Cultural adaptation and content validation of the RAC (Rodríguez-Almeida-Cañon) adult infection risk assessment scale for portuguese from Portugal

Authors

  • Mónica Martins Unidade Local de Saúde do Oeste, Caldas da Rainha, Portugal | Instituto Politécnico de Leiria, Leiria, Portugal https://orcid.org/0009-0003-6705-1179
  • Luís Todo Bom Instituto Politécnico de Leiria, Leiria, Portugal | Unidade Local de Saúde da Região de Leiria, Leiria, Portugal | Comprehensive Health Research Centre (CHRC), Évora, Portugal | Centre for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal https://orcid.org/0000-0001-6739-8648
  • Filipe Paiva-Santos UICISA: E - Unidade de Investigação em Ciências da Saúde: Enfermagem, Coimbra, Portugal https://orcid.org/0000-0003-0962-6635
  • Maria dos Anjos Dixe Instituto Politécnico de Leiria, Leiria, Portugal | Centre for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal https://orcid.org/0000-0001-9035-8548
  • Cristina Costeira Instituto Politécnico de Leiria, Leiria, Portugal | UICISA: E - Unidade de Investigação em Ciências da Saúde: Enfermagem, Coimbra, Portugal | Centre for Innovative Care and Health Technology (ciTechCare), Leiria, Portugal https://orcid.org/0000-0002-4648-355X

DOI:

https://doi.org/10.29352/mill0228.41505

Keywords:

risk measurement; hospital-acquired infection; infection control; validation study

Abstract

Introduction: Healthcare-Associated Infections (HAIs) have been a concern in the healthcare field due to their impact on public health. Therefore, risk stratification of hospitalized populations, using validated instruments, is essential for implementing effective measures to prevent HAIs.

Objective: Aimed to culturally adapt the RAC Infection Risk Assessment Scale (Rodríguez-Almeida-Cañon) for adult patients. This article describes the following steps: preparation, preliminary translation, back-translation, review of the back-translation, and content validation through a panel of experts.

Methods: After translating and back-translating the scale using bilingual translators, content validation was carried out through a Delphi panel involving 11 experts in the field of HAIs, of both sexes, with clinical experience and/or previous involvement in infection prevention and control research. The items of the RAC scale were evaluated for clarity, theoretical relevance, and practical pertinence. La validez de contenido se determinó mediante el índice de validez de contenido.

Results: Based on the feedback from the experts, there was consensus to retain the 15 assessment items, grouped into intrinsic and extrinsic factors. The Portuguese (Portugal) version of the scale achieved a 95% agreement level.

Conclusion: The RAC scale proved to be valid in terms of content. The use of infection risk assessment instruments is essential for infection prevention, contributing to improved quality of care and guiding healthcare professionals’ interventions. To ensure the validity of the scale, a psychometric validation will also be conducted.

Downloads

Download data is not yet available.

References

Acelas, A. L. R. (2017). Escala de avaliação do risco de infecção no adulto hospitalizado: Desenvolvimento e validação. https://lume.ufrgs.br/handle/10183/238230

Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186–3191. https://doi.org/10.1097/00007632-200012150-00014

European Centre for Disease Prevention and Control. (2018). Healthcare-associated infections – a threat to patient safety in Europe. https://www.ecdc.europa.eu/en/publications-data/infographic-healthcare-associated-infections-threat-patient-safety-europe

Gaynes, R., Edwards, J. R., & National Nosocomial Infections Surveillance System. (2005). Overview of nosocomial infections caused by gram-negative bacilli. Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America, 41(6), 848–854. https://doi.org/10.1086/432803

Jünger, S., Payne, S. A., Brine, J., Radbruch, L., & Brearley, S. G. (2017). Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: Recommendations based on a methodological systematic review. Palliative Medicine, 31(8), 684–706. https://doi.org/10.1177/0269216317690685

Khan, H. A., Baig, F. K., & Mehboob, R. (2017). Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine, 7(5), 478–482. https://doi.org/10.1016/j.apjtb.2017.01.019

Lynn, M. R. (1986). Determination and quantification of content validity. Nursing Research, 35(6), 382–385.

Markus, K., Smith, K., & Salkind, N. (2025). Encyclopedia of Research Design (Vol. 1–0). SAGE Publications, Inc. https://doi.org/10.4135/9781412961288

McMillan, S. S., King, M., & Tully, M. P. (2016). How to use the nominal group and Delphi techniques. International Journal of Clinical Pharmacy, 38(3), 655–662. https://doi.org/10.1007/s11096-016-0257-x

Monegro, A. F., Muppidi, V., & Regunath, H. (2025). Hospital-Acquired Infections. Em StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK441857/

Ordem dos Enfermeiros. (2017). Padrões de qualidade dos cuidados especializados em enfermagem médico-cirúrgica. https://www.ordemenfermeiros.pt/media/5681/ponto- 2_padroes-qualidade-emc_rev.pdf

Polit, D. F., & Beck, C. T. (2006). The content validity index: Are you sure you know what’s being reported? critique and recommendations. Research in Nursing & Health, 29(5), 489–497. https://doi.org/10.1002/nur.20147

Polit, D. F., Beck, C. T., & Owen, S. V. (2007). Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in Nursing & Health, 30(4), 459–467. https://doi.org/10.1002/nur.20199

Rodríguez Acelas, A. L., Montañez, W. C., & Almeida, M. D. A. (2019). Scale for measurement of healthcare-associated infection risk in adult patients: Development and content validation. Revista Cuidarte. https://doi.org/10.15649/cuidarte.v10i2.771

Rodríguez-Acelas, A. L., Cañon-Montañez, W., & Almeida, M. de A. (2019). Escala para a medição do risco de infecção associada à assistência à saúde em pacientes adultos: Desenvolvimento e validação de conteúdo. Revista Cuidarte, 10(2). https://doi.org/10.15649/cuidarte.v10i2.771

Rodríguez-Acelas, A. L., Cañon-Montañez, W., Almeida, M. de A., Rodríguez-Acelas, A. L., Cañon-Montañez, W., & Almeida, M. de A. (2019). Scale for measurement of healthcare-associated infection risk in adult patients: Development and content validation. Revista Cuidarte, 10(2). https://doi.org/10.15649/cuidarte.v10i2.771

Rodríguez-Acelas, A. L., de Abreu Almeida, M., Engelman, B., & Cañon-Montañez, W. (2017). Risk factors for health care-associated infection in hospitalized adults: Systematic review and meta-analysis. American Journal of Infection Control, 45(12), e149–e156. https://doi.org/10.1016/j.ajic.2017.08.016

Rodríguez-Acelas, A. L., de Abreu Almeida, M., Schmarczek Figueiredo, M., Monteiro Mantovani, V., Mattiello, R., & Cañon-Montañez, W. (2021). Validity and reliability of the RAC adult infection risk scale: A new instrument to measure healthcare-associated infection risk. Research in Nursing & Health, 44(4), 672–680. https://doi.org/10.1002/nur.22139

Rodríguez-Acelas, A. L., López de Ávila, M., Yampuezán Getial, D., de Abreu Almeida, M., & Cañon-Montañez, W. (2022). Adaptación transcultural para Colombia y validez de contenido de la escala RAC de evaluación del riesgo de infección en el adulto hospitalizado. rev.cuid. (Bucaramanga.2010), 1–14.

Rodríguez-Acelas, A. L., López De Ávila, M., Yampuezán Getial, D., De Abreu Almeida, M., & Cañon-Montañez, W. (2022). Adaptación transcultural para Colombia y validez de contenido de la escala RAC de evaluación del riesgo de infección en el adulto hospitalizado. Revista Cuidarte. https://doi.org/10.15649/cuidarte.2406

Rosenthal, V. D., Guzman, S., & Safdar, N. (2005). Reduction in nosocomial infection with improved hand hygiene in intensive care units of a tertiary care hospital in Argentina. American Journal of Infection Control, 33(7), 392–397. https://doi.org/10.1016/j.ajic.2004.08.009

Siracusa, M., Scuri, s., & Grappasonni, I. (2019). Healthcare acquired infections: Malpractice and litigation issues. Annali Di Igiene Medicina Preventiva e Di Comunità, 5, 496–506. https://doi.org/10.7416/ai.2019.2310

The World Medical Association. (2024). Declaration of Helsinki – Ethical Principles for Medical Research Involving Human Participants. https://www.wma.net/policies-post/wma-declaration-of-helsinki/

Trindade, C. S., Kato, S. K., Gurgel, L. G., & Reppold, C. T. (2018aWh). Processo de construção e busca de evidências de validade de conteúdo da equalis-OAS. Revista Avaliação Psicológica, 271–277. https://doi.org/10.15689/ap.2018.1702.14501.13

Walraven, C., & Musselman, R. (2013). The Surgical Site Infection Risk Score (SSIRS): A Model to Predict the Risk of Surgical Site Infections. PloS One, 8(6), e67167. https://doi.org/10.1371/journal.pone.0067167

Whitehead, M., & Dahlgren, G. (1991). What can be done about inequalities in health? Lancet (London, England), 338(8774), 1059–1063. https://doi.org/10.1016/0140-6736(91)91911-d

World Health Organization. (2002). Quality of care: Patient safety: Fifty-fifth World Health Assembly Provisional. https://apps.who.int/gb/archive/pdf_files/WHA55/ea5513.pdf

World Health Organization. (2011). Report on the Burden of Endemic Health Care-Associated Infection Worldwide. https://www.who.int/publications/i/item/report-on-the-burden-of-endemic-health-care-associated-infection-worldwide

World Health Organization. (2019). Minimum requirements for infection prevention and control programmes. https://www.who.int/publications/i/item/9789241516945

Yusoff, M. S. B. (2019). ABC of Content Validation and Content Validity Index Calculation. Education in Medicine Journal, 11(2), 49–54. https://doi.org/10.21315/eimj2019.11.2.6

Zaha, D. C., Kiss, R., Hegedűs, C., Gesztelyi, R., Bombicz, M., Muresan, M., Pallag, A., Zrinyi, M., Pall, D., Vesa, C. M., & Micle, O. (2019). Recent Advances in Investigation, Prevention, and Management of Healthcare-Associated Infections (HAIs): Resistant Multidrug Strain Colonization and Its Risk Factors in an Intensive Care Unit of a University Hospital. BioMed Research International, 2019, 2510875. https://doi.org/10.1155/2019/2510875

Published

2025-10-15

How to Cite

Martins, M., Todo Bom, L., Paiva-Santos, F., Dixe, M. dos A., & Costeira, C. (2025). Cultural adaptation and content validation of the RAC (Rodríguez-Almeida-Cañon) adult infection risk assessment scale for portuguese from Portugal . Millenium - Journal of Education, Technologies, and Health, 2(28), e41505. https://doi.org/10.29352/mill0228.41505

Issue

Section

Life and Healthcare Sciences