Cross-Cultural Adaptation and Content Validity of the 2019 CDC Worksite Health ScoreCard for Use in Brazil

Purpose To develop a cross-cultural adaptation and analyze evidence of content validity of the 2019 CDC Worksite Health ScoreCard (WHSC) for use in Brazil. Design Psychometric study conducted according to international guidelines for cross-cultural adaptation and evidences of validity. Setting Brazil, November to December 2023. Sample Five independent bilingual reviewers evaluated linguistic equivalence; 18 experts in occupational health or psychometrics assessed content validity (response rate 52.9%); 10 occupational health and safety professionals participated in cognitive testing with gender parity. Measures Semantic, idiomatic, conceptual, and experiential equivalences; clarity, practical and theoretical relevance, and dimensionality of items. Analysis Content Validity Ratio (CVR) was applied, with critical values ranging from 0.44 to 0.50; qualitative thematic analysis was performed on cognitive testing. Results Initial evaluations identified items with CVR <0.99 due to clarity issues, which were revised. In content validity assessment, CVR values ranged from 0.80 to 1.00 across all items, confirming acceptable agreement among experts. Cognitive testing confirmed comprehension and cultural adequacy, with participants suggesting inclusion of diversity-related items in future versions. Conclusions The Brazilian Portuguese version of the WHSC demonstrated strong linguistic quality and evidence of content validity with adequate clarity and cultural relevance for electronic administration. Limitations include reliance on a convenience sample of experts and the need for further evaluation of additional psychometric properties, such as internal structure and reliability.