Adaptation and Validation of Ethics in Health Care Questionnaire Version 2 (EHCQ-2) to European Portuguese

Filipa Moreira; Cecília Leão; João Bessa; Pedro M. Teixeira

doi:10.20344/amp.23531

Authors

Filipa Moreira Department of Otorhinolaryngology and Head and Neck Surgery. Hospital de Braga. Braga. https://orcid.org/0000-0002-9983-3445
Cecília Leão Life and Health Sciences Research Institute (ICVS). School of Medicine. Universidade do Minho. Braga. https://orcid.org/0000-0003-1311-7884
João Bessa Department of Psiquiatry. Hospital de Braga. Braga. & Population Health. Life and Health Sciences Research Institute (ICVS). School of Medicine. Universidade do Minho. Braga. https://orcid.org/0000-0001-6385-2452
Pedro M. Teixeira Population Health. Life and Health Sciences Research Institute (ICVS). School of Medicine. Universidade do Minho. Braga. https://orcid.org/0000-0001-6322-4923

DOI:

https://doi.org/10.20344/amp.23531

Keywords:

Decision Making/ethics, Education, Medical, Undergraduate/ethics, Ethics, Medical, Portugal, Reproducibility of Results, Surveys and Questionnaires, Translating

Abstract

Introduction: Even though ethical decision-making is a cornerstone of medical practice there is a lack of validated tools to assess ethical sensitivity among medical students, junior, and senior doctors. The aim of this study was to adapt and validate the Ethics in Health Care Questionnaire – Version 2 (EHCQ-2) for use in Portugal, ensuring its relevance in evaluating ethical sensitivity within the Portuguese healthcare context.
Methods: The EHCQ-2 was translated into European Portuguese and culturally adapted through a rigorous process involving forward and back-translation, expert review, cognitive interviews with medical professionals, and pilot testing. A validation study was conducted with a sample of 156 participants, including medical students, junior, and senior doctors, to evaluate the questionnaire’s reliability and validity.
Results: The adapted EHCQ-2 demonstrated good internal consistency (Cronbach’s alpha = 0.74) and variable inter-rater reliability (ranging from 0.12 to 0.67 across tasks), reflecting the complexity of ethical dilemmas. Content validity was established through expert evaluation, while construct validity was supported by significant correlations between individual scenarios and overall scores (e.g., r = 0.683 for Scenario 7). Regression analysis revealed that sub-scales measuring issue identification, explanation sophistication, and value recognition collectively explained 99.6% of the variance in total scores, underscoring the questionnaire’s robust predictive validity.
Conclusion: The European Portuguese version of the EHCQ-2 is a reliable and valid tool for assessing ethical sensitivity among medical students, junior and senior doctors. Its application can enhance ethics training programs, inform curriculum development, and support efforts to improve ethical decision-making skills in future healthcare professionals. Further research should explore its longitudinal utility and applicability in diverse cultural contexts.

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