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OBJECTIVE: To perform the translation and cross-cultural adaptation from English into Brazilian Portuguese of the Composite Abuse Scale, an instrument that identifies and quantifies intimate partner violence. METHODS: This study is based on the strict implementation of its previously published protocol, which consists of ten steps: (a) conceptual analysis; (b) double-blind translation; (c) comparison and first reconciled version of the two translations; (d) back-translation; (e) review of the back-translation by the developer and second reconciled version; (f) expert committee review (n = 6); (g) comparison of expert reviews and third reconciled version; (h) cognitive interviews with women from the Casa da Mulher Brasileira in Curitiba (n = 15); (i) assessments of user perceptions and final reconciliation; and (j) submission of the final version of the questionnaire to the developer. RESULTS: The implementation of the 10 steps of the protocol allowed the idiomatic, semantic, conceptual and experiential equivalences of the Composite Abuse Scale, incorporating suggestions and criticisms from the different participants of the process. Participants included the developer, professional translators, researchers specialized on the subject, women in situation of intimate partner violence, and professionals who provide care to them. Experts and cognitive interviews with women were instrumental in ensuring equivalence, and facilitating the understanding, including: (1) adaptation of the term "intimate relation" to "affective or conjugal relation"; (2) substitution of enclisis for proclisis cases in 20 items; (3) adoption of gender-neutral language, allowing its use in heterosexual, bisexual, and same-sex relations; (4) materialization of an instrument of scientific rigor and self-applicable, which may help women to visualize the situations of abuse in their relations. CONCLUSIONS: The translation and cross-cultural adaptation process of the Composite Abuse Scale resulted in the Composite Abuse Scale Brazilian Portuguese Version, a 30-item self-applicable instrument, capable to identify and quantify intimate partner violence, its frequency, severity and typologies (physical, emotional, harassment and severe combined violence).

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Establishing rigorous translation and cross-cultural adaptation (TCCA) processes for abuse questionnaires is challenging. We propose a methodological TCCA protocol for abuse questionnaires based on our current adaptation of the Composite Abuse Scale (CAS) into Brazilian Portuguese. This 10-step protocol includes: (a) conceptual analysis; (b) double-blinded forward translation; (c) comparison of forward translations; (d) back-translation; (e) developer analysis; (f) specialist committee review; (g) comparison of specialist reviews; (h) cognitive interviews; (i) final reconciliation; and (j) presenting the final version to the developer. We aim to rigorously implement this protocol to achieve a reliable Brazilian Portuguese version of the CAS.

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Intimate partner abuse (IPA) affects women's health, requiring accurate questions to identify the abuse. We investigated the accuracy of three questions about fear of an intimate partner in identifying exposure to IPA. We compared the sensitivity and specificity of these questions with the Composite Abuse Scale (CAS) using secondary data analysis of four existing studies. All studies recruited adult women from clinical settings, with sample sizes ranging from 1,257 to 5,871. We examined associations between demographic factors and fear through multivariate logistic regression, and analysis of the sensitivity and specificity of the questions about fear and IPA (CAS), generating a receiver operating curve (ROC). The prevalence of lifetime fear of a partner ranged from 9.5% to 26.7%; 14.0% of women reported fear in the past 12 months; and current fear ranged from 1.3% to 3.3%. Comparing the three questions, the question "afraid of a partner in the past 12 months" was considered the best question to identify IPA. This question had the greatest area under the ROC (0.80, 95% confidence interval (CI) = [0.78-0.81]) compared with "are you currently afraid" (range 0.57-0.61) or "have you ever been afraid" (range 0.66-0.77); and demonstrated better sensitivity (64.8%) and specificity (94.8%). Demographic factors associated with "fear of a partner in the past 12 months" included being divorced/separated (odds ratio [OR] = 8.49, 95% CI = [6.70-10.76]); having a low income (OR = 4.21, 95% CI = [3.46-5.13]); and having less than 12 years of education (OR = 2.48, 95% CI = [2.04-3.02]). The question "In the last 12 months did you ever feel frightened by what your partner says or does?" has potential to identify a majority of women experiencing IPA, supporting its utilization where more comprehensive measures are not possible.

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ABSTRACT OBJECTIVE To perform the translation and cross-cultural adaptation from English into Brazilian Portuguese of the Composite Abuse Scale, an instrument that identifies and quantifies intimate partner violence. METHODS This study is based on the strict implementation of its previously published protocol, which consists of ten steps: (a) conceptual analysis; (b) double-blind translation; (c) comparison and first reconciled version of the two translations; (d) back-translation; (e) review of the back-translation by the developer and second reconciled version; (f) expert committee review (n = 6); (g) comparison of expert reviews and third reconciled version; (h) cognitive interviews with women from the Casa da Mulher Brasileira in Curitiba (n = 15); (i) assessments of user perceptions and final reconciliation; and (j) submission of the final version of the questionnaire to the developer. RESULTS The implementation of the 10 steps of the protocol allowed the idiomatic, semantic, conceptual and experiential equivalences of the Composite Abuse Scale, incorporating suggestions and criticisms from the different participants of the process. Participants included the developer, professional translators, researchers specialized on the subject, women in situation of intimate partner violence, and professionals who provide care to them. Experts and cognitive interviews with women were instrumental in ensuring equivalence, and facilitating the understanding, including: (1) adaptation of the term "intimate relation" to "affective or conjugal relation"; (2) substitution of enclisis for proclisis cases in 20 items; (3) adoption of gender-neutral language, allowing its use in heterosexual, bisexual, and same-sex relations; (4) materialization of an instrument of scientific rigor and self-applicable, which may help women to visualize the situations of abuse in their relations. CONCLUSIONS The translation and cross-cultural adaptation process of the Composite Abuse Scale resulted in the Composite Abuse Scale Brazilian Portuguese Version, a 30-item self-applicable instrument, capable to identify and quantify intimate partner violence, its frequency, severity and typologies (physical, emotional, harassment and severe combined violence).

RESUMO OBJETIVO Realizar a tradução e adaptação transcultural do inglês para o português brasileiro da Composite Abuse Scale, instrumento que identifica e quantifica a violência por parceiro íntimo. MÉTODOS Este estudo baseia-se na execução rigorosa de seu protocolo, previamente publicado, e que consiste em dez etapas: (a) análise conceitual; (b) tradução duplo-cega; (c) comparação e primeira versão reconciliada das duas traduções; (d) retrotradução; (e) revisão da retrotradução feita pela desenvolvedora e segunda versão reconciliada; (f) revisão por comitê de especialistas (n = 6); (g) comparação das revisões por especialistas e terceira versão reconciliada; (h) entrevistas cognitivas com mulheres da Casa da Mulher Brasileira de Curitiba (n = 15); (i) avaliações das percepções das usuárias e reconciliação final; e (j) apresentação da versão final do questionário à desenvolvedora. RESULTADOS A execução das 10 etapas do protocolo permitiu as equivalências idiomática, semântica, conceitual e experiencial da Composite Abuse Scale, incorporando sugestões e críticas dos diferentes participantes do processo, que incluíram desde a desenvolvedora, tradutores profissionais, pesquisadores especializados no tema, mulheres em situação de violência por parceiro íntimo e profissionais que as atendem. Especialistas e entrevistas cognitivas com mulheres foram fundamentais para garantir equivalências e facilitar a compreensão, incluindo: (1) adaptação do termo "relacionamento íntimo" para "relacionamento afetivo ou conjugal"; (2) substituição de ênclises por próclises em 20 itens; (3) adoção de linguagem de gênero neutro, permitindo sua utilização em relacionamentos hetero, bi e homoafetivos; (4) materialização de um instrumento de rigor científico e autoaplicável, que pode auxiliar as mulheres a visibilizarem as situações de abuso em seus relacionamentos. CONCLUSÕES O processo de tradução e adaptação transcultural da Composite Abuse Scale resultou na Composite Abuse Scale Versão Português brasileiro, instrumento autoaplicável com 30 itens, capaz de identificar e quantificar a violência por parceiro íntimo, sua frequência, severidade e tipologias (violências física, emocional, assédio e grave combinada).

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INTRODUCTION: Intimate partner violence (IPV) considerably harms the health, safety and well-being of women. In response, public health systems around the globe have been gradually implementing strategies. In particular, low-income and middle-income countries (LMIC) have been developing innovative interventions in primary healthcare (PHC) addressing the problem. This paper describes a protocol for a systematic review of studies addressing the impacts and outcomes of PHC centre interventions addressing IPV against women from LMIC. METHODS AND ANALYSIS: A systematic search for studies will be conducted in African Index Medicus, Africa Portal Digital Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, Index Medicus for the Southeast Asia Region, IndMed, Latin American and Caribbean Health Science Literature Database (LILACS), Medecins Sans Frontieres, MEDLINE, Minority Health and Health Equity Archive, ProQuest, PsycINFO, Scientific Electronic Library Online, (SciELO) and Social Policy and Practice. Studies will be in English, Spanish and Portuguese, published between 2007 and 2017, addressing IPV against women from LMIC, whose data quantitatively report on the impacts and outcomes for survivors and/or workers and/or public health systems preintervention and postintervention. Two trilingual reviewers will independently screen for study eligibility and data extraction, and a librarian will cross-check for compliance. Risk of bias and quality assessment of studies will be measured according to: (1) the Cochrane Collaboration's tool for assessing risk of bias for randomised controlled trials and (2) the Methodological Index for Non-Randomised Studies (MINORS). Data will be analysed and summarised using meta-analysis and narrative description of the evidence across studies. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols(PRISMA P) guidelines. ETHICS AND DISSEMINATION: This systematic review will be based on published studies, thus not requiring ethical approval. Findings will be presented in conferences and published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER: CRD42017069261.

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