TRANSLATION AND CULTURAL ADAPTATION OF THE PRIMARY CARE ASSESSMENT TOOL

初级保健评估工具的翻译和文化适应

• 批准号: 7622832
• 负责人: RUTH E RIOS
• 金额: $ 1.41万
• 依托单位: UNIVERSITY OF PUERTO RICO MED SCIENCES
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2008-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7622832
• 关键词: AIDS/HIV problem; Accounting; Achievement; Acquired Immunodeficiency Syndrome; Address; Administrator; Adult; Advocate; Affect; Age; Ambulatory Care; American; Area; Authorization documentation; Back; Behavior; Caregivers; Caring; Case Manager; Characteristics; Charge; Child; Clinic; Clinical Management; Cognitive; Committee Members; Communities; Computer Retrieval of Information on Scientific Projects Database; Condition; Consultations; Device or Instrument Development; Disease; Educational Status; Effectiveness; English Language; Ethnic group; Female; Focus Groups; Fostering; Funding; General Population; General Practitioners; Grant; HIV; HIV Infections; HIV Seropositivity; Health; Health Services; Hispanics; Immunology; Institution; Instruction; Interview; Laboratories; Language; Language Development; Life; Light; Maintenance; Measures; Methodology; Methods; Modeling; Outcome; Participant; Patient Care; Patients; Personal Satisfaction; Persons; Physical Examination; Physicians; Play; Policies; Population; Preventive; Primary Care Physician; Primary Health Care; Process; Provider; Psychologist; Psychometrics; Puerto Rican; Puerto Rico; Quality of Care; Rate; Recommendation; Recruitment Activity; Rehabilitation therapy; Reporting; Research; Research Ethics Committees; Research Personnel; Resources; Role; Sampling; Schedule; Series; Services; Source; Specialist; System; Testing; Time; Training; Translating; Translations; United States National Institutes of Health; Visit; Well in self; Writing; antiretroviral therapy; disorder prevention; experience; improved; instrument; mortality; programs; skills; tool

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. 1. Specific Aims A strong primary care system has been recognized as a requirement for the achievement of effectiveness and equity in a health service system. In the clinical management of AIDS, previous studies show that the presence of a primary source of ambulatory care increases the likelihood of receiving antiretroviral therapy decreasing mortality rates. Primary care has been defined as that level of a health service system that provides entry into the system for all new needs and problems, provides person-focused rather than disease-oriented care over time, provides care for the most common problems in the community by providing preventive, curative, and rehabilitative services to maximize health and well-being, and coordinates or integrates care provided elsewhere or by others. The Primary Care Assessment Tools (PCAT) has been widely used as a measure to assess the health services delivery system according to the characteristics of their approach to providing primary care. We propose to translate into Spanish these instruments using the methods developed by Mat¿as-Carrelo and colleagues (2003) that aim to achieve a valid and generalizable instrument. We specifically aim to: a. To translate and culturally adapt the Primary Care Assessment Tools (PCAT) to Spanish for use with Puerto Ricans with HIV/AIDS. 2. Brief Project Description For the first step of the translation, a professional translator certified by the American Translation Association will translate the instruments from English to Spanish. Once the translation is done a committee of experts in the area who are fluent in both English and Spanish will review the Spanish instrument. The members of this committee must be fluent in both Spanish and English, must be familiar with the primary care services for people with HIV/AIDS in Puerto Rico, and knowledgeable about the constructs that the instruments assess. The experts committee would assess the content and technical equivalence. The recommendations of the expert committee will be incorporated to the instruments and presented to an additional review by providers and consumers of HIV/AIDS primary care services. Three different types of focus groups will be conducted, one will include HIV/ AIDS patients care providers, the second will include adult HIV/ AIDS patients consumers of primary care and the third will consist of administrators of primary care facilities. Participants for the focus groups will be recruited from immunology clinics. A convenience sample of 30 participants is expected, approximately 10 for each focus group. The focus groups aim to discuss the constructs under study and to assess the tools items comprehensibility, appropriateness, and relevance. To guide the discussion a series of open-ended questions will be developed to elicit participants point of view regarding the meaning of the constructs. Each item and the instructions in the instruments will also be reviewed individually. The next step will be to submit for a second review the recommendations from the focus groups to the experts committee. The committee will consider these recommendations and will provide a final version of the instruments. This process is done to assure that the language will be appropriate to the level of the cognitive, cultural and language development of the persons to be interviewed. This final version will be given to a professional translator certified by the American Translation Association and who is not familiar with the original version for back-translation, that is, to translate the final version to English. Finally, there will be a final review by the same committee of experts to compare both versions of the English instrument. This final step is essential to assure that the Spanish-version include items similar in meaning to those of the English language instrument. 3. Significance of the Study Primary care physicians can play an important role in helping patients to the management the progress of their conditions. Taking charge by making improvements in these areas can enhance patients feelings of well-being and mastery of their lives. Primary care providers can encourage and advocate for these positive behaviors with their patients in a supportive way. According to the Ryan White 2004 Report, more than two thirds of CARE Act funds were used for primary care and treatment in 2002. Almost one third of the recipients were 45 years or older; about 46 percent of recipients were black and about 20 percent were Hispanic; more than 31 percent of HIV-positive recipients were female; and 2 percent of recipients were children 12 years or younger. The current model of HIV/AIDS care often lacks a periodic, comprehensive physical examination and the routine laboratory and radiographic studies that are recommended as part of primary- and secondary-disease prevention for all adults. In addition to routine "HIV-directed" physical examinations every 3 to 4 months, patients over the age of 40 should undergo a yearly comprehensive physical examination and a detailed review of systems. Patients should be evaluated both for evidence of the complications of HIV infection and the normal health problems that affect adults. It may be necessary to schedule dedicated health-maintenance visits or collaborate closely with a primary care provider to address patients' health maintenance needs (Reiter, 2000). Several studies indicate that greater experience in HIV care leads to improved patient outcomes. The relation between outcomes and type of training (sub-specialist or generalist) is less clear, and studies have not distinguished between type of training and experience. Less experienced physicians may be able to provide high-quality care if appropriate consultation from expert physicians is available. Components of primary care, including accessibility, continuity, coordination, and comprehensiveness, are associated with better patient outcomes. Optimal care of HIV infection requires a combination of disease-specific expertise and primary care skills and organization (Hecht et al, 1999). In light of these results from previous studies, it is imperative to have available valid and reliable methodologies to provide evidence of the effectiveness of the primary care system providing services to HIV/AIDS patients. The Spanish-translation, and cultural adaptation test of the PCAT will make available a valid and reliable method of assessing the quality of the primary care system providing services for the HIV/AIDS patients that may be easily adapted to the general population including Puerto Ricans in mainland US, an ethnic group that represents a rising segment of the diverse US Latino population. The resulting instruments must be written in a grammatically correct and simple language, they would be comprehensible to the Spanish-speaking Puerto Rican population regardless of their educational level. 4. Preliminary results As proposed for the first step of the translation, a professional translator certified by the American Translation Association translated the instruments from English to Spanish. Once the translation was done a committee of experts in the area who are fluent in both English and Spanish reviewed the Spanish instrument. The members of this committee are fluent in both Spanish and English, are familiar with the primary care services in Puerto Rico, and knowledgeable about the constructs that the instruments assess. Since primary care for the population with HIV in Puerto Rico is provided by the same providers that offer care to the general population we added a step and included in the committee three primary care physicians, two community representatives (consumer perspective, adult and childs caregiver), two primary care facility administrators, a policy expert, an organizational psychologist with experience in instrument development and psychometrics (M. Rodr¿guez) and a health services researcher and program evaluator (R. Rios). The experts committee assessed the content and technical equivalence. The recommendations of the expert committee are in the process of being incorporated to the instruments. Their main concern was that the providers tool should be more specific in terms of identifying which setting is evaluating. Providers in Puerto Rico may serve in different administrative settings and could evaluate each setting in a different way. The research team is taking these concerns into account and is developing a set of questions that will be integrated to the main instrument. We hope to explore these concerns further with the providers focus groups. This initial committee considers that the HIV population in Puerto Rico is the one that receives the best primary care because of the efforts of the case managers. They identified the case managers as the one fostering specifically, coordination of services. As our third step, experts in HIV care have been already contacted to review and adapt the tools for HIV-primary care, before submitting the instruments to the focus groups. IRB authorizations have been approved.

该副本是使用众多研究子项目之一 由NIH/NCRR资助的中心赠款提供的资源。子弹和 调查员（PI）可能已经从其他NIH来源获得了主要资金， 因此可以在其他清晰的条目中代表。列出的机构是 对于中心，这是调查员的机构。 1。具体目的 强大的初级保健系统被认为是实现卫生服务系统中有效性和公平性的要求。在艾滋病的临床管理中，先前的研究表明，门诊护理的主要来源的存在增加了接受抗逆转录病毒疗法的可能性降低了死亡率。初级保健已被定义为卫生服务系统的水平，该系统为所有新需求和问题提供了进入系统，随着时间的推移提供了以人为中心的，而不是以疾病为导向的护理，为社区中最常见的问题提供了护理，通过提供预防性，治愈性和康复性服务，以最大程度地提高健康和福祉，以及在其他地方或其他地方或其他地方或其他地方或其他地方或综合服务。初级保健评估工具（PCAT）已被广泛用作根据其提供初级保健方法的特征评估卫生服务提供系统的措施。我们建议使用Mat�As-Carrelo及其同事（2003年）开发的方法转化为西班牙语，这些方法旨在获得有效且可推广的工具。 我们专门针对： 一个。将初级保健评估工具（PCAT）转化为西班牙语，以与艾滋病毒/艾滋病的波多黎各人一起使用。 2。简短项目描述 在翻译的第一步中，由美国翻译协会认证的专业翻译人员将把乐器从英语翻译成西班牙语。翻译完成后，该地区流利的英语和西班牙语的专家委员会将审查西班牙仪器。该委员会的成员必须流利的西班牙语和英语，必须熟悉波多黎各艾滋病毒/艾滋病患者的初级保健服务，并且对仪器评估的结构有了了解。专家委员会将评估内容和技术等效性。专家委员会的建议将纳入这些工具，并由艾滋病毒/艾滋病初级保健服务的提供者和消费者提交给额外的审查。将进行三种不同类型的焦点小组，其中一个将包括艾滋病毒/艾滋病患者护理提供者，第二个将包括成人艾滋病毒/艾滋病患者初级保健的消费者，第三个将由初级保健设施的管理人员组成。焦点小组的参与者将从免疫学诊所招募。预计有30名参与者的便利样本，每个焦点组约为10个。 焦点小组旨在讨论所研究的结构并评估工具项目的可理解性，适当性和相关性。为了指导讨论，将开发一系列开放式问题，以引起参与者关于结构含义的观点。每个项目和仪器中的说明也将进行单独审查。 下一步将是向专家委员会提交第二次审查焦点小组的建议。委员会将考虑这些建议，并将提供该工具的最终版本。进行此过程是为了确保该语言适合要采访的人的认知，文化和语言发展水平。该最终版本将提供给经美国翻译协会认证的专业翻译人员，并且不熟悉反向翻译的原始版本，也就是说，将最终版本翻译成英语。最后，同一专家委员会将进行最终审查，以比较两个版本的英语工具。这一最后一步对于确保西班牙语的含义与英语工具的含义相似，至关重要。 3。研究的意义 初级保健医师可以在帮助患者到管理状况进步方面发挥重要作用。通过改进这些领域来负责，可以增强患者对生活的幸福感和掌握的感觉。初级保健提供者可以以支持的方式鼓励和倡导患者进行这些积极的行为。根据Ryan White 2004年的报告，2002年使用了三分之二的护理法案基金进行初级保健和治疗。几乎三分之一的接受者为45岁或以上。大约46％的接收者是黑人，大约20％是西班牙裔。超过31％的HIV阳性接受者是女性。 2％的接受者是12岁以下的儿童。 当前的艾滋病毒/艾滋病护理模型通常缺乏周期性的，全面的体格检查以及常规的实验室和射线照相研究，这些研究被建议作为所有成年人预防初级和次要疾病的一部分。除了每3至4个月进行常规的“ HIV指导”体格检查外，40岁以上的患者还应进行年度全面的体格检查和系统详细审查。应对患者进行评估，以证明艾滋病毒感染并发症和影响成年人的正常健康问题。可能有必要安排专门的健康维护访问，或与初级保健提供者紧密合作，以满足患者的健康维持需求（Reiter，2000）。几项研究表明，艾滋病毒护理方面的更多经验会改善患者的结果。结局与培训类型之间的关系（亚专家或通才）尚不清楚，研究尚未区分培训类型和经验。如果有专家医师的适当咨询，经验较低的医生可能能够提供高质量的护理。初级保健的组成部分，包括可访问性，连续性，协调和全面性，与更好的患者结局有关。对艾滋病毒感染的最佳护理需要特定于疾病的专业知识和初级保健技能和组织（Hecht等，1999）。鉴于先前研究的这些结果，必须具有可用的有效和可靠的方法，以提供为艾滋病毒/艾滋病患者提供服务的初级保健系统有效性的证据。 西班牙翻译和PCAT的文化适应测试将使您提供一种有效可靠的方法，用于评估为艾滋病毒/艾滋病患者提供服务的质量，可轻松适应美国大陆上的普通人群，包括美国大陆，这是一个族裔，代表了美国拉美裔拉丁裔拉丁美洲人群的促进部分。由此产生的乐器必须用语法正确且简单的语言编写，无论其教育水平如何，它们都将全面地对讲西班牙语的波多黎各人口。 4。初步结果 正如翻译的第一步所提出的那样，由美国翻译协会认证的专业翻译员将工具从英语翻译成西班牙语。翻译完成后，该地区的专家委员会精通英语和西班牙语，对西班牙仪器进行了审查。该委员会的成员熟悉西班牙语和英语，熟悉波多黎各的初级保健服务，并了解了工具评估的结构。由于为波多黎各的艾滋病毒人群的初级保健由向普通人群提供护理的同一提供者提供，因此我们在委员会中增加了一步，包括三名初级保健医师，两名社区代表（消费者的观点，成人和儿童照顾者），两名初级保健设施管理员，两名政策专家，一名组织心理学家，具有仪器开发和心理学的组织经验（M. IDERSIORS和RODRESIORS和RODRS）（RODR？）（我助长）（RODR？dep）（Rodr dec）（Rodr？dec）。专家委员会评估了内容和技术等效性。 专家委员会的建议正在纳入工具。他们主要关心的是，在确定哪种设置正在评估的情况下，提供者工具应该更具体。波多黎各的提供者可以在不同的管理环境中服务，并且可以以不同的方式评估每个设置。研究团队正在考虑这些问题，并正在制定一组将集成到主要工具的问题。我们希望与提供者焦点小组进一步探讨这些问题。该初始委员会认为，由于案件经理的努力，波多黎各的艾滋病毒人口是获得最好的初级保健的人群。他们将案件经理确定为专门培养服务的人，即服务的协调。作为我们的第三步，在将工具提交焦点小组之前，已经联系了艾滋病毒护理专家，以审查和调整艾滋病毒主要护理工具。 IRB授权已获得批准。