Cross-cultural adaptation of the knowledge of disease management-CF-adolescent questionnaire for Brazilian Portuguese

Jimenez, Hilda Angélica Iturriaga; Teixeira-Salmela, Luci Fuscaldi; Magalhães, Lívia de Castro; Velloso, Marcelo

doi:10.1590/1809-2950/e24008126en

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ORIGINAL RESEARCH • Fisioter. Pesqui. 33 • 2026 • https://doi.org/10.1590/1809-2950/e24008126en linkcopy

Cross-cultural adaptation of the knowledge of disease management-CF-adolescent questionnaire for Brazilian Portuguese

Adaptação transcultural do questionário knowledge of disease management-cf-adolescent para o português brasileiro

Adaptación transcultural del cuestionario Knowledge of Disease Management-CF-Adolescent al portugués brasileño

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aimed to cross-culturally adapt the Knowledge of Disease Management-CF-Adolescent (KDM-CF-Adolescent) questionnaire for Brazilian Portuguese, as well as to test its measurement properties. Cross-cultural adaptation followed five standardized steps: translation; consensus version of the translation, back translation, consensus version of back translation, and application of the final version to 35 adolescent patients with cystic fibrosis (FC), aged 11 to 20 years. Due to the COVID-19 pandemic and social isolation measures, the questionnaire was applied online using the Google Forms. Data were subjected to Rasch analysis, using the WINSTEPS software. There were no problems regarding understanding the questions, so making changes in any of the translated items was not necessary. The KDM-CF-Adolescent divided the sample into two levels of knowledge and the items into three levels of difficulty, leading to person and item reliability indices of 0.67 and 0.81, respectively and internal consistency of 0.69. All items fit the Rasch model expectations, since all infit/outfit and associated z-values were within the expected range. The principal component analysis confirmed the existence of two dimensions; however, they did not function as independent scales. There was no duplication of any content and no floor and/or ceiling effects were found. The Brazilian Portuguese version of KDM-CF-Adolescent questionnaire demonstrated satisfactory properties to measure the knowledge adolescents with CF have about the disease.

Keywords:
Cystic Fibrosis; Patient Health Questionnaire; Knowledge Management; Health Knowledge, Attitudes, Practice; Healthy Lifestyle

Items	Calibration n (logits)	Error (logits)	Infit		Outfit		Serial Point
Items	Calibration n (logits)	Error (logits)	MnSq	ZSTD	MnSq	ZSTD	Serial Point
13. Foods that contain the highest quantity of energy/calories are:	2.77	0.55	0.99	0.11	1.14	0.42	0.22
3. Which of the following options is a sign that your body is losing too much salt?	1.52	0.40	0.97	−0.09	0.86	−0.42	0.39
8. To make the most of your doctor’s appointment, you should:	0.93	0.37	0.93	−0.49	0.87	−0.63	0.45
10. Stress, too much homework or problems with a friend can affect yours):	0.93	0.37	0.99	−0.02	0.95	−0.19	0.38
15. Time is everything; what is the right order to do the following treatments?	0.79	0.37	0.98	−0.11	1.01	0.12	0.38
2. Most of the food you eat is absorbed in:	0.39	0.37	0.95	−0.39	0.88	−0.71	0.45
4. To inhale antibiotics are usually more effective if they are made:	0.39	0.37	1.08	0.70	1.14	0.83	0.28
11. Exercise can replace regular airway clearance.	0.26	0.37	1.16	1.32	1.19	1.08	0.21
17. When you feel stressed, it can help:	−0.26	0.37	0.84	−1.37	0.76	−1.44	0.56
6. When you exercise, you should:	−0.01	0.37	0.90	−0.70	0.86	−0.68	0.48
23. People with Cystic Fibrosis take vitamins A, D, E and K because these vitamins:	−0.01	0.37	1.25	1.76	1.33	1.60	0.11
1. Pulmonary function tests (PFT) is the name used by physicians for tests that:	−0.15	0.38	0.88	−0.85	0.84	−0.77	0.50
9. How can you decrease the number of lung infections you get?	−0.15	0.38	0.95	−0.33	0.91	−0.39	0.43
20. Being open and communicative with your Cystic Fibrosis team is important because:	−0.30	0.38	0.85	−0.95	0.75	−1.11	0.54
16. Adolescents with Cystic Fibrosis should eat:	−0.45	0.39	0.85	−0.88	0.83	−0.62	0.51
12. Changes in your mucus, and cough or energy levels:	−0.60	0.40	1.31	1.54	1.59	1.88	−0.01
14. Your Cystic Fibrosis team will check your blood glycose:	−0.60	0.40	1.17	0.90	1.06	0.31	0.22
19. One way to add calories to scrambled eggs is:	−0.60	0.40	1.11	0.62	1.09	0.39	0.26
21. To avoid acquiring new bacteria in your lungs, you should:	−0.60	0.40	0.79	−1.15	0.69	−1.15	0.58
22. Adolescents with Cystic Fibrosis need to eat more because:	−0.60	0.40	1.04	0.25	1.13	0.53	0.30
7. If your body is not digesting fat from the foods you eat, your stool may:	−0.95	0.43	0.87	−0.50	0.74	−0.71	0.49
5. Cramps in the stomach and gases can be signs of hunger and:	−1.60	0.51	1.03	0.20	0.72	−0.42	0.34
18. With Cystic Fibrosis, cough:	−1.60	0.51	1.16	0.56	2.07	1.76	0.05
Mean	0.00	0.40	1.00	0.01	1.02	−0.01

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[TFN1] SD: Standard deviation; kg/m²: kilograms per square meter; FEV₁: forced expiratory volume in one second; KDM-CF-Adolescent-Brazil: Knowledge of disease management-Cistic Fibrosis-adolescent Brazil.

Parameter		n=35
Age (years), mean±SD (minimum-maximum)		15.7±3.1 (11-20)
Sex (males), n (%)		23 (65.7)
Schooling, n (%)	Elementary	13 (37.1)
	Middle	21 (60)
	High	1 (2.9)
Body mass index (m/kg²)		20.2 ±3.8 (13-31.6)
Physical activity (yes), n (%)		25 (71.4)
Hospitalization (yes), n (%)		14 (40)
VEF₁% of predicted (n=21) mean±SD		72.1±14.7
Pancreatic insufficiency (yes), n (%)		25 (71)
Antibiotic use
One, n (%)		15 (43)
Two, n (%)		4 (11)
None, n (%)		16 (46)
KDM-CF-Adolescent- Brazil (scores), mean±SD (minimum-maximum)		13±4.4 (4-20)

Item	Criteria	Score
Time for administration, analysis and interpretation	< 10 minutes: score 3	2
	10 to 30 minutes: score 2
	30 to 60 minutes: score 1
	60 minutes: zero score
Cost	< 100 BRL: score 3	3
	to 500 BRL: score 2
	500 to 1,000 BRL: score 1
	1,000 BRL: zero score
Need for equipment and training	No: score 2	2
	Yes, but it’s simple, easy to use and requires no specialized training: score 1
	Yes: zero score
Portability	Yes, it fits in a bag: score 2	2
	Yes, it fits in a briefcase or cart: score 1
	No: zero score
KDM-FC-Adolescent-Brazil total score		9