Cross-cultural adaptation for Brazilian Portuguese and measurement properties of sexual function questionnaires for women: a systematic review

Saldanha, Maria Elisabete Salina; Padula, Rosimeire Simprini; Avila, Mariana Arias; Driusso, Patricia

doi:10.1590/1809-2950/20005128042021

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SYSTEMATIC REVIEW • Fisioter. Pesqui. 28 (4) • Oct-Dec 2021 • https://doi.org/10.1590/1809-2950/20005128042021 copy

Cross-cultural adaptation for Brazilian Portuguese and measurement properties of sexual function questionnaires for women: a systematic review

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ABSTRACT

This article aims to list questionnaires used to assess female sexual function, as well as to analyze the cross-cultural adaptation process for Brazilian Portuguese and the measurement properties tested. Search strategies were performed in the PubMed, Embase, CINAHL and LILACS databases, using words in English, Portuguese, and Spanish. Based on the inclusion criteria, data about the translation, cross-cultural adaptation, and measurement properties of each eligible questionnaire were extracted. The measurement properties reported were evaluated by two evaluators using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. The search returned a total of 46,987 studies, of which 131 were read in full, and only 12 were included in the review. Of the seven instruments that assess female sexual function found only three had their psychometric properties evaluated as good, with the Female Sexual Function Index (FSFI) being the most validated instrument for different clinical populations. There is a need to improve the validated versions of sexual dysfunction assessment instruments for the female population throughout their life cycle.

Keywords:
Sexuality; Physical Therapy Specialty; Psychometrics

Phase	Execution	Quality
1) Translation	Two or more independent translators must translate the method. Preferably, the translators should be native speakers of the target language.	0 There is no information about the translation;
		+ Translation performed by two or more independent translators;
		− Translation performed by a single translator;
		? Questionable translation process.
2) Synthesis of the translations	Translators must synthesize translations and generate a consensus translation.	0 There is no information on the synthesis or the translation was performed by only one translator;
		+ Synthesis performed by two or more translators;
		? Questionable synthesis process.
3) Back-translation	Two or more independent translators who are not aware of the original method must translate the consensus translation back to its source language.	0 There is no information on back-translation.
		+ Back-translation performed by two or more independent translators;
		− Back-translation performed by a single translator;
		? Questionable back-translation process.
4) Review committee	An expert committee should review the method versions and develop the pre-final version of the method.	0 There is no information about the expert committee;
		+ Clearly reported expert committee;
		? Questionable committee review process.
5) Pre-test of the pre-final version	Pre-final version must be tested on members of the target population.	+ Pre-test performed.
		? Doubtful design.
		0 There is no information about the pre-test.

Measurement property	Concept
Internal consistency	Homogeneity measure of a method's (sub)scale. It indicates the degree to which (sub)scale items are related to each other, and assesses whether they verify the same construct. Factor analysis must be applied to determine whether the (sub)scale items form a single dimension.
Reliability	Evaluates the extent to which participants can be differentiated from each other, despite measurement errors (relative error).
Measurement error	Assesses data measurement error and how it is reported in the study.
Agreement	Measures how close two or more repeated measures are to each other (absolute error).
Construct validity	Checks the extent to which the method score relates to other similar methods according to specific predefined correlation hypotheses.
Hypothesis testing	Assess whether the hypothesis and its correlations have been tested.
Cross-cultural adaptation validity	Assesses the cross-cultural adaptation process and if the expected steps were followed.
Validation criterion	Evaluates losses and if there was comparison with a standard “gold” scale.
Responsiveness	Ability of the method to detect clinical changes over time.

Method	Summary
PSFQ	The instrument assesses changes in sexual function during pregnancy, comprising 27 questions that relate the general idea of sex during pregnancy, body perception, the couple's intimate life, frequency of sexual intercourse, sexual desire and satisfaction, vaginal lubrication and dyspareunia. A pre-test was carried out with 30 pregnant women. The test and retest was performed with 100 pregnant women in the last trimester of pregnancy.
FSFI	The instrument consists of 19 questions divided into six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction and pain), with a score ranging from 2 to 36. The higher the score, the better the sexual function. One hundred women from the urology service were evaluated.
FSFI	The instrument consists of 19 questions divided into six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction and pain), with a score ranging from 2 to 36. The higher the score, the better the sexual function. Tested on women who voluntarily underwent surgical sterilization, systematically selecting 235 cases.
FSFI	The instrument consists of 19 questions divided into six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction and pain), with a score ranging from 2 to 36. The higher the score, the better the sexual function. A total of 215 women who spontaneously sought the service and were in a stable relationship were evaluated.
FSFI-pregnant	The instrument consists of 19 questions divided into six domains of sexual function (desire, arousal, lubrication, orgasm, satisfaction and pain), with a score ranging from 2 to 36. The higher the score, the better the sexual function. A total of 92 normal pregnant women were evaluated, 60 of whom participated in the cross-cultural adaptation phase and 32 in the testing and retesting of the instrument.
QS-F	It assesses the stages of sexual activity (desire, arousal, orgasm and their psychophysical correlates) using a 5-point scale with 10 questions; the higher the score, the better the sexual function. It was validated in a pre-test with 30 women with sexual dysfunction and, later, with 30 women without diagnosed sexual dysfunction, found by random searches of the institution's medical records.
SSS-W	Scale comprising 30 items that assess: personal sexual satisfaction, communication, compatibility, relational concerns, discomfort over sexual interpersonal relationship concerns, and personal concerns. Possible answers were given on a five-point Likert scale. The instrument was tested on a sample of 20 women.
PISQ-12	A pre-test was carried out with 25 women from the urogynecology and vaginal surgery clinic. Sixty-four women with urinary complaints and 68 women without urinary complaints participated in the final validation. The instrument has 12 questions divided into three domains: emotional-behavioral, physical and relationship. Answers are graded on a Likert scale, ranging from always, often, sometimes, rarely, and never, with scores from 0 to 48 points. The greater the score, the worse the sexual function.
QSF	Sexual function quality scale (all genders), with 40 questions. The proposal was a cross-cultural adaptation, but there was no testing of measurement properties, only one test with 18 people.
FSFM	The instrument assesses sexual dysfunction. It included nine domains, in which each item included was adapted according to the Likert scale. Participated in the pre-test 251 women and in the validation 196 women, with a mean age of 54 years, 2 to 15 years after natural menopause, treated at a gynecology outpatient clinic. The lower the score, the better the sexual function.
FSFI Online version	Instrument tested by online application, consisting of six domains, adapted and validated for Brazilian Portuguese by Hentschel et al.21 It was tested in 273 women, with a re-test in 15 days.

Method	Translation	Synthesis	Back-translation	Review committee	Pre-test
PSFQ	+	+	+	+	+
FSFI	+	?	+	+	+
FSFI	+	+	+	+	+
FSFI	+	+	−	+	−
FSFI-pregnant	+	+	−	+	+
SSS-W	+	−	−	+	−
PISQ-12	+	+	+	+	+
QSF	+	+	+	−	+
FSFM	+	+	+	−	−
QS-F	Not applicable - instrument developed in Brazilian Portuguese
FSFI Online version	Not applicable - study used the FSFM instrument cross-culturally adapted into Brazilian Portuguese by Hentschel et al.²¹21. Hentschel H, Alberton DL, Capp E, Goldim JR, Passos EP. Validação do female sexual function index (FSFI) para uso em língua portuguesa. Rev HCPA & Fac Med Univ Fed Rio Gd do Sul. 2007;27(1):10-4.

Instrument	General response requirements	Internal consistency	Reliability	Measurement error	Agreement	Structural validity	Hypothesis testing	Cross-cultural adaptation validity	Validation criterion	Responsiveness	Overall mean of results	Average of the variables related to the reproducibility of the instrument	Mean of the variables related to the validity of the instrument	Instrument responsiveness
PSFQ	4/4	10/10	12/13	9/11	5/5	6/6	3/10	14/14	3/6	7/17	73/96	24/26	38/49	7/17
	100%	100%	87%	72%	100%	100%	30%	100%	46%	40%	77.4%	90%	72%	40%
											Excellent	Excellent	Excellent	Weak
FSFI	3/4	8/10	9/13	9/11	4/5	4/6	6/10	12/14	3/6	12/17	70/96	21/26	34/49	12/17
	80%	75%	77%	72%	71%	75%	78%	67%	50%	79%	72%	72%	69%	79%
											Good	Good	Good	Excellent
FSFI	3/4	8/10	5/13	5/11	2/5	4/6	2/10	12/14	2/6	2/17	58/96	15/26	25/49	2/17
	80%	82%	40%	41%	35%	66%	21%	89%	50%	14%	51%	52%	53%	14%
											Good	Good	Weak	Poor
FSFI	4/4	7/10	3/13	1/11	1/5	3/6	1/10	7/14	1/6	1/17	29/96	9/26	15/49	1/17
	75%	78%	40%	13%	27%	50%	13%	43%	14%	7%	36%	39%	32%	7%
											Weak	Weak	Weak	Poor
FSFI-pregnant	3/4	3/10	8/13	6/11	2/5	2/6	4/10	10/14	3/6	13/17	54/96	11/26	27/49	13/17
	80%	39%	62%	63%	57%	58%	47%	83%	53%	81%	62%	53%	60%	81%
											Good	Good	Good	Excellent
QS-F	1/4	1/10	1/13	0/11	0/5	0/6	0/10	Not applicable	0/6	0/17	3/82	1/26	1/35	0/17
	20%	25%	8%	16%	7%	16%	0%		15%	6%	12%	16%	9%	6%
											Poor	Poor	Poor	Poor
SSS-W	1/4	0/10	0/13	0/11	0/5	0/6	0/10	1/14	0/6	0/17	2/96	0/26	1/49	0/17
	20%	9%	0%	0%	0%	0%	0%	18%	0%	0%	5%	0%	3.6%	0%
											Poor	Poor	Poor	Poor
PISQ-12	3/4	6/10	11/13	9/11	4/5	3/6	8/10	9/14	4/6	14/17	71/82	19/26	35/49	14/17
	80%	67%	91%	86%	85%	66%	86%	64%	84%	84%	80%	79%	78%	84%
											Excellent	Excellent	Excellent	Excellent
QSF	Not applicable	Not applicable	Not applicable	Not applicable	Not applicable	Not applicable	Not applicable	5/14	Not applicable	Not applicable	5/96	Not applicable	5/49	Not applicable
								35%			3.5%		7%
											Poor		Poor
FSFM	3/4	4/10	4/13	2/8	4/5	3/6	7/10	12/14	4/6	11/17	54/96	10/26	30/49	11/17
	80%	54%	28%	26%	92%	75%	78%	81%	80%	64%	65%	57%	68%	64%
											Good	(Good)	(Good)	Good
FSFI	4/4	9/10	11/13	9/11	5/5	5/6	8/10	Not applicable	5/6	16/17	72/82	23/26	29/35	16/17
	100%	96%	94%	93%	100%	91%	91%		96%	97%	95%	96%	93%	97%
											Excellent	Excellent	Excellent	Excellent

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[1] Corresponding address: Patricia Driusso - Rodovia Washington Luís, km 235 - São Carlos (SP), Brazil - ZIP Code: 13565-090 - E-mail: pdriusso@ufscar.br