Article Text

Download PDFPDF

Original research
Translation and cultural adaptation of a prostate cancer screening decision aid: a qualitative study in Portugal
  1. Sofia Baptista1,2,3,
  2. Bruno Heleno4,5,
  3. Marta Pinto3,6,
  4. Bruna Guimarães2,
  5. Diogo China2,
  6. João Pedro Ramos6,
  7. Andreia Teixeira1,3,
  8. Kathryn L Taylor7,
  9. Carlos Martins1,3
  1. 1Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
  2. 2Serpa Pinto Family Medicine Unit, Agrupamento de Centros de Saúde Porto Ocidental, Porto, Portugal
  3. 3Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
  4. 4NOVA Medical School|Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, Lisboa, Portugal
  5. 5Comprehensive Health Research Center (CHRC), Universidade NOVA de Lisboa, Lisboa, Portugal
  6. 6Department of Psychology of deviance and justice, Faculty of Psychology and Education Sciences, University of Porto, Porto, Portugal
  7. 7Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
  1. Correspondence to Dr. Sofia Baptista; baptistas{at}


Objectives To translate and culturally adapt an English language patient decision aid addressing prostate cancer screening, so it can be used by Portuguese men.

Design Qualitative study. We followed the European Centre for Disease Prevention and Control’s (ECDC) five-step, stakeholder-based approach to adapting health communication materials: (1) selection of materials and process coordinators, (2) early review, (3) translation and back translation, (4) comprehension testing with cognitive semi-structured interviews and (5) proofreading. Content analysis was performed using Ligre software.

Setting and participants Cognitive interviews with 15 men to refine a decision aid after its translation. Eligible participants were Portuguese native-speaking men aged 55–69 years old recruited from the local community (urban and suburban) of Oporto district through advertisements in social media and senior universities between January and March 2019. A previous diagnosis of prostate cancer was the single exclusion criterion.

Results Five main themes are presented: informational content, information comprehension, sociocultural appropriateness, feelings and main message and personal perspective concerning prostate cancer screening. Most men found the translated version of the decision aid to be clear, comprehensive and appropriate for its target population, although some suggested that medical terms could be a barrier. The data collected from men’s interviews afforded the researchers the opportunity to clarify concepts and expand existing content.

Conclusions A decision aid was successfully translated and adapted to the Portuguese cultural setting. Our ECDC based approach can be replicated by other workgroups to translate and culturally adapt decision aids.

  • decision making
  • decision aid
  • patient participation
  • prostate cancer
  • screening
  • early detection

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from


  • Twitter @bruno_m_heleno, @mgfamiliarnet

  • Presented at 89th European General Practice Research Network meeting (EGPRN) - prize for best poster.

  • Contributors SB, BH, CM, MP and KLT designed the study. SB coordinated the translation process. SB, BG and DC conducted the interviews and their transcription, supervised by MP. SB and JPR coded the interviews. SB, JPR and AT undertook the data analysis. SB made the final manuscript. All authors approved the final manuscript after revising it critically.

  • Funding The authors have received financial support of €3808.20 from the #H4A Primary Healthcare Research Network scholars programme for support of research. This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDB/4255/2020).

  • Competing interests None declared.

  • Patient and public involvement statement As target end-users of the prostate cancer screening decision aid, men are at at the core of our methodology. They were first involved during the usability and comprehensibility testing by participating in cognitive interviews. Men’s opinions and preferences were used to refine the decision aid and complete its cultural adaptation. We also intend to make the decision aid publicly available to all Portuguese men.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Health Ethics Committee from Centro Hospitalar Universitário de São João/Faculdade de Medicina da Universidade do Porto (reference 339-18).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.