title: CROSS-CULTURAL VALIDATION OF THE PORTUGUESE VERSION OF THE EDUCATIONAL NEEDS ASSESSMENT TOOL (PortENAT).
abstract: OBJECTIVE
  To undertake a cross-cultural adaptation and validation of the educational needs assessment tool (ENAT) into Portuguese.
  
  
  METHODS
  The first phase of this research (cross-cultural adaptation) utilised a well-established translation method comprising five sequential steps: forward-translation, synthesis of translations, back-translation, expert committee and field-testing of the adapted version. The second phase involved collecting data from 123 patients and subjecting them to Rasch analysis for validity testing including cross-cultural invariance.
  
  
  RESULTS
  The translation and field-testing phase went smoothly giving rise to minor adjustments in the phrasing of some items. The preliminary analysis of the 39 items, revealed some deviations from the model with the overall item-person interaction fit statistics 2(df) = 56.025 (39), p = 0.038. Significant item-item correlations caused artificial inflation of the internal consistency, therefore violating the model assumption of local independence of items. To correct this, all locally dependent items were then grouped into their respective domains, creating a 7 testlet-scale which demonstrated a good fit to the Rasch model, 2(df) = 2.625 (7), p = 0.917 and internal consistency PSI = 0.975. Analysis of the pooled (Portuguese and the English) data revealed cross-cultural DIF, requiring adjustments in two testlets: 'treatments' and 'support' which ensured cross-cultural equivalence.
  
  
  CONCLUSIONS
  This study confirms the Portuguese ENAT is a robust unidimensional tool with which to assess the educational needs of Portuguese people with RA. Cross-cultural adjustments are required only if the data from Portugal and the UK are pooled or compared. The tool is now available for use in clinical practice and research.
authors.forename: A
authors.initials: A
authors.lastname: Cruz
authors.forename: P
authors.initials: P
authors.lastname: Machado
authors.forename: J
authors.initials: J
authors.lastname: Hill
authors.forename: M
authors.initials: M
authors.lastname: Campos
authors.forename: J
authors.initials: J
authors.lastname: Apóstolo
authors.forename: A
authors.initials: A
authors.lastname: Marques
authors.forename: A
authors.initials: A
authors.lastname: Malcata
authors.forename: M
authors.initials: M
authors.lastname: Ndosi
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D010353:Patient Education as Topic; D012648:Self Care; D014177:Translations