Translation and Cross-Cultural Adaptation of the “Child Drawing: Hospital” (CD:H) Scale for Paediatric Dentistry in Brazil

Custódio, Natália Baschirotto; Mathias, Fernanda Burkert; Cademartori, Mariana Gonzalez; Goettems, Marília Leão

doi:10.1590/pboci.2023.005

Natália Baschirotto Custódio

contributed to critical review of intellectual content

approval of the final version

Conceptualization

Methodology

Validation

Investigation

Writing - Original Draft

Writing - Review and Editing

Supervision

Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

https://orcid.org/0000-0003-0724-0069

Fernanda Burkert Mathias

contributed to critical review of intellectual content

approval of the final version

Methodology

Validation

Formal Analysis

Investigation

Writing - Original Draft

Writing - Review and Editing

Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

https://orcid.org/0000-0002-1617-6727

Mariana Gonzalez Cademartori Mariana Cademartori, 457, Gonçalves Chaves Street, Pelotas, RS, Brazil. E-mail: marianacademartori@gmail.com

contributed to critical review of intellectual content

approval of the final version

Conceptualization

Methodology

Validation

Formal Analysis

Investigation

Data Curation

Writing - Original Draft

Writing - Review and Editing

Supervision

Project Administration

Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

https://orcid.org/0000-0002-2433-8298

Marília Leão Goettems

contributed to critical review of intellectual content

approval of the final version

Conceptualization

Methodology

Validation

Formal Analysis

Investigation

Writing - Original Draft

Writing - Review and Editing

Supervision

Project Administration

Postgraduate Program in Dentistry, Federal University of Pelotas, Pelotas, Rio Grande do Sul, Brazil.

https://orcid.org/0000-0002-6512-2602

Mariana Cademartori, 457, Gonçalves Chaves Street, Pelotas, RS, Brazil. E-mail: marianacademartori@gmail.com

How to cite: Custódio NB, Mathias FB, Cademartori MG, Goettems ML. Translation and cross-cultural adaptation of the “Child Drawing: Hospital” (CD:H) scale for paediatric dentistry in Brazil. Pesqui Bras Odontopediatria Clín Integr. 2023; 23:e210229. https://doi.org/10.1590/pboci.2023.005

Academic Editor: Ana Maria Gondim Valença

Conflict of Interest

The authors declare no conflicts of interest.

Section A	1	2	3	4	5	6	7	8	9	10
1. Position of person	Standing-grounded	Standing-not grounded	Standing with crutches	Standing on bed/dental chair	Sitting in regular chair	Sitting in bed/dental chair	Sitting in bed/dental chair, covered	Lying in bed/dental chair	Lying in bed/dental chair covered	Floating or no person
2. Action - Life	Visibly moving		Person or Picture lively		Shows some life		Potential for movement	No movement, but life		Rigid, no life
3. Length of person	Body tall, occupies whole paper	Tall body appropriate to picture	Short body appropriate to picture		Short people, bodies exposed		Very small, constricted people	Upper torso only	Head only, body covered	Floating head, no body
4. Width of person related to length	Width appropriate to length	Width slightly reduced compared to length	Width thin compared to length clothed	Width thin, not clothed, or appropriate, but not clothed	Appropriate body size, covered	Stick figures. with clothing	Stick figures. Not clothing	Very thin body or stick figure, covered	Ambiguous body shapes	No body, floating head, no evidence of body under covers
5. Facial Expression	Smile		1/2 smile		Neutral			1/2 Frown	Frown	No face, no expression
6. Eyes/pupils						Piercing	Pinpoint	Closed	Vacant, unseeing	No eyes
7. Size of person in comparison to environment	Appropriate size		Medium to small		Small			Very small		Tiny, overwhelmed
8. Color predominance	Yellow		Green		Blue	Orange	Purple	Brown	Red	Black
9. Number colors used	8	7	6		5	4	3		2	1
10. Use of paper	All		3/4		1/2			1/4		Restricted to 1/6 of the sheet
11. Placement on paper
12. Quality of strokes	Firm, dark		Dark, some light		Medium, equal light and dark			Light		Very light
13. Dental equipment	None included		Proportional in size		Slight increase in size			Larger equipment		Large and threatening
14. Developmental level	Above normal		Normal		Slight below normal			Below normal		Markedly below normal

Total Score CD: H	Anxiety Level	Necessary Intervention
≤ 43	Very low	Intervention with parents can provide means to stimulate the child's coping ability.
44-83	Low	Intervention with the child can prevent the development of difficulties.
84-129	Medium	Recommendation of daily intervention with therapeutic toy.
130-167	High	Continue the intervention daily with therapeutic toys; consultation with the psychologist.
≥ 168	Very High	Forward to the psychologist.

Item	Changes Needed
Part A
1. Position of person	The word “solo” was replaced by the word “floor”, the word dental chair was added to the scores to contextualize the dental environment.
2. Portrayal of action/life	The score drawings were modified for the dentistry context, as well as the explanations of each score. The words dental chair, dental instrument, dental owl, and bib were added.
6. Eyes/ pupils	A discrepancy between the description of the items and the drawings on the original scale was identified. Thus, it was necessary to adapt the drawings to match the item descriptions.
7. Size of the person in comparison to the environment	In the original scale, there was no reference image for comparison with the item descriptions; therefore, a table with images was added to the work to facilitate interpretation.
8. Predominant color	A question was observed as to whether the item referred to “the color most used in the painting of the drawing”. For this reason, the expression “in the drawing” was added to the 10 scores of that item at the end of each score. For example: score 1: the yellow color is predominant in the drawing.
9. Number of colors used	The expression “all colors” was replaced by “8 colors”.
13. Inclusion/size of dental equipment	A table of specific drawings was added for each score, as requested in the suggestions of the scale's evaluators.
Part B	To facilitate interpretation, drawings were added for each item.

Item	Age (Years)	Scores CD:H scale				Anxiety Level
Item	Age (Years)	Part A	Part B	Part C	Global Score	Anxiety Level
Drawing 1	5	76	10	1	87	Medium
Drawing 2	9	62	10	5	77	Low
Drawing 3	10	89	5	7	101	Medium
Drawing 4	8	68	10	1	79	Low
Drawing 5	9	69	10	1	80	Low
Drawing 6	7	51	0	1	52	Low
Drawing 7	7	48	10	1	59	Low
Drawing 8	10	74	15	8	97	Medium
Drawing 9	7	58	5	5	68	Low
Drawing 10	6	52	0	1	53	Low
Drawing 11	7	44	10	1	55	Low
Drawing 12	6	65	0	1	66	Low
Drawing 13	5	39	15	1	55	Low
Drawing 14	6	50	10	1	61	Low
Drawing 15	8	43	0	1	44	Low

CD:H Scale	Reliability*	Reproducibility**
	Evaluators A and B wK (se)	Evaluator A wK (se)	Evaluator B wK (se)
Part A	0.8982 (0.1650)	0.9651 (0.1636)	0.9085 (0.1605)
Part B	0.9402 (0.1886)	0.9402 (0.1886)	0.8810 (0.1869)
Part C	0.7273 (0.1881)	0.8888 (0.1996)	0.6512 (0.2096)
Global score	0.9647 (0.1664)	0.9619 (0.1676)	0.8260 (0.1716)

[1] Mariana Cademartori, 457, Gonçalves Chaves Street, Pelotas, RS, Brazil. E-mail: marianacademartori@gmail.com

Brasil

Brasil

Translation and Cross-Cultural Adaptation of the “Child Drawing: Hospital” (CD:H) Scale for Paediatric Dentistry in Brazil

Abstract

Objective:

Material and Methods:

Results:

Conclusion: