Translation, Adaptation, and Validation of the Portuguese Version of the Exercise of Self-Care Agency Scale

Round 1

Reviewer 1 Report

The title of the manuscript is coherent and consistent with the purpose of the study. Its extension is adequate.

The summary has a functional structure. Provides information about the objective, method and results. However, it lacks explicit elements referring to the discussion. Its writing could be improved.

Regarding the introduction, it is possible to clearly understand the theoretical background that supports the research problem. It is explicitly stated that the purpose of the study was “to translate, adapt and validate Kearney and Fleischer's Exercise Self-Care Agency Scale (ESCA), revised by Riesch and Hauck for the European Portuguese version.” To this end, they highlight the importance of self-care in promoting people's health and well-being, taking as reference the contributions of the World Health Organization. Likewise, they refer to some theoretical models related to the study of self-care, even when the depth of the arguments is purely descriptive. As a suggestion, it would be desirable that you could refer to at least 3 or 4 theoretical models that explain (from different disciplines included, although ideally from the field of health sciences) self-care, with its various implications for health.

The presentation of the method is disorganized. The subsections should be reorganized, trying to respond in this suggested order, to the following elements: paradigm, study design, sample, instruments, data collection procedure, data analysis strategy, ethical criteria. Despite the above, the information provided regarding the instrument, its pre-test assessment; process of cultural adaptation and statistical analysis (exploratory and confirmatory factor analysis, with support from SPSS and AMOS) is correct and consistent. On the other hand, the study has a favorable report from the ethics committee of the Regional Health Authority of the Lisbon Valley).

Regarding the results, it stands out that four factors could explain the phenomenon studied. When analyzing the 230 similarities and variables belonging to each ESCA factor, it was decided to eliminate items 1, 4, 15, 19, 25 and 30. Subsequently, it was obtained that the 29 items are organized into 4 factors with a total explained variance of 44% and an eigenvalue greater than 1. For its part, Bartlett's test of sphericity (5288.701, p= 0.000) and the Kaiser-Meyer-Olkin [KMO] 243 (0.890) measure of sampling adequacy were considered good, demonstrating that the factor analysis model was appropriate. The first factor explains 24.42% of the total variance, the second 8.22%, the third 6.55% and the fourth 4.95%. Cronbach's alpha for the global scale is α= 0.87, for the sub-261 scales: Initiative and Self-Responsibility α= 0.84, Self-concept α= 0.71, Knowledge and Information Search α= 0.76 and Passivity α= 0.65. Consequently, it is possible to point out that the section is constructed appropriately, in addition to indicating that the use of tables is functional/consistent.

Regarding the discussion, it is possible to point out that a large part of the ideas addressed in the section revolve around statistical aspects (exclusively) of the validation of the instrument, neglecting the social, health, psychological, cultural and/or emotional implications that could be mentioned to address self-care in the post-pandemic context. Other equally relevant aspects such as health literacy, the influence of social determinants of health on self-care, the importance of the family health model in the integration of this instrument, self-esteem and other individual variables (personality, educational level) are barely addressed. , socioeconomic level, age, etc.). Likewise, the limitations and projections of the study are described superficially (despite the enormous value of the work presented). The entire section could be improved in terms of argumentative depth of the topics addressed.

The conclusions are somewhat limited. They deserve improvement in terms of their writing and argumentative depth.

Author Response

Dear reviewer

Thank you for your comments and suggestions, which were integrated along the text, highlighted in blue.

The main focus for changes were related to:

• the organization of the Method section, clarification and integration of the several Selfcare Theories, although, as the ESCA is based on a theoretical model, we kept the underlying construct (OREM) along the discussion of the results and conclusions;
• improvement of the discussion and conclusion, in which we included the dimension related to the social determinants of health, the importance of selfcare beyond healthcare, integrating the educational perspective manly defended by WHO
• globally trying to incorporate more argumentative depth and improve the wording.

Best regards

Reviewer 2 Report

I suggest incorporating into the discussion the fact that the modification (even if minimal) of the scale does not guarantee that the instrument will maintain its metric properties.

It is important to note that the adaptation and validation of a measurement instrument are distinct processes, although they are closely interconnected, emphasizing that in both cases, it is crucial to be extremely meticulous with the technique.

Author Response

Dear reviewer

Thank you for your comments.

With regard to the proposed suggestions, we have included in the discussion the reference to the existence of a modification (even a minimal one) to the scale, and we emphasize that adaptation and validation are distinct but interconnected processes. Integrating the study design into the methodology could reinforce this perspective.

The changes appear in blue.

We are happy to answer any other questions you may have.

Sincerely