title: Sexual Dysfunction in Breast Cancer Survivors: Cross-Cultural Adaptation of the Sexual Activity Questionnaire for Use in Portugal.
abstract: BACKGROUND
  The increasing survivor population of breast cancer has shifted research and practice interests into the impacts of the disease and treatment in quality of life aspects. The lack of tools available in Portuguese to objectively evaluate sexual function led to the development of this study, which aimed to cross-culturally adapt and validate the Sexual Activity Questionnaire for use in Portugal.
  
  
  METHODS
  The questionnaire was translated and back-translated, refined following face-to-face interviews with seven breast cancer survivors, and then self-administered by a larger sample at baseline and a fortnight later to test validity and reliability.
  
  
  RESULTS
  Following cognitive debriefing (n = 7), minor changes were made and the Sexual Activity Questionnaire was then tested with 134 breast cancer survivors. A 3-factor structure explained 75.5% of the variance, comprising the Pleasure, Habit and Discomfort scales, all yielding good internal consistency (Cronbach's α > 0.70). Concurrent validity with the FACt-An and the BCPT checklist was good (Spearman's r > 0.65; p-value < 0.001) and reliability acceptable (Cohen's k > 0.444). The Sexual Activity Questionnaire allowed the identification of 23.9% of sexually inactive women, for whom the main reasons were lack of interest or motivation and not having a partner.
  
  
  CONCLUSIONS
  Patient-reported outcomes led to a more comprehensive and improved approach to cancer, tackling areas previously abandoned. Future research should focus on the validation of this scale in samples with different characteristics and even in the overall population to enable generalizability of the findings.
  
  
  CONCLUSIONS
  The adapted Sexual Activity Questionnaire is a valid tool for assessing sexual function in breast cancer survivors in Portugal.
authors.affiliation: Serviço de Epidemiologia. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal. Centro de Investigação Interdisciplinar Egas Moniz. Costa da Caparica. Portugal.
authors.forename: Filipa Alves
authors.initials: FA
authors.lastname: da Costa
authors.affiliation: Serviço de Epidemiologia. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal; Centro de Recursos Naturais e Ambiente. Instituto Superior Técnico. Universidade de Lisboa. Lisboa. Portugal.
authors.forename: Manuel Castro
authors.initials: MC
authors.lastname: Ribeiro
authors.affiliation: Serviço de Oncologia Médica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Braga
authors.affiliation: Unidade de Investigação Clínica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Carvalho
authors.affiliation: Unidade de Investigação Clínica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal.
authors.forename: Fátima
authors.initials: F
authors.lastname: Francisco
authors.affiliation: Serviço de Epidemiologia. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal.
authors.forename: Ana Costa
authors.initials: AC
authors.lastname: Miranda
authors.affiliation: Serviço de Oncologia Médica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal; Unidade de Investigação Clínica. Instituto Português de Oncologia de Lisboa Francisco Gentil. Lisboa. Portugal.
authors.forename: António
authors.initials: A
authors.lastname: Moreira
authors.affiliation: Unit of Psycho Oncology. Sussex Health Outcomes Research & Education in Cancer (SHORE-C). Brighton & Sussex Medical School. University of Sussex. Sussex. United Kingdom.
authors.forename: Lesley
authors.initials: L
authors.lastname: Fallowfield
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000150:complications* / Q000523:psychology*; D000073116:Cancer Survivors / Q000523:psychology*; D003466:Cultural Characteristics; D005260:Female; D006801:Humans; D008875:Middle Aged; D011174:Portugal; D015203:Reproducibility of Results; D057566:Self Report; D012725:Sexual Behavior; D012735:Sexual Dysfunction, Physiological / Q000209:etiology*; D020018:Sexual Dysfunctions, Psychological / Q000209:etiology*; D055815:Young Adult