Open Access Research article

Transcultural adaptation and initial validation of Brazilian-Portuguese version of the Basel assessment of adherence to immunosuppressive medications scale (BAASIS) in kidney transplants

Elisa de Oliveira Marsicano12, Neimar da Silva Fernandes3, Fernando Colugnati12, Fabiane Rossi dos Santos Grincenkov12, Natalia Maria da Silva Fernandes12, Sabina De Geest4 and Helady Sanders-Pinheiro12*

Author Affiliations

1 Renal Transplantation Unit, Division of Nephrology, Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil

2 Núcleo Interdisciplinar de Estudos e Pesquisas em Nefrologia [NIEPEN], Juiz de Fora, Minas Gerais, Brazil

3 Centre for Public Policy and Education Evaluation (CAED), Federal University of Juiz de Fora, Juiz de Fora, Minas Gerais, Brazil

4 Institute of Nursing Science, University of Basel, Basel, Switzerland

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BMC Nephrology 2013, 14:108  doi:10.1186/1471-2369-14-108

Published: 21 May 2013



Transplant recipients are expected to adhere to a lifelong immunosuppressant therapeutic regimen. However, nonadherence to treatment is an underestimated problem for which no properly validated measurement tool is available for Portuguese-speaking patients. We aimed to initially validate the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS®) to accurately estimate immunosuppressant nonadherence in Brazilian transplant patients.


The BAASIS® (English version) was transculturally adapted and its psychometric properties were assessed. The transcultural adaptation was performed using the Guillemin protocol. Psychometric testing included reliability (intraobserver and interobserver reproducibility, agreement, Kappa coefficient, and the Cronbach’s alpha) and validity (content, criterion, and construct validities).


The final version of the transculturally adapted BAASIS® was pretested, and no difficulties in understanding its content were found. The intraobserver and interobserver reproducibility variances (0.007 and 0.003, respectively), the Cronbach’s alpha (0.7), Kappa coefficient (0.88) and the agreement (95.2%) suggest accuracy, preciseness and reliability. For construct validity, exploratory factorial analysis demonstrated unidimensionality of the first three questions (r = 0.76, r = 0.80, and r = 0.68). For criterion validity, the adapted BAASIS® was correlated with another self-report instrument, the Measure of Adherence to Treatment, and showed good congruence (r = 0.65).


The BAASIS® has adequate psychometric properties and may be employed in advance to measure adherence to posttransplant immunosuppressant treatments. This instrument will be the first one validated to use in this specific transplant population and in the Portuguese language.

Patient adherence; Immunosuppression; Medication nonadherence; Transplantation; Validation