Avaliação da fragilidade social de pessoas idosas: tradução, adaptação cultural e validação da "HALFT SCALE" no Brasil

Abstract

Frailty is considered a global health problem and is a multidimensional syndrome that increases in prevalence with age, in addition to being considered a predictor of negative health-related outcomes. It seriously impacts health systems, as frail individuals use community resources, hospitals and long-term care institutions more frequently. Studies on the biological dimension of frailty are the most common in the literature, it is important to highlight that the social dimension of frailty is less explored, as is the case in frailty assessment instruments. In 2018, Chinese researchers created a scale for screening social fragility called HALFT (Help, Participation, Loneliness, Financial and Talk) and which proved to be useful for screening elderly people in a process of social frailty. Objective: Translate, culturally adapt and validate the HALFT Scale for use in Brazil. Method: This is a methodological study, which respected the steps recommended in the literature, namely initial translation, consensual version, back-translation, evaluation by a committee of judges, pre-test and evaluation of psychometric properties. For this stage, the following instruments were used: Sociodemographic Characterization Questionnaire, HALFT Social Fragility Scale (EFS-HALFT); Tilburg Frailty Indicator (TFI); Subjective Frailty Assessment (ASF); Hospital Anxiety and Depression Scale (HADS); 12-Item Short-Form Health Survey (SF-12); Social Support Scale (MOS-SSS); UCLA Loneliness Scale (version 3). Data collection for the thesis involved the participation of 160 elderly people throughout the process of cultural adaptation and validation of the ESF-HALFT. This work was approved by the research ethics committee. Results: The initial translation of the HALFT Scale was carried out by two independent translators. The consensual version was then established by combining the translations, which was back-translated into English by a third translator. The name of the instrument underwent an adaptation, with the aim of facilitating its use in Brazil, so the Brazilian version was called the Social Fragility Scale (EFS-HALFT). The expert committee was made up of seven health professionals, all with expertise in frailty and/or the social area. Only one item on the scale had a content validity index lower than one (0.85). The instrument was pre-tested with 35 older person, who considered it clear and understandable, with no suggestions for changes. In analyzing the reliability (reproducibility) of the adapted version of the HALFT with test-retest of the scale with 23 participants, a Kappa index of 0.62 was obtained, showing good agreement. In the psychometric properties analysis stage, data collection included the participation of 102 elderly people living in Brazil. The Exploratory Factor Analysis (AFE) showed that the EFS-HALFT has two dimensions, the first being related to the person's interaction with the environment, called “Social interaction” and the second, which covers the social support that the person receives from the environment , called “Social support”. The KMO index was 0.60, Bartlett's test of sphericity was significant (p<0.001) and the explained variance was 57.2%. These data show that the EFA was adequate, with factor loadings ranging from 0.70 to 0.78. Regarding the convergent validity of the EFS-HALFT, there was a positive and significant correlation with the ASF and the TIF. There was also a negative and significant correlation between the scale and the MOS-SSS domains and the physical component of the SF-12. Regarding discriminant validity, the EFS-HALFT showed discriminative power, as the average score of symptoms of depression, anxiety and loneliness of socially fragile older person were higher than that of non-socially fragile older person, who presented average scores of 3.40. symptom of depression, 2.76 of anxiety and 29.93 of loneliness, all with a statistically significant difference (p<0.001). Conclusion: The EFS-HALFT is culturally adapted and presents evidence of satisfactory reliability and validity. Further research is recommended to verify the psychometric performance of the scale in Brazil in different populations.