Measurement of contextual factors related to the management of chronic musculoskeletal pain – cross-cultural adaptation of the short form of the Healing Encounters and Attitudes Lists (HEAL) for the Brazilian context

Abstract

Introduction: Several contextual factors are related to therapeutic interventions and can positive or negative impact the symptoms of patients with chronic musculoskeletal pain. Despite the increasing use of self-administered measurement instruments, there is currently no tool available to assess the interference of contextual factors in health treatments in Brazil. The Healing Encounters and Attitudes Lists (HEAL) tool assesses patients' perceptions and attitudes about contextual factors that interfere with health treatments. Objective: The aim of this thesis was to translate and cross-culturally adapt the short form of the HEAL tool to the Brazilian context. Methods: A translation and cross-cultural adaptation study of the short form of the HEAL tool was conducted, including translation from English to Portuguese, back-translation, review by a committee of experts, and pre-testing with questionnaires on sociodemographic data, pain intensity, level of functionality, and the HEAL tool. A descriptive analysis of the pre-test participant data was performed, and the internal consistency of the instrument was assessed using Cronbach's alpha test. Results: Four translators, five specialists and thirty patients with chronic musculoskeletal pain participated in the study. The final version was well understood by the pre-test participants, except for the subscale “Attitudes towards Complementary and Alternative Medicine”, in which 70% of the participants had doubts. As a solution, examples were included in the items evaluated. The subscales of the HEAL tool showed excellent internal consistency (Cronbach's alpha between 0.88 and 0.92). Conclusion: The Brazilian version of the short form of the HEAL tool is available for research and clinical practice and can contribute to the identification of the interference of contextual factors in the treatment of chronic musculoskeletal pain. However, caution is recommended in the use of this tool until its psychometric properties are widely evaluated.