Health professionals’ attitudes towards people experiencing homelessness in Portugal
Abstract
Background: Attitudes of healthcare professionals can shape access, quality, and continuity of care for people experiencing homelessness (PEH). This study aimed to translate, adapt, and conduct a preliminary validation the Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI) for use in Portugal.
Methods: The HPATHI scale was culturally adapted into European Portuguese using two independent forward translations, reconciliation by the research team, and one independent back translation. Preliminary validation focused on content and face validity, assessed jointly by an expert panel. Experts rated each item for relevance, clarity, and essentiality, and provided qualitative feedback on face validity and wording. Content validity was assessed using the Item-Level Content Validity Index (I-CVI) and the Scale-Level Content Validity Index, Average method (S-CVI/Ave), calculated separately for relevance and clarity (threshold ≥ 0.78). Content Validity Ratio (CVR) was used to assess the essentiality of items (threshold ≥ 0.78).
Results: Nine experts participated. The original tool had 2 items added and 1 removed. Overall content validity demonstrated high relevance (S-CVI/Ave=0.95) and clarity (S-CVI/Ave=0.91). At item level, two items were under the clarity threshold (I-CVI=0.67). Ratings of essentiality varied across items, with CVR values ranging from 1.00 to -0.11, allowing identification of nine items requiring potential revision. Qualitative feedback suggested rewording five items to improve comprehensibility.
Conclusions: The HPATHI-PT showed appropriate preliminary content and face validity. These findings support its use in the next stage of field testing, which will include further psychometric validation. Moreover, the instrument may help identify attitudinal barriers and priorities for healthcare professional education, informing public health recommendations to address stigma and equitable healthcare responses for PEH.
Key messages: • A Portuguese version of the HPATHI showed good preliminary content and face validity, supporting its use for further field testing in Portugal.
• Measuring health professionals’ attitudes could help identify stigma-related barriers and inform educational strategies to improve access and quality of care for people experiencing homelessness.
Related
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- Social and environmental factors impacting the health in adults experiencing episodic homelessness in Houston, Texas.
- ‘My dog is my life’: One Health approaches to healthcare for people and their companion animals experiencing homelessness in the United Kingdom
BibTeX
@article{paparatto2026health,
title = {{Health professionals’ attitudes towards people experiencing homelessness in Portugal}},
author = {G Paparatto and D Gorski and S Crisóstomo and RMS Fuertes and CJS Quelhas and F Tonin and L Tavoschi and J Gama-Marques and FA Costa},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.1370},
url = {https://doi.org/10.1093/eurpub/ckag169.1370},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Health professionals’ attitudes towards people experiencing homelessness in Portugal
AU - G Paparatto
AU - D Gorski
AU - S Crisóstomo
AU - RMS Fuertes
AU - CJS Quelhas
AU - F Tonin
AU - L Tavoschi
AU - J Gama-Marques
AU - FA Costa
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.1370
UR - https://doi.org/10.1093/eurpub/ckag169.1370
AB - Background: Attitudes of healthcare professionals can shape access, quality, and continuity of care for people experiencing homelessness (PEH). This study aimed to translate, adapt, and conduct a preliminary validation the Health Professionals’ Attitudes Toward the Homeless Inventory (HPATHI) for use in Portugal. Methods: The HPATHI scale was culturally adapted into European Portuguese using two independent forward translations, reconciliation by the research team, and one independent back translation. Preliminary validation focused on content and face validity, assessed jointly by an expert panel. Experts rated each item for relevance, clarity, and essentiality, and provided qualitative feedback on face validity and wording. Content validity was assessed using the Item-Level Content Validity Index (I-CVI) and the Scale-Level Content Validity Index, Average method (S-CVI/Ave), calculated separately for relevance and clarity (threshold ≥ 0.78). Content Validity Ratio (CVR) was used to assess the essentiality of items (threshold ≥ 0.78). Results: Nine experts participated. The original tool had 2 items added and 1 removed. Overall content validity demonstrated high relevance (S-CVI/Ave=0.95) and clarity (S-CVI/Ave=0.91). At item level, two items were under the clarity threshold (I-CVI=0.67). Ratings of essentiality varied across items, with CVR values ranging from 1.00 to -0.11, allowing identification of nine items requiring potential revision. Qualitative feedback suggested rewording five items to improve comprehensibility. Conclusions: The HPATHI-PT showed appropriate preliminary content and face validity. These findings support its use in the next stage of field testing, which will include further psychometric validation. Moreover, the instrument may help identify attitudinal barriers and priorities for healthcare professional education, informing public health recommendations to address stigma and equitable healthcare responses for PEH. Key messages: • A Portuguese version of the HPATHI showed good preliminary content and face validity, supporting its use for further field testing in Portugal. • Measuring health professionals’ attitudes could help identify stigma-related barriers and inform educational strategies to improve access and quality of care for people experiencing homelessness.
SN - 1101-1262
SN - 1464-360X
ER -