Abstract General Information

Title

TRANSLATION, CROSS-CULTURAL ADAPTATION AND VALIDATION OF THE SHORT SCREENING INSTRUMENT FOR PSYCHOLOGICAL PROBLEMS IN ENURESIS FOR USE IN BRAZIL (SSIPPE-BR)

Introduction and objective

Enuresis is common and affects about 15% of children aged seven years. The rate of clinically relevant psychological/psychiatric disorders is 20% to 30%, directly impacting adherence to effective therapy. The most common disorder is attention deficit and hyperactivity disorder (ADHD). The Short Screening Instrument for Psychological Problems in Enuresis (SSIPPE) is a quick application and easy to interpret tool that allows the initial screening of these comorbidities.

This study aimed to translate, culturally adapt, and validate the SSIPPE for Brazilian children and adolescents

Method

Six stages were performed for translation and cross-cultural adaptation: translation, synthesis of translations, reverse translation, preparation of the pre-final version of the translated instrument, test of comprehensibility of the pre-final version of the tool (applied to 40 people randomly recruited) and elaboration of the instrument adapted cross-culturally for Brazil. For the validation of the SSIPPE, the validated Brazilian version of the Child and Adolescent Behavior Inventory (CABI) was used.

Results

Validation was performed on 127 children and adolescents with a mean age of 9.7 ± 2.8 years, 48% male. Internal consistency was estimated by Cronbach's alpha for the total scale, and each domain ranged from 0.86 to 0.89, indicating very good internal consistency. A "scree plot" graph was created for factor analysis, and according to it, a model with three factors and 13 items was developed. No item had a reduced factorial load (less than 0.40) and had to be excluded. It is noteworthy that the standard model by factor analysis presented a good fit according to the Kaiser Meyer Olkin (KMO) statistic (0.755) and Bartlett's test (<0.001) and explained 70.5% of the data variability. Therefore, these results were identical to the theoretical model. No item had a factorial load lower than 0.4. In the reproducibility analysis (87% of the sample), the Kappa coefficient ranged from 0.94 to 1. There was a highly significant (p-value<0.001) and direct transfer (positive coefficients) between the three domains of the SSIPPE and all domains of the CABI evaluated. One hundred eleven individuals were assessed in the test and retest analysis (87.4% of the original sample). Among the items in the emotional problems domain, the evaluation of the Kappa coefficient in the total sample varied between 0.96 and 1, which can be considered almost perfect. Among the items in the domain symptoms of inattention, hyperactivity and impulsivity, the agreement was 100% (Kappa=1).

Conclusion

The SSIPPE-Br validated for the Brazilian population appears to be a reliable tool for rapid initial screening of emotional problems and inattention, hyperactivity and impulsivity symptoms for children and adolescents aged six to 17 years with enuresis, whose first language is Brazilian Portuguese. It is believed that the SSIPPE-Br will be helpful both in clinical practice and scientific research in Brazil.