054.06). The seven-factor BSHS-R Brazilian-Portuguese version showed Cronbach's α of .93. CONCLUSIONS: The BSHS-R Brazilian-Portuguese version with seven factors is reliable and valid and measures the perceived health status construct.

Validation of the Perceived Stigmatization Questionnaire for Brazilian adult burn patients.

Currently, there is no questionnaire to assess perceived stigmatization among people with visible differences in Brazil. The Perceived Stigmatization Questionnaire (PSQ), developed in the United States, is a valid instrument to assess the perception of stigmatizing behaviours among burn survivors. The objective of this cross-sectional and multicentre study was to assess the factor structure, reliability and validity of the Brazilian Portuguese version of the PSQ in burn patients. A Brazilian version of the 21-item PSQ was answered by 240 adult burn patients, undergoing rehabilitation in two burns units in Brazil. We tested its construct validity by correlating PSQ scores with depression (Beck Depression Index-BDI) and self-esteem (Rosenberg Self-Esteem Scale-RSE), as well as with two domains of the Revised Burn Specific Health Scale-BSHS-R: affect and body image, and interpersonal relationships. We used Confirmatory Item Factor Analysis (CIFA) to test whether the data fit a measurement model involving a three-factor structure (absence of friendly behaviour; confusing/staring behaviour; and hostile behaviour). We conducted Exploratory Factor Analyses (EFA) of the subscale in a 50% random sample of individuals (training split), treating items as ordinal categorical using unweighted least squares estimation. To assess discriminant validity of the Brazilian version of the PSQ we correlated PSQ scores with known groups (sex, total body surface area burned, and visibility of the scars) and assessed its reliability by means of Cronbach's alpha and using test-retest. Goodness-of-fit indices for confirmatory factor analysis were satisfactory for the PSQ, but not for the hostile behaviour subscale, which was modified to improve fit by eliminating 3 items. Cronbach's alphas for the PSQ refined version (PSQ-R) ranged from 0.65 to 0.88, with test-retest reliability 0.87 for the total score. The PSQ-R scores correlated strongly with depression (0.63; p < 0.001), self-esteem (-0.57; p < 0.001), body image (-0.63; p < 0.001), and interpersonal relationships (-0.55; p < 0.001). PSQ-R total scores were significantly lower for patients with visible scars (effect size = 0.51, p = 0.029). The PSQ-R showed reliability and validity comparable to the original version. However, the cross-cultural structure of the subscale "hostile behaviour" and sensitivity to change of the PSQ should be further evaluated.

[Translation and cultural adaptation of the Perceived Stigmatization Questionnaire for burn victims in Brazil]. / Tradução e adaptação transcultural do Perceived Stigmatization Questionnaire para vítimas de queimaduras no Brasil.

This methodological study aimed to describe the process of translation and cultural adaptation of the Perceived stigmatization Questionnaire (PSQ) and analyze the internal consistency of the items in the step of pre-testing. The PSQ was developed to evaluate the perception of stigmatizing behaviors of burn victims. The adaptation process was carried out from August 2012 to February 2013, comprising the steps outlined in the literature. As part of this process, the pre-test with 30 adult burn victims was held. All participants at this step reported to understand the instrument items and the scale of responses. There were no suggestions or changes in the tested version. The value of Cronbach's alpha at pre-test was 0.87. The contribution of this study is to describe the operation of each of the steps of this methodological process and show the internal consistency of the items in the pre-test.

Translation and cultural adaptation of the Perceived Stigmatization Questionnaire for burn victims in Brazil / Tradução e adaptação transcultural do Perceived Stigmatization Questionnaire para vítimas de queimaduras no Brasil / Traduccion y adaptacion transcultural del Perceived Stigmatization Questionnaire para victimas de quemaduras en el Brasil

This methodological study aimed to describe the process of translation and cultural adaptation of the Perceived stigmatization Questionnaire (PSQ) and analyze the internal consistency of the items in the step of pre-testing. The PSQ was developed to evaluate the perception of stigmatizing behaviors of burn victims. The adaptation process was carried out from August 2012 to February 2013, comprising the steps outlined in the literature. As part of this process, the pre-test with 30 adult burn victims was held. All participants at this step reported to understand the instrument items and the scale of responses. There were no suggestions or changes in the tested version. The value of Cronbach’s alpha at pre-test was 0.87. The contribution of this study is to describe the operation of each of the steps of this methodological process and show the internal consistency of the items in the pre-test.

Este estudio tuvo como objetivos describir el proceso de traducción y adaptación cultural del instrumento Perceived Stigmatization Questionnaire (PSQ) y analizar la consistencia interna de los ítems en la etapa del pre-test. El PSQ fue desarrollado para la evaluación de la percepción de los comportamientos estigmatizantes de víctimas de quemaduras. El proceso de adaptación fue realizado de agosto del 2012 a febrero del 2013, incluyendo las etapas preconizadas en la literatura. Como parte de ese proceso, fue realizado el pre-test con 30 adultos víctimas de quemaduras. Todos los participantes de esa etapa informaron comprender los ítems del instrumento y la escala de respuesta. No hubo sugerencias o cambios en la versión probada. El valor del alfa de Cronbach en el pre-test fue de 0,87. La contribución del estudio está en la descripción de la operacionalización de cada una de las etapas de ese proceso metodológico y demuestra la consistencia interna de los ítems en el pre-test.

Este estudo metodológico teve como objetivos descrever o processo de tradução e adaptação cultural do instrumento Perceived Stigmatization Questionnaire (PSQ) e analisar a consistência interna dos itens na etapa do pré-teste. O PSQ foi desenvolvido para avaliação da percepção de comportamentos estigmatizantes de vítimas de queimaduras. O processo de adaptação foi realizado de agosto de 2012 a fevereiro de 2013, compreendendo as etapas preconizadas na literatura. Como parte desse processo, foi realizado o pré-teste com 30 adultos vítimas de queimaduras. Todos os participantes dessa etapa reportaram compreender os itens do instrumento e a escala de respostas. Não houve sugestões ou alterações na versão testada. O valor do alfa de Cronbach no pré-teste foi de 0,87. A contribuição do estudo reside em descrever a operacionalização de cada uma das etapas desse processo metodológico e mostrar a consistência interna dos itens no pré-teste.

Sexuality in burn victims: an integrative literature review.

AIMS: To analyze and synthesize knowledge concerning sexuality in adult burn victims through an integrative literature review. METHOD: Two researchers independently searched six electronic databases (PUBMED, LILACS, ISI Web of Science, PSYCINFO, CINAHL and EMBASE) and also performed a hand search using the following descriptors, in different combinations: burn, sexuality, gender identity, sexual behavior and sexual factors, in order to identify the articles published in English, Portuguese or Spanish, in the last 20 years. A total of 1781 articles were found and 22 were selected based on the inclusion and exclusion criteria. RESULTS: The findings were organized into two categories that influence sexuality: (1) studies where the main purpose was to assess sexuality in burn victims; (2) studies that indirectly assess sexuality. CONCLUSION: The synthesis of the knowledge concerning sexuality in burn victims showed that sexual dysfunction can be related to the younger ages, TBSA > 20%, burns on the genitalia and on exposed areas, prolonged length of hospital stay, avoidance coping, and mental disorders. The multidisciplinary team should be prepared to integrate sexuality as an important variable in the continuing treatment of burn patients.