Translation and validation of Warmometer, a tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese

ABSTRACT BACKGROUND: Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese. DESIGN AND SETTING: Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI). RESULTS: The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105). CONCLUSIONS: Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

【研究背景】医患关系中的共情与医疗实践中的重要结局密切相关。本研究旨在将用于评估医患关系温暖程度的可视化工具Warmometer进行巴西葡萄牙语版本的译制与效度验证。
【研究设计与实施场景】本研究为横断面研究，实施地点为巴西圣保罗一所公立大学附属医院的产前门诊。
【研究方法】该研究工具被译为巴西葡萄牙语并完成文化调适。研究于2015年6月至2016年1月期间开展，共纳入32名孕妇对该工具的信效度进行检验。为评估结构效度，本研究将该工具与医患关系共情评估金标准——问诊与关系共情量表（Consultation and Relational Empathy, CARE）以及人际反应指针量表（Interpersonal Reactivity Index, IRI）进行相关性分析。
【研究结果】Warmometer巴西葡萄牙语译版具有良好的表面效度与内容效度；同一评估者内部的重现性较低（组内相关系数（intraclass correlation coefficient, ICC）=0.224，95%置信区间（confidence interval, CI）：-0.589~0.621，P=0.242），而不同评估者之间的重现性较高（ICC=0.952，95%CI：0.902~0.977，P＜0.001）。Warmometer与CARE量表呈强相关性（r=0.632），与IRI量表呈弱相关性（r=0.105）。
【研究结论】本研究成功完成了Warmometer的巴西葡萄牙语译制、文化调适与效度验证。该译版工具可可靠地用于评估患者感知到的医患关系共情程度。