Brazilian Version of the Dental Environment Stress Questionnaire

Aims: To perform cross-cultural adaptation of the Dental Environment Stress Questionnaire (DES) for use in Portuguese-speaking populations, evaluate its psychometric properties, and determine the effects of gender and educational level in the perception of stress sources in dental students.

Methodology: An observational cross-sectional study design was implemented to examine face and content validity. 466 Brazilian students participated in the study in 2015 (UNESP students response rate=79.2%; UNIARA students response rate=82.4%). Construct validity was assessed via the determination of factorial, convergent, and discriminant validity. Reliability was estimated using Cronbach's α, and composite reliability. A model was designed using structural equation modeling, to verify the effects of gender and educational level on the perception of stress sources.

Results: The complete model purposed was not a good fit to the sample (λs=0.358–0.955, ꭙ2/df=3.36, CFI=0.881, TLI=0.870, RMSEA=0.071, r=0.426–0.664, AVE=0.366–0.856). After the removal of item 12 and insertion of a correlation between the errors for items 1 and 2 (LM=399.154) and Items 14 and 16 (LM=146.216) the model fitted the sample (λs=0.411–0.955, ꭙ2/df=2.54, CFI=0.926, TLI=0.919, RMSEA=0.058, AVE=0.363–0.850). Adequate content validity ratios were observed for 23 items. Gender affected all DES factors, and educational level influenced four factors.

Conclusion: Cross-cultural adaptation process provided an instrument that was easy to understand, with adequate idiomatic and cultural equivalence. The Portuguese version of the DES showed good psychometric properties and reliability in the study sample. Gender and educational level exerted significant effects on seven and four factors, respectively.