# Translation and cultural adaptation of the hyperacusis handicap questionnaire to Brazilian Portuguese

## TL;DR

This paper describes the translation and cultural adaptation of a questionnaire for measuring hyperacusis into Brazilian Portuguese, ensuring it is suitable for use in Brazil.

## Contribution

The study provides a culturally adapted version of the Hyperacusis Handicap Questionnaire for the Brazilian population.

## Key findings

- The HHQ was successfully translated and adapted into Brazilian Portuguese following COSMIN guidelines.
- More than 80% of participants understood the questionnaire items in BP, and adjustments led to full comprehension in the final version.
- The final version, titled HHQ-BP, is now being validated for use in Brazil.

## Abstract

To translate and culturally adapt the Hyperacusis Handicap Questionnaire (HHQ) to Brazilian Portuguese.

The cultural adaptation followed the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines and included five stages: 1) translation of the questionnaire from English to Brazilian Portuguese (BP) by two bilingual translators; 2) synthesis of the translations into a consensus version; 3) back-translation into English by two professional translators; 4) development of the pre-final version of the HHQ in Brazilian Portuguese by a committee of experts; and 5) testing of the pre-final and adjusted pre-final versions with individuals from the target population.

No discrepancies were observed in the title, key responses, or questionnaire items throughout the translation process. In the pre-final version testing phase, more than 80% of participants understood the HHQ items in BP, demonstrating the effectiveness of the adaptation. However, four items were adjusted based on participants’ suggestions during the testing phase. Subsequently, the adjusted pre-final version was tested, with 100% of participants demonstrating comprehension of the items, confirming its appropriateness for the Brazilian population. During the linguistic equivalence assessment, none of the participants selected the "not applicable" option, further validating the relevance of the questions to the Brazilian context. Additionally, an introductory statement was added, providing detailed instructions on how to complete the questionnaire.

The cultural adaptation of the HHQ to Brazilian Portuguese was completed, resulting in the final version titled Hyperacusis Handicap Questionnaire in Brazilian Portuguese (HHQ-BP). Validation of this version is currently in progress.