TRANSLATION, CROSS-CULTURAL ADAPTATION AND MEASUREMENT PROPERTIES
OF THE ENGLISH VERSION OF THE LEVEL OF INSTITUTIONALIZATION (LOIN)
SCALES FOR HEALTH PROMOTION PROGRAMS
Implementation Science, Evidence-Based Practice, Sustainability.
Introduction: The LOIN scale aims to assess the level of integration of a program or intervention within an organization, such as hospitals and clinics. This evaluation is based on the routinization and niche saturation across four subsystems: production, maintenance, support, and management. Objective: To translate and culturally adapt the LOIN scale, validate it, and test its measurement properties for use in Brazil. Methodology: This is a longitudinal descriptive study with a clinimetric design, following COSMIN guidelines as the basis for development. Two Portuguese-BR native translators were invited: one with a health background and knowledge of LOIN, and the other without a health background and unfamiliar with the instrument. Two separate translations were produced, followed by a meeting to synthesize the two translations and resolve discrepancies, resulting in version 1 of the translated instrument. Version 1 was sent to a back translator who was a native American speaker to undergo a back translation process, ensuring that the translated version reflected the same content as the original version’s items, thus generating version 2. This was then evaluated by an expert committee, where versions 1 and 2 were compared to identify and resolve discrepancies between the English and Portuguese versions, ensuring that the PortugueseBrazilian translation and adaptation of the LOIN achieved semantic, idiomatic, experiential (cultural), and conceptual equivalence. Following the committee’s decisions, a pre-final version was applied to 10 managers, who responded to the scale and completed a questionnaire, as well as a Likert-type questionnaire, varying from 1 (I don’t understand) to 5 (I fully understand). Inclusion criteria for the study were health service managers in public or private hospitals or clinics with at least 6 consecutive months in management roles, while exclusion criteria included those who had been terminated, resigned, or absent due to vacation or leave during the data collection process. Results: The translation and cultural adaptation of the instrument were performed by two Brazilian natives, with a back translation by an American native speaker to ensure that the original content was preserved. For the analysis, a positive assessment was defined as IVC ≥ 0.8, while a negative assessment was defined as IVC < 0.8. The IVC was calculated as IVC = (Number of “4” and “5” responses / Total responses) x 100, and descriptive analysis of the manager's questionnaire was performed using Jamovi, employing the ShapiroWilk test, mean ± SD, and median with percentiles. The variable analysis showed that the managers responded to the questionnaire in the first phase with minimal difficulty, yielding an IVC of 82.5%. Conclusion: After analysis, we observed that the IVC reached a value of 82.5%, validating the content described by the translators. Keywords: Implementation Science, Evidence-Based Practice, Sustainability.