Cross-cultural adaptation and validation to Brazil of the scale of attitudes toward physician-pharmacists collaboration


Background: Despite the increasing complexity of medication therapies and the expansion of pharmaceutical clinical services to optimize patient care working in collaboration with physicians. In this sense, interdisciplinary education has been encouraged. However, no instrument is available to measure attitudes toward collaborative relationships.

Objective: To translate, cross-cultural adaptation and validation an instrument to measure collaboration attitudes toward students of medicine/pharmacy and physicians/pharmacists.

Methods: The process of cross-cultural adaptation was carried out using international recommendations and was performed from January 2014 to April 2015. The instrument under consideration was translated and re-translated. A panel of experts compared the generated documents and the translation was evaluated for 20 undergraduate students of Pharmacy, 20 undergraduate students of Medicine and professionals (20 pharmacists and 20 physicians).

Results: The process of cross-cultural translation and validation result in the Portuguese version. Modifications to the grammatical structures were made in order to establish a cross-cultural similarity between the English and Portuguese versions. Regarding the evaluation of the expert panel, six questions required modifications.

Conclusions: Psychometric evaluation demonstrated and confirmed the validity of the Brazilian-Portuguese version to assess collaborative attitudes among pharmacists and physicians. Moreover, the scale can be used to evaluate undergraduates and postgraduates and foster the development of teaching methods that promote comprehensive attitudes in patient care.


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1. Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P. Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012;10:CD006525. doi: 10.1002/14651858.CD006525.pub2

2. WHO. Framework for action on interprofessional education & collaborative practice. Geneva: WHO; 2010.

3. Zatzick D, Russo J, Lord SP, Varley C, Wang J, Berliner L, Jurkovich G, Whiteside LK, O'Connor S, Rivara FP. Collaborative care intervention targeting violence risk behaviors, substance use, and posttraumatic stress and depressive symptoms in injured adolescents: a randomized clinical trial. JAMA Pediatr. 2014;168(6):532-539. doi: 10.1001/jamapediatrics.2013.4784

4. Coluccio M, Maguire P. Collaborative pratice: becoming a reality througt primary nursing. Nurs Adm Q. 1983;7(4):59-63.

5. Kelly DV, Bishop L, Young S, Hawboldt J, Phillips L, Keough TM. Pharmacist and physician views on collaborative practice: Findings from the community pharmaceutical care Project. Can Pharm J (Ott). 2013;146(4):218-226. doi: 10.1177/1715163513492642

6. Sousa IF. A interdisciplinaridade na formação farmacêutica: uma abordagem à luz da fenomenologia. Campo Grande, 2014. [PhD Dissertation] – Universidade Federal de Mato Grosso do Sul.

7. Zanotti R, Sartor G, Canova C. Effectiveness of interprofessional education by on-field training for medical students, with a pre-post design. BMC Med Educ. 2015;15:121. doi: 10.1186/s12909-015-0409-z

8. Van Winkle LJ, Fjortoft N, Hojat M. Validation of an instrument to measure pharmacy and medical student´s attitudes toward physician-pharmacist collaboration. Am J Pharm Educ. 2011;75(9):178. doi: 10.5688/ajpe759178

9. Van C, Costa D, Abbott P, Mitchell B, Krass I. Community pharmacist attitudes towards collaboration with general practitioners: development and validation of measure and a model. BMC Health Serv Res. 2012;12:320. doi: 10.1186/1472-6963-12-320

10. Carter BL, Bergus GR, Dawson JD, Farris KB, Doucette WR, Chrischilles EA, Hartz AJ. A cluster randomized trial to evaluate physician/pharmacist collaboration to improve blood pressure control. J Clin Hypertens (Greenwich). 2008;10(4):260-271.

11. Zillich AJ, Milchak JL, Carter BL, Doucette WR. Utility of a questionnaire to measure physician–pharmacist collaborative relationships. J Am Pharm Assoc (2003). 2006;46(4):453-458.

12. Hojat M, Spandorfer J, Isenberg GA, Vergare MJ, Fassihi R, Gonnella JS. Psychometrics of the scale of attitudes toward physician–pharmacist collaboration: A study with medical students. Med Teach. 2012;34(12):e833-7. doi: 10.3109/0142159X.2012.714877

13. Fike DS, Zorek JA, MacLaughlin AA, Samiuddin M, Young RB, MacLaughlin EJ. Development and Validation of the Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education (SPICE) Instrument. Am J Pharm Educ. 2013;77(9):190. doi: 10.5688/ajpe779190

14. McDonough RP, Doucette WR. Developing collaborative working relationships between pharmacists and physicians. J Am Pharm Assoc (2003). 2004;44(3):358-365.

15. Zillich AJ, Doucette WR, Carter BL, Kreiter CD. Development and initial validation of an instrument to measure physician pharmacist collaboration from the physician perspective. Value Health. 2005;8(1):59-66. doi: 10.1111/j.1524-4733.2005.03093.x

16. Hojat M, Gonnella JS. An instrument for measuring pharmacist and physician attitudes toward collaboration: Preliminary psychometric data. J Interprof Care. 2011;25(1):66-72. doi: 10.3109/13561820.2010.483368

17. Van Winkle LJ, Fjortoft N, Hojat M. Validation of an instrument to measure pharmacy and medical students’ attitudes toward physician-pharmacist collaboration. Am J Pharm Educ. 2011;75(9):178. doi: 10.5688/ajpe759178

18. Shoukri MM, Asyali MH, Donner A. Sample size requirements for the design of reliability study: review and new results. Stat Meth Med Res. 2004;13(4):251-271.

19. Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46(12):1417-1432.

20. Guillemin F. Cross-cultural adaptation and validation of health status measures. Scand J Rheumatol. 1995;24(2):61-63.

21. Beaton DE, Bombardier C. Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976). 2000;25(24):3186-3191.

22. Vituri DW, Matsuda LM. [Content validation of quality indicators for nursing care evaluation]. Rev Esc Enferm USP. 2009;43(2):429-437.

23. Gasparino RC, Guirardello EB. Translation and cross-cultural adaptation of the "Nursing Work Index - Revised" into Brazilian Portuguese. Acta Paul Enferm 2009;22(3):281-287. doi: 10.1590/S0103-21002009000300007

24. Yu J, Shah BM, Ip EJ, Chan J. A Markov model of the cost-effectiveness of pharmacist care for diabetes in prevention of cardiovascular diseases: evidence from Kaiser Permanente Northern California. J Manag Care Pharm. 2013;19(2):102-114. doi: 10.18553/jmcp.2013.19.2.102

25. Beaton D, Bombardier C, Guillemin F, Ferraz MB. Recommendations for the Cross-Cultural Adaptation of Health Status Measures. Available at: (accessed 28-Oct-2016).

26. Pasquali L. Instrumentação Psicológica: fundamentos e práticas. First Edition. Porto Alegre/RS: Artmed; 2010. ISBN: 9788536322520

27. Mesquita AR, Santos EA, Porto JG, Barros IMC, Lyra Jr DP. Translation in Brazilian Portuguese and Content Validation of the Instrument Avaliação do Processo de Atendimento Farmacêutico. Lat Am J Pharm 2012;31(10):1422-1429.

28. Abed MM. Brazilian´s cross-cultural adaptation of Jefferson Scale of Attitudes Toward Interprofessional Collaboration: a study in primary care professionals. [Master Thesis] - Universidade Federal de Goiás, Goiânia, 2015; 98.

29. Correr CJ, Pontarolo R, Melchiors AC, Rossignoli P, Fernández-Llimós F, Radominski RB. [Translation to portuguese and validation of the Diabetes Quality Of Life Measure (DQOL-Brazil)]. Arq Bras Endocrinol Metabol. 2008;52(3):515-522.

30. Da Silva G.T. Formação interprofissional em saúde: reflexões. Avaliable at http://voticscxs1.otics,org/trabalhosredeunida/resumos/RE1297-1 (accessed 27-Mar-2015).

31. Alexandre NM, Guirardello EB. [Cultural adaptation of instruments utilized in occupational health]. Rev Panam Salud Publica. 2002;11(2):109-111.
How to Cite
CUNHA, Luiza et al. Cross-cultural adaptation and validation to Brazil of the scale of attitudes toward physician-pharmacists collaboration. Pharmacy Practice, [S.l.], v. 15, n. 2, p. 872, june 2017. ISSN 1886-3655. Available at: <>. Date accessed: 17 oct. 2017.
Original Research


Interprofessional Relations; Cooperative Behavior; Attitude of Health Personnel; Pharmacists; Physicians; Validation Studies as Topic; Surveys and Questionnaires; Brazil