Translation and cross-cultural adaptation of the hospital food access questionnaire for the brazilian population
DOI:
https://doi.org/10.21527/2176-7114.2026.51.16258Keywords:
Food Service, Diet Therapy, TranslationsAbstract
Objective: to translate and cross-culturally adapt the Hospital Food Access Questionnaire and administer it to hospitalized patients. Methods: in the first stage, the questionnaire was translated and adapted through six steps: initial translations, synthesis of translations, back-translation, committee review, pre-testing, and submission and approval. The Content Validity Index (CVI) was calculated based on the assessment conducted by a committee of experts established for this study, and the Misunderstanding Index (MI) was calculated based on the pre-test conducted with 11 hospitalized patients. In the second stage, a descriptive study was conducted using the final version of the questionnaire with 53 hospitalized patients. Socioeconomic, clinical, and anthropometric data were collected to characterize the sample. Results: all steps were completed. The CVI obtained from the assessment of the original, back-translated, and pre-final Portuguese versions was ≥ 80%, confirming the equivalence of the items. The MI in the pre-test was < 20% for all items. After administration of the questionnaire, frequency analysis showed that most patients (56.6%) were at risk or compromised regarding organizational and physical barriers. It was observed that 30.2% of patients did not receive food when a meal was missed and/or had difficulty reaching their food. Conclusion: the questionnaire translated and cross-culturally adapted into Portuguese was well understood by the target population, and a considerable frequency of barriers to food access was identified among the patients assessed.
References
1. Thibault R, Abbasoglu O, Ioannou E, Meija L, Ottens-Oussoren K, Pichard C, et al. ESPEN guideline on hospital nutrition. Clin Nutr. 2021;40(12):5684–709. DOI: https://doi.org/10.1016/j.clnu.2021.09.039
2. Vaillant MF, Alligier M, Baclet N, Capelle J, Dousseaux MP, Eyraud E, et al. Guidelines on Standard and Therapeutic Diets for Adults in Hospitals by the French Association of Nutritionist Dieticians (AFDN) and the French Speaking Society of Clinical Nutrition and Metabolism (SFNCM). Nutrients. 2021;13(7):2434. DOI: https://doi.org/10.3390/nu13072434
3. Wu XS, Miles A, Braakhuis AJ. Texture-Modified Diets, Nutritional Status and Mealtime Satisfaction: A Systematic Review. Healthcare. 2021;9(6):624. DOI: https://doi.org/10.3390/healthcare9060624
4. Dock-Nascimento D, Campos L, Dias M, Fabre M, Lopes N, Oliveira Junior P, et al. Dieta oral no ambiente hospitalar: posicionamento da BRASPEN. BRASPEN J 2022;37(3): 207-27. DOI: 10.37111/braspenj.2022.BRASPEN_dietaoral
5. Larby A, Roberts S, Desbrow B. Accuracy and adequacy of food supplied in therapeutic diets to hospitalised patients: An observational study. Nutr Diet. 2016;73(4):342–7. DOI: 10.1111/1747-0080.12270
6. Hope K, Ferguson M, Reidlinger DP, Agarwal E. “I don’t eat when I’m sick”: Older people’s food and mealtime experiences in hospital. Maturitas. 2017;97:6–13. DOI: http://dx.doi.org/10.1016/j.maturitas.2016.12.001
7. Kozica‐Olenski S, Treleaven E, Hewitt M, McRae P, Young A, Walsh Z, et al. Patient‐reported experiences of mealtime care and food access in acute and rehabilitation hospital settings: a cross‐sectional survey. J Hum Nutr Diet. 2021;34(4):687–94. DOI: 10.1111/jhn.12854
8. Correia MITD, Sulo S, Brunton C, Sulz I, Rodriguez D, Gomez G, et al. Prevalence of malnutrition risk and its association with mortality: nutritionDay Latin America survey results. Clin Nutr. 2021;40(9):5114–21. DOI: https://doi.org/10.1016/j.clnu.2021.07.023
9. Bellanti F, Lo Buglio A, Quiete S, Vendemiale G. Malnutrition in Hospitalized Old Patients: Screening and Diagnosis, Clinical Outcomes, and Management. Nutrients. 2022;14(4):910. DOI: https://doi.org/10.3390/nu14040910
10. Naithani S, Whelan K, Thomas J, Gulliford MC, Morgan M. Hospital inpatients’ experiences of access to food: a qualitative interview and observational study. Health Expect. 2008;11(3):294–303. DOI: 10.1111/j.1369-7625.2008.00495.x
11. Naithani S, Thomas JE, Whelan K, Morgan M, Gulliford MC. Experiences of food access in hospital. A new questionnaire measure. Clin Nutr. 2009;28(6):625–30. DOI: 10.1016/j.clnu.2009.04.020
12. Keller H, Allard J, Vesnaver E, Laporte M, Gramlich L, Bernier P, et al. Barriers to food intake in acute care hospitals: a report of the Canadian Malnutrition Task Force. J Hum Nutr Diet. 2015;28(6):546–57. DOI: 10.1111/jhn.12314
13. IBGE – Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios Contínua (PNAD Contínua): segurança alimentar 2024–2025. Rio de Janeiro: IBGE; 2025.
14. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures: Spine. 2000;25(24):3186–91.
15. Fortes CPDD, Araújo APDQC. Check list para tradução e Adaptação Transcultural de questionários em saúde. Cad Saúde Coletiva. 2019;27(2):202–9. DOI: 10.1590/1414-462X201900020002
16. Alexandre NMC, Coluci MZO. Validade de conteúdo nos processos de construção e adaptação de instrumentos de medidas. Ciênc Saúde Coletiva. 2011;16(7):3061–8. DOI: https://doi.org/10.1590/S1413-81232011000800006
17. Nusbaum L, Natour J, Ferraz MB, Goldenberg J. Translation, adaptation and validation of the Roland-Morris questionnaire - Brazil Roland-Morris. Braz J Med Biol Res. fevereiro de 2001;34(2):203–10. DOI: https://doi.org/10.1590/S0100-879X2001000200007
18. Spexoto MCB, Serrano SV, Halliday V, Maroco J, Campos JADB. Cancer Appetite and Symptom Questionnaire (CASQ) for Brazilian Patients: Cross-Cultural Adaptation and Validation Study. Eldabe S, organizador. PLOS ONE. 2016;11(6):e0156288. DOI: 10.1371/journal.pone.0156288
19. World Health Organization. Obesity: preventing and managing the globalepidemic. Genebra, 1997.
20. Organización Panamericana de la Salud. División de Promoción y Protección de la Salud. Encuesta Multicentrica salud beinestar y envejecimiento (SABE) em América Latina el Caribe: Informe Preliminar. In: XXXVI Reunión del Comité de investigaciones em Salud; p. 9-11 jun 2001; Kingston, Jamaica: OPAS, 2002
21. Tanaka M, Marques APA, Costa VS, Piovacari SMF, Sandoval LCN. Terapia nutricional oral. In: Piovacari SMF, Toledo DO, Figueiredo EJA. Equipe multiprofissional de terapia nutricional em prática. Rio de Janeiro: Atheneu, 2017. p. 235-259.
22. Waitzberg DL, Caiaffa WT, Correia MITD. Hospital malnutrition: the Brazilian national survey (IBRANUTRI): a study of 4000 patients. Nutrition. 2001;17(7–8):573–80. DOI: 10.1016/s0899-9007(01)00573-1
23. Dijkink S, Meier K, Krijnen P, Yeh DD, Velmahos GC, Schipper IB. Malnutrition and its effects in severely injured trauma patients. Eur J Trauma Emerg Surg. 2020;46(5):993–1004. DOI: https://doi.org/10.1007/s00068-020-01304-5
24. Baron MV, Itaquy VP, Santos TGD, Silveira JBD, Gelb GT, Nerys F, et al. Relação entre lesão por pressão e estado nutricional em pacientes hospitalizados: Revisão de literatura. Práticas Educ Mem e Oralidades - Rev Pemo. 2020;2(1):1-16. DOI: https://doi.org/10.47149/pemo.v2i1.3581
25. Pourhassan M, Rommersbach N, Lueg G, Klimek C, Schnatmann M, Liermann D, et al. The Impact of Malnutrition on Acute Muscle Wasting in Frail Older Hospitalized Patients. Nutrients. 2020;12(5):1387. DOI: 10.3390/nu12051387
26. Toledo DO, Piovacari SMF, Horie LM. Campanha “Diga não à desnutrição”: 11 passos importantes para combater a desnutrição hospitalar. 2018; 33(1):86-100.
27. Ehsan AN, Jones A, Saha S, Hathi P, Huang CC, Vengadassalapathy S, et al. Food insecurity and clinical outcomes in surgical trauma patients. JAMA Surg. 2025;160(5):545–552. https://doi.org/10.1001/jamasurg.2025.0045
28. Da Hora HRM, Rego Monteiro GT, Arica J. Confiabilidade em Questionários para Qualidade: Um Estudo com o Coeficiente Alfa de Cronbach. Prod Produção. 2010; 11(2):85-103. DOI: 10.22456/1983-8026.9321
29. Curtis LJ, Valaitis R, Laur C, Mcnicholl T, Nasser R, KELLER H. Low food intake in hospital: patient, institutional, and clinical factors. Applied physiology, nutrition, and metabolism. Physiologie appliquee, nutrition et metabolisme.2018; 43(12):1239–1246. DOI: 10.1139/apnm-2018-0064
30. Osman NS, Md Nor N, Md Sharif MS, Hamid SBA, Rahamat S. Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review. Nutrients. 2021;13(10):3649. DOI: https://doi.org/10.3390/nu13103649
31. Teeling SP, Coetzee H, Phillips M, McKiernan M, Ní ShÉ É, Igoe A. Reducing risk of development or exacerbation of nutritional deficits by optimizing patient access to mealtime assistance. Int J Qual Health Care. 2019;31(Supplement_1):6–13. DOI: 10.1093/intqhc/mzz060
32. IBGE – Instituto Brasileiro de Geografia e Estatística. Diretoria de pesquisa, Coordenação de Pesquisas de amostras por domicílio. Pesquisa Nacional por Amostra de Domicílios Contínuas, 2022. Disponível em: https://www.ibge.gov.br/estatisticas/ sociais/ trabalho/9171 -pesquisa-nacional-por-amostra-de-domicilios-continua-mensal.html
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