Translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil) to evaluate patients with head and neck cancer

Abstract Introduction: Head and neck cancer is the sixth leading cause of death from cancer worldwide and its treatment may involve surgery, chemotherapy and/or radiation therapy. The surgical procedure may cause mutilating sequelae, that can alter patient self-image. Thus, head and neck cancer is often connected to the negative stigma with decreased quality of life. Few studies assess the social stigma and shame perceived by patients with head and neck cancer. Objective: To perform the translation and cultural adaptation of the Shame and Stigma Scale (SSS) into Portuguese (Brazil). Methods: Two independent translations (English into Portuguese) were carried out by two professionals fluent in the English language. After the synthesis of the translations, two independent back-translations (from Portuguese into English) were performed by two translators whose native language is English. All translations were critically assessed by a committee of experts consisting of five members. A sample of 15 patients answered the Brazilian Portuguese version of the SSS to carry out the pretest. At this step, the patients were able to suggest modifications and evaluate the understanding of the items. Results: There was no need to change the scale after this step. Based on the previous steps, we obtained the Portuguese (Brazil) version of the SSS, which was called "Escala de Vergonha e Estigma". Conclusion: The Portuguese (Brazil) version of the SSP was shown to be adequate to be applied to the population with HNC and, therefore, the psychometric properties of the tool will be evaluated during following steps.

**摘要 引言**：头颈部癌（Head and Neck Cancer, HNC）是全球第六大癌症致死病因，其治疗手段可涵盖手术、化学治疗及/或放射治疗。手术治疗可能引发毁损性后遗症，进而改变患者的自我形象。因此，头颈部癌常与负面污名相关联，导致患者生活质量下降。目前鲜有研究对头颈部癌患者所感知到的社会污名与羞耻感进行评估。

**研究目的**：对羞耻与污名量表（Shame and Stigma Scale, SSS）进行巴西葡萄牙语版的翻译与文化调适。

**研究方法**：由两名精通英语的专业人员独立完成两次英语至葡萄牙语的翻译。整合两次翻译内容后，由两名母语为英语的翻译人员独立完成两次葡萄牙语至英语的回译。由五名专家组成的委员会对所有翻译版本进行批判性审核评估。招募15名患者参与巴西葡萄牙语版SSS的预试验，在此阶段患者可提出修改建议并对条目的理解程度进行评价。

**研究结果**：经此阶段评估后，无需对该量表进行修改。基于上述步骤，我们最终获得了巴西葡萄牙语版SSS，将其命名为"Escala de Vergonha e Estigma"。

**研究结论**：巴西葡萄牙语版SSP适用于头颈部癌人群，因此后续研究将对该工具的心理测量学特性进行评估。