Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool

Azevedo, Paula Schmidt; de Souza, Juli Thomaz; Jacinto, Alessandro Ferrari; Oliveira, Déborah; Santos, Fania Cristina dos; Minicucci, Marcos Ferreira; Villas Boas, Paulo José Fortes; Achterberg, Wilco; Wachholz, Patrick Alexander

doi:10.3390/ijerph22091324

Open AccessArticle

Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool

by

Paula Schmidt Azevedo

¹

,

Juli Thomaz de Souza

^1,*,

Alessandro Ferrari Jacinto

²,

Déborah Oliveira

^3,4

,

Fania Cristina dos Santos

⁵,

Marcos Ferreira Minicucci

¹,

Paulo José Fortes Villas Boas

¹

,

Wilco Achterberg

⁶

and

Patrick Alexander Wachholz

¹

Internal Medicine Department, Botucatu Medical School, São Paulo State University (UNESP), Botucatu 18618-687, Brazil

²

Department of Medicine, Centro Universitário de Adamantina (FAI), Adamantina 17800-000, Brazil

³

Faculty of Nursing, Campus Viña del Mar, Universidad Andrés Bello, Viña del Mar 2531015, Chile

⁴

Millenium Institute for Care Research (MICARE), Santiago 8370134, Chile

⁵

Department of Medicine, Paulista School of Medicine, Federal University of Sao Paulo (UNIFESP), São Paulo 04025-002, Brazil

⁶

Department of Public Health and Primary Care, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands

^*

Author to whom correspondence should be addressed.

Int. J. Environ. Res. Public Health 2025, 22(9), 1324; https://doi.org/10.3390/ijerph22091324

Submission received: 29 May 2025 / Revised: 5 August 2025 / Accepted: 21 August 2025 / Published: 26 August 2025

(This article belongs to the Special Issue Addressing Healthcare Inequities for Older Adults: Challenges and Pathways to Equitable Healthcare Services)

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Abstract

Background: Pain detection and management in older people with impaired cognition is an unmet need, leading to healthcare inequalities. This study aimed to enhance pain detection by translating and culturally adapting the PAIC-15 questionnaire into Brazilian Portuguese, establishing its content validity and comparing findings with a similar Dutch study. Methods: Following the same international standards used in the English-to-Dutch validation, we translated and culturally adapted PAIC-15 for Brazil. Content validity was assessed using two questions: (A) whether the item indicated pain and (B) whether it was specific to pain. An online form was distributed to ‘target users’ (nurses and geriatricians in LTCFs or other settings) and other healthcare professionals (HCPs) experienced in pain assessment in people with cognitive decline. Results were compared with the English-to-Dutch validation. Results: A total of 103 HCPs responded (mean age 45.2 ± 11.4 years)—76 (74%) were female and 54 (52%) had previously used pain assessment tools. Among the 63 target users, 13 items (87%) were validated as indicative and/or specific to pain. Comparing Brazilian and Dutch users, 10 items (67%) showed agreement on pain specificity. Conclusions: The Brazilian Portuguese PAIC-15 is now available, showing acceptable content validity. Linguistic challenges highlight the need for training and further validation in larger samples.

Keywords: impaired cognition; dementia; pain assessment; tool; Brazilian Portuguese

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MDPI and ACS Style

Azevedo, P.S.; de Souza, J.T.; Jacinto, A.F.; Oliveira, D.; Santos, F.C.d.; Minicucci, M.F.; Villas Boas, P.J.F.; Achterberg, W.; Wachholz, P.A. Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool. Int. J. Environ. Res. Public Health 2025, 22, 1324. https://doi.org/10.3390/ijerph22091324

AMA Style

Azevedo PS, de Souza JT, Jacinto AF, Oliveira D, Santos FCd, Minicucci MF, Villas Boas PJF, Achterberg W, Wachholz PA. Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool. International Journal of Environmental Research and Public Health. 2025; 22(9):1324. https://doi.org/10.3390/ijerph22091324

Chicago/Turabian Style

Azevedo, Paula Schmidt, Juli Thomaz de Souza, Alessandro Ferrari Jacinto, Déborah Oliveira, Fania Cristina dos Santos, Marcos Ferreira Minicucci, Paulo José Fortes Villas Boas, Wilco Achterberg, and Patrick Alexander Wachholz. 2025. "Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool" International Journal of Environmental Research and Public Health 22, no. 9: 1324. https://doi.org/10.3390/ijerph22091324

APA Style

Azevedo, P. S., de Souza, J. T., Jacinto, A. F., Oliveira, D., Santos, F. C. d., Minicucci, M. F., Villas Boas, P. J. F., Achterberg, W., & Wachholz, P. A. (2025). Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool. International Journal of Environmental Research and Public Health, 22(9), 1324. https://doi.org/10.3390/ijerph22091324

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Reducing Barriers for Best Practice in People Living with Dementia: Cross-Cultural Adaptation and Content Validity of the Brazilian Version of the Pain Assessment in Impaired Cognition (PAIC-15) Meta-Tool

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