Spanish Translation, Adaptation, and Validation of Strategies to Mitigate Cardiac Rehabilitation Barriers

Background: Despite its demonstrated benefits, cardiac rehabilitation (CR) is grossly underutilized. Validated interventions are needed to mitigate the established barriers to accessing and adhering to these services. A strategy has been created based on the Cardiac Rehabilitation Barriers Scale (CBRS), by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR), with initial support of helpfulness. Purpose: To translate, adapt, and content validate the CR barrier mitigation strategy for the Colombian context. Methods: A 2-phase exploratory sequential multimethod study was conducted in accordance with best practices. The 21 barrier mitigation strategies were first translated to Spanish by a bilingual health care professional and then adapted for the Colombian population following semi-structured interviews with 6 Colombian CR staff. The second phase of content validation involved 8 experts and 8 CR patients, who evaluated the mitigation strategies regarding engagement, comprehensibility, applicability, acceptability, and motivation on a 5-point Likert scale (higher scores more favorable). The content validity coefficient was computed. Results: Content analysis of interviews resulted in revisions to all 21 Spanish barrier mitigation strategies. Content validity of the revised version was rated as at least acceptable (≥0.70) for all 21 strategies, but each strategy was rated as requiring revision on 1 to 4 of the above indicators. Revisions ensued accordingly. Conclusions: The rigorous adaptation and content validation process has established the Spanish CR barrier mitigation strategies, which will now be tested at the bedside in a randomized controlled trial in Colombia to determine effect on CR use.