Translation, cultural adaptation, and validation of the international patient decision aid standards minimal criteria instrument for the portuguese population

Abstract

Introduction. Patient decision aids support health care decision making by dynamically integrating evidence-based information with patients' values, goals, and preferences. However, most of these aids are available only in English, limiting accessibility for non-English-speaking populations. Although Portuguese is one of the most spoken languages worldwide, validated decision aids and evaluation instruments in Portuguese remain scarce. Objectives. To translate, culturally adapt, and conduct preliminary content validation of the International Patient Decision Aid Standards (IPDAS) Minimal Criteria instrument for the Portuguese population. Methods. A multidisciplinary team conducted a structured linguistic validation process, including forward and backward translation, synthesis meetings, expert committee review, and pilot testing. Clarity and content relevance were evaluated by a panel of 10 experts using a dichotomous clarity scale and a 4-point relevance scale. Quantitative measures included percentage agreement, Fleiss' kappa, and item-level and scale-level content validity indices (I-CVI, S-CVI/Ave). Qualitative input was gathered through open-ended responses and discussion during the expert panel meeting. Results. Five of the 44 criteria were identified as unclear by more than 20% of the expert panel and were revised. The overall agreement was high (0.93 [0.89; 0.97]), but Fleiss' kappa indicated low interrater agreement (0.03 [20.01; 0.08]). Eleven criteria were rated by at least 1 panel member as less relevant or in need of revision and were refined accordingly. For all criteria, the I-CVI was .0.79, and the overall S-CVI/Ave was 0.97. Fleiss' kappa for content validity was 20.02 [20.06; 0.02]. Conclusions. The Portuguese version of the IPDAS Minimal Criteria demonstrated strong content validity and linguistic appropriateness. This adapted instrument will enable more rigorous evaluation of patient decision aids in Portuguese-speaking contexts and support broader implementation of shared decision making.