ABSTRACT

OBJECTIVES

Translate and culturally adapt the short version of Copenhagen Psychosocial Questionnaire II (COPSOQ II) into Brazilian Portuguese (COPSOQ II-Br) and evaluate its psychometric properties.

METHODS

Translation and cultural adaptation followed the standardized guidelines. Structural validity was assessed using exploratory factorial analysis. Test-retest reliability was evaluated by intraclass correlation coefficient (ICC_3,1) and internal consistency by Cronbach’s alpha. Floor and ceiling effect was considered acceptable if less than 15% of participants reported the lowest or highest scores. Measurement error was assessed by standard error of measurement (SEM), while construct validity was tested by correlating the COPSOQ II-Br, the Job Content Questionnaire and the Nordic Musculoskeletal Questionnaire.

RESULTS

The study evaluated a total of 211 civil servants and service providers in the test and 157 in the retest. After cross-cultural adaptation, the COPSOQ II-Br structure comprised seven domains and 11 dimensions. Most dimensions showed acceptable floor and ceiling effects, excepting “Work family conflicts” (floor effect of 26.1%), and “Meaning and commitment” and “Job satisfaction,” with ceiling floor of 27.5% and 22.3%, respectively. Cronbach’s alpha values reached the recommended levels (varied between 0.70 and 0.87). Test-retest reliability indicated that all dimensions had ICC between 0.71 and 0.81. SEM ranged from 0.6 to 2.2 and the construct validity showed good results with the tested instruments (significant positive and negative correlations).

CONCLUSIONS

All psychometric properties of the short version COPSOQ II-Br are suitable for use in Brazil. The instrument is thus validated and can be used by occupational health and human resources professionals to evaluate psychosocial working conditions.

Job Satisfaction; Occupational Health; Psychological Tests; Surveys and Questionnaires; Translating; Validation Study

INTRODUCTION

Research on mental disorders has increased worldwide given its growing impact on workers’ health, wellbeing and productivity¹1. Steel Z, Marnane C, Iranpour C, Chey T, Jackson J, Patel W, et al. The global prevalence of common mental disorders: a systematic review and meta-analysis 1980-2013. Int J Epidemiol. 2014;43(2):476-93. https://doi.org/10.1093/ije/dyu038
https://doi.org/10.1093/ije/dyu038... ,²2. Pinheiro MA, Ivandic I, Razzouk D. The economic impact of mental disorders and mental health problems in the workplace. In: Razzouk D, editor. Mental health economics: the costs and benefits of psychiatric care. Cham (CH): Spriger; 2017. p 415-30. https://doi.org/10.1007/978-3-319-55266-8_28
https://doi.org/10.1007/978-3-319-55266-... . Between 2006 and 2017, Brazil registered 8.474 cases of work-related mental disorders, with severe stress reactions and adjustment disorders being the most common diagnoses (47%), followed by depressive episodes (24%) and other anxiety disorders (17%)³3. Centro Colaborador de Vigilância dos Agravos a Saúde do Trabalhador - CCVISAT. Programa Integrado em Saúde Ambiental e do Trabalhador -PISAT. Transtornos mentais relacionados ao trabalho no Brasil, 2006-2017. Bol Epidemiol. 2019 [cited 2019 April 25];9(13):1-5. Available from: https://renastonline.ensp.fiocruz.br/recursos/boletim-epidemiologico-transtornos-mentais-relacionados-trabalho-brasil-2006-2017.
https://renastonline.ensp.fiocruz.br/rec... .

Mental disorders can be caused by psychosocial risk factors such as high work and emotional demands, low decision authority, low social support, high work efforts and obligations, low rewards (remuneration, recognition and career opportunities), and feelings of injustice⁴4. Molen HF, Nieuwenhuijsen K, Frings-Dresen MHW, Groene G. Work-related psychosocial risk factors for stress-related mental disorders: an updated systematic review and meta-analysis. BMJ Open. 2020;10(7):e034849. https://doi.org/10.1136/bmjopen-2019-034849
https://doi.org/10.1136/bmjopen-2019-034... . Exposure to these factors can compromise healthy functioning at the organic, emotional, cognitive, social, and behavioral levels⁵5. Silva C, Amaral V, Pereira AC, Bem-Haja P, Pereira A, Rodrigues V, et al. Copenhagen Psychosocial Questionnaire - COPSOQ: Portugal e países africanos de língua oficial portuguesa, 2011. Aveiro (PT): Departamento de Educação, Universidade de Aveiro; 2011..

Psychosocial risk factors can be assessed using questionnaires, a widely employed practice since its application and data analysis is relatively easy and cheap⁶6. Tabanelli MC, Depolo M, Cooke RMT, Sarchielli G, Bonfiglioli R, Mattioli S, Violante FS. Available instruments for measurement of psychosocial factors in the work environment. Int Arch Occup Environ Health. 2008;82(1):1-12. https://doi.org/10.1007/s00420-008-0312-6
https://doi.org/10.1007/s00420-008-0312-... ,⁷7. Ganster DC, Perrewé PL. Theories of occupational stress. In: Quick JC, Tetrick LE, editors. Handbook of occupational health psychology. 2. ed. Washington, DC: American Psychological Association; 2011. p. 37-53..

One such questionnaire is the Copenhagen Psychosocial Questionnaire (COPSOQ), developed in Denmark and translated, adapted, and tested in several countries⁸8. Moncada S, Utzet M, Molinero E, Llorens C, Moreno N, Galtés A, et al. The Copenhagen Psychosocial Questionnaire II (COPSOQ II) in Spain: a tool for psychosocial risk assessment at the workplace. Am J Ind Med. 2014;57(1):97-107. https://doi.org/10.1002/ajim.22238
https://doi.org/10.1002/ajim.22238... . Based on a multifaceted approach, unlike other questionnaires¹⁵15. Kristensen TS, Hannerz H, Hogh A, Borg V. The Copenhagen Psychosocial Questionnaire - a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438-49. https://doi.org/10.5271/sjweh.948
https://doi.org/10.5271/sjweh.948... ,¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... , the instrument covers seven psychosocial theories: the Job Characteristics Model, the Michigan Organization Stress Model, the Job Demands-Control Model, the Sociotechnical Approach, the Action-Theoretical Approach, the Effort-Reward Imbalance Model, and the Vitamin Model¹⁵15. Kristensen TS, Hannerz H, Hogh A, Borg V. The Copenhagen Psychosocial Questionnaire - a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438-49. https://doi.org/10.5271/sjweh.948
https://doi.org/10.5271/sjweh.948... . Made available in 2005¹⁵15. Kristensen TS, Hannerz H, Hogh A, Borg V. The Copenhagen Psychosocial Questionnaire - a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438-49. https://doi.org/10.5271/sjweh.948
https://doi.org/10.5271/sjweh.948... , COPSOQ I was then revised in 2010 (COPSOQ II) to include other relevant¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... and less studied dimensions. In 2019, the International Network made the COPSOQ III available (https://www.copsoq-network.org/) to facilitate the communication and international use of the instrument¹⁷17. Burr H, Berthelsen H, Moncada S, Nübling M, Dupret E, Demiral Y, et al; International COPSOQ Network. The Third Version of the Copenhagen Psychosocial Questionnaire. Saf Health Work. 2019;10(4):482-503. https://doi.org/10.1016/j.shaw.2019.10.002
https://doi.org/10.1016/j.shaw.2019.10.0... .

Created to address important work-related aspects such as recognition, justice, and trust and to incorporate aspects brought forth by the experience of applying COPSOQ I, COPSOQ II also had a short version designed to be applied in the workplace¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... . In Brazil, the medium version of COPSOQ I was translated and validated¹⁸18. Silva MA, Wendt GW, Argimon IIL. Propriedades psicométricas das medidas do Questionário Psicossocial de Copenhague I (COPSOQ I), versão curta. REGE Rev Gestão. 2017;24:348-59., as was the Spanish version of COPOSOQ II – COPSOQ-ISTAS21 II¹⁹19. Lima IAX, Parma GOC, Cotrim TMCP, Moro ARP. Psychometric properties of a medium version of the Copenhagen Psychosocial Questionnaire (COPSOQ II) for southern Brazil. Work. 2019;62(2):175-84. https://doi.org/10.3233/WOR-192853
https://doi.org/10.3233/WOR-192853... .

However, we still lack studies on the cross-cultural adaptation of the short version of COPSOQ II into Brazilian Portuguese. In this sense, due to its comprehensive characteristics and great utility for organizations, making a Brazilian Portuguese version of this instrument available to occupational health professionals is paramount.

This study proposed, thus, to translate and cross-culturally adapt the short version of COPSOQ II and to evaluate the psychometric properties of the Brazilian Portuguese version (COPSOQ II-Br) – structural validity, test-retest reliability, internal consistency, floor and ceiling effect, measurement error and construct validity.

METHODS

Study Design

This cross-sectional study was conducted according to the recommendations of the COnsensus-based Standards for the selection of health Measurement Instruments (COSMIN) for analysis of psychometric properties²⁰20. Mokkink LB, Prinsen CA, Bouter LM, Vet HCW, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105-13. https://doi.org/10.1590/bjpt-rbf.2014.0143
https://doi.org/10.1590/bjpt-rbf.2014.01... and according to the stages of cross-cultural adaptation²¹21. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-91. https://doi.org/10.1097/00007632-200012150-00014
https://doi.org/10.1097/00007632-2000121... . The research project was approved by the Human Research Ethics Committee (CAAE: 64255917.7.0000.5504; Opinion number: 1.912.156).

Participants

The study took place in the city of São Carlos in several productive sectors from October 2016 to September 2018, using a non probabilistic sample of civil servants and service providers in the areas of education, health, administration and human resources, general services (cleaners and conservation), maintenance and repair (building assistance and zookeepers). The inclusion criteria were: workers between 18 and 65 years of age¹⁴14. Rosário S, Azevedo LF, Fonseca JA, Nienhaus A, Nübling M, Costa JT. The Portuguese long version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II): a validation study. J Occup Med Toxicol. 2017;12:24. https://doi.org/10.1186/s12995-017-0170-9
https://doi.org/10.1186/s12995-017-0170-... ,¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... , with at least six months on the job and a work routine of at least 20 hours a week (4 hours/day, 5 days a week). All participants were informed about the study and those who agreed to participate signed an Informed Consent Form (ICF).

A total of 785 workers were invited to participate in the study. Of the 228 who agreed to participate, 211 were included in the study (Figure 1).

Instruments

COPSOQ II

COPSOQ comprises seven conceptual models to identify psychosocial risk factors, and all versions have dimensions that measure exposure indicators (risks), health effects, satisfaction and stress⁵5. Silva C, Amaral V, Pereira AC, Bem-Haja P, Pereira A, Rodrigues V, et al. Copenhagen Psychosocial Questionnaire - COPSOQ: Portugal e países africanos de língua oficial portuguesa, 2011. Aveiro (PT): Departamento de Educação, Universidade de Aveiro; 2011.,¹⁵15. Kristensen TS, Hannerz H, Hogh A, Borg V. The Copenhagen Psychosocial Questionnaire - a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438-49. https://doi.org/10.5271/sjweh.948
https://doi.org/10.5271/sjweh.948... ,¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... .

COPSOQ II has three versions: long (41 dimensions and 127 questions), medium (28 dimensions and 87 questions) and short (23 dimensions and 40 questions)¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... . In the short version, questions are answered according to a 5-level Likert scale, with question 1B being the only one with an inverted value. Score is calculated by adding up the responses of each dimension, except for the domain offensive behaviour¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... . According to the number of questions in each dimension, the score can vary from 0 to 3, 0 to 4, 0 to 6 or 0 to 8 points. For each dimension, the values obtained can be classified as favorable (green), require attention (yellow) and unfavorable (red)⁵5. Silva C, Amaral V, Pereira AC, Bem-Haja P, Pereira A, Rodrigues V, et al. Copenhagen Psychosocial Questionnaire - COPSOQ: Portugal e países africanos de língua oficial portuguesa, 2011. Aveiro (PT): Departamento de Educação, Universidade de Aveiro; 2011.. Another classification method involves calculating the average value of each dimension.

Job Content Questionnaire (JCQ)

JCQ is a standardized instrument proposed to measure the dimensions of the demand-control-social support model²²22. Alves MGM, Chor D, Faerstein E, Lopes CS, Werneck GL. Versão resumida da “job stress scale”: adaptação para o português. Rev Saude Publica. 2004;38(2):164-71. https://doi.org/10.1590/S0034-89102004000200003
https://doi.org/10.1590/S0034-8910200400... . The short and adapted version into Brazilian Portuguese consists of 17 questions covering psychological demand, control, and social support, evaluated by a Likert scale. Score is obtained by adding the questions that make up the dimension, with demand varying between 5 and 20 points, control between 6 and 24 points, and social support between 6 and 24 points²²22. Alves MGM, Chor D, Faerstein E, Lopes CS, Werneck GL. Versão resumida da “job stress scale”: adaptação para o português. Rev Saude Publica. 2004;38(2):164-71. https://doi.org/10.1590/S0034-89102004000200003
https://doi.org/10.1590/S0034-8910200400... .

Nordic Musculoskeletal Questionnaire (NMQ)

NMQ is used to identify the presence of musculoskeletal symptoms in the past seven days and 12 months, seeking health care and having functional limitations due to these symptoms²³23. Barros ENC, Alexandre NMC. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int Nurs Rev. 2003;50(2):101-8. https://doi.org/10.1046/j.1466-7657.2003.00188.x
https://doi.org/10.1046/j.1466-7657.2003... . Participants report the presence of musculoskeletal symptoms such as pain, numbness or discomfort in the neck, lower back, shoulders and other areas in the past 12 months and seven days, on a dichotomous scale (presence or absence)²³23. Barros ENC, Alexandre NMC. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int Nurs Rev. 2003;50(2):101-8. https://doi.org/10.1046/j.1466-7657.2003.00188.x
https://doi.org/10.1046/j.1466-7657.2003... .

Cross-Cultural Adaptation and Psychometric Properties of COPSOQ II-Br

Cross-cultural adaptation of COPSOQ II-Br

After obtaining the approval for translation, the process of translation and cross-cultural adaptation followed 5 stages²¹21. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the process of cross-cultural adaptation of self-report measures. Spine. 2000;25(24):3186-91. https://doi.org/10.1097/00007632-200012150-00014
https://doi.org/10.1097/00007632-2000121... :

1. Translation from English into Brazilian Portuguese (a layman translator and an expert translator, both bilingual and Brazilian Portuguese native speaker, worked independently);

2. Synthesis of translation (synthesis of the translations made by two experts in the field of ergonomics, discussions of differences and consensus among translators);

3. Back-translation (made by two English native speaker specialist translators without prior access to COPSOQ content);

4. Meeting with a committee of specialists for the pre-final version (professionals trained in ergonomics, language professionals, researchers specialized in cross-cultural adaptation and translators);

5. Pre-test (2 pre-tests, where participants were interviewed and the understanding of the questionnaire items assessed).

The final version of the COPSOQ II-Br short version was thus developed and cross-culturally adapted into Brazilian Portuguese. After this 5-step process, we finally tested the psychometric properties of the instrument.

Procedures

Data collection included in-person and online (invitation via link on social and institutional media) questionnaires¹⁴14. Rosário S, Azevedo LF, Fonseca JA, Nienhaus A, Nübling M, Costa JT. The Portuguese long version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II): a validation study. J Occup Med Toxicol. 2017;12:24. https://doi.org/10.1186/s12995-017-0170-9
https://doi.org/10.1186/s12995-017-0170-... . In-person data collection took place both in the process of cross-culturally adaptating the instrument into Brazilian Portuguese (pre-test) and in the evaluation of psychometric properties. Online data collection was conducted only for the measurement properties. We chose one or the other according to the participants’ schooling level, e.g., cleaners, building assistance and zookeepers were unfamiliar with answering online forms. First, the participants received the ICF and those who consented were included in the study. Then, after a explanation about the questions and guarantee of confidentiality, a researcher sent the questionnaires to the participants, or devilered them in person. The questionnaire is self applicable. Doubts about the questionnaire were solved in the workplace and via e-mail (online format).

To assess test-retest reliability, we perfomed two data collection with an interval of two weeks between measurements to ensure that no changes had occurred²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... . Participants received e-mails reminding them of their participation in the study, with a five-day deadline set for the retest response.

To assess construct validity, we applied the NMQ in the testing phase and the JCQ in the retest, so that the evaluations would not become extensive. The participants completed the questionnaires without additional hours of work or sallary reduction.

Psychometric properties of COPSOQ II-Br

Structural validity

Structural validity concerns the degree to which the scores of an instrument adequately reflect the dimensionality of the construct to be measured²⁰20. Mokkink LB, Prinsen CA, Bouter LM, Vet HCW, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105-13. https://doi.org/10.1590/bjpt-rbf.2014.0143
https://doi.org/10.1590/bjpt-rbf.2014.01... . Exploratory factor analysis determines whether items compose one or more dimensions and should be carried out when internal consistency is adequate or in the impossibility of conducting confirmatory analysis²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... . The present study carried out a exploratory factor analysis, considering the same sample as that used to assess internal consistency, i. e., a minimum of 100 participants²⁰20. Mokkink LB, Prinsen CA, Bouter LM, Vet HCW, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105-13. https://doi.org/10.1590/bjpt-rbf.2014.0143
https://doi.org/10.1590/bjpt-rbf.2014.01... ,²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... .

Principal Component Analysis (PCA) with a final solution based on the Varimax orthogonal rotation was used to evaluate the internal structure of the measurement. The relevance of performing a factor analysis was evaluated by the sample adequacy ratio Kaiser-Meyer-Olkin (KMO)¹³13. Aminian M, Dianat I, Miri A, Asghari-Jafarabadi M. The Iranian version of the Copenhagen Psychosocial Questionnaire (COPSOQ) for assessment of psychological risk factors at work. Health Promot Perspect. 2017;7(1):7-13. https://doi.org/10.15171/hpp.2017.03
https://doi.org/10.15171/hpp.2017.03... ,²⁵25. Bekiari EI, Lyrakos GN, Damigos D, Mavreas V, Chanopoulos K, Dimoliatis IDK. A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population. J Musculoskelet Neuronal Interact. 2011;11(1):52-76.. Retained factors were derived according to the magnitude of the eigenvalues (greater than 1) and the proportion of extracted variance. Scree plot was used to determine the number of factors to be extracted. When items had low loads (less than 0.4) in more than one component (complex structure), they were removed from the analysis²⁵25. Bekiari EI, Lyrakos GN, Damigos D, Mavreas V, Chanopoulos K, Dimoliatis IDK. A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population. J Musculoskelet Neuronal Interact. 2011;11(1):52-76.. A forced analysis with one or two factors was performed when results indicated more than two factors¹³13. Aminian M, Dianat I, Miri A, Asghari-Jafarabadi M. The Iranian version of the Copenhagen Psychosocial Questionnaire (COPSOQ) for assessment of psychological risk factors at work. Health Promot Perspect. 2017;7(1):7-13. https://doi.org/10.15171/hpp.2017.03
https://doi.org/10.15171/hpp.2017.03... ,²⁵25. Bekiari EI, Lyrakos GN, Damigos D, Mavreas V, Chanopoulos K, Dimoliatis IDK. A validation study and psychometrical evaluation of the Maastricht Upper Extremity Questionnaire (MUEQ) for the Greek-speaking population. J Musculoskelet Neuronal Interact. 2011;11(1):52-76..

Internal consistency

Internal consistency assess the degree of interrelation between items, i. e., whether the items are measuring the same concept²⁰20. Mokkink LB, Prinsen CA, Bouter LM, Vet HCW, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105-13. https://doi.org/10.1590/bjpt-rbf.2014.0143
https://doi.org/10.1590/bjpt-rbf.2014.01... . We considered a minimum sample of 100 participants to ensure the stability of the variance-covariance matrix and evaluate the internal consistency²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... . Cronbach’s alpha was calculated separately for each dimension using baseline data (n = 211). Scores between 0.70–0.95 indicate acceptable internal consistency²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... .

Floor and Ceiling Effect

Floor and ceiling effects reflect problems with content validity and can limit detecting changes over time²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... . These were considered acceptable if less than 15% of participants reported the lowest or highest scores²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... . Distribution of the dimensions is presented in mean, standard deviation (SD), median and interquartile range (IQR).

Test-retest reliability

Reliability is the degree to which a measurement is free of measurement error, and if the scores are identical in repeated measurements over time (test-retest) for the same participants²⁰20. Mokkink LB, Prinsen CA, Bouter LM, Vet HCW, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105-13. https://doi.org/10.1590/bjpt-rbf.2014.0143
https://doi.org/10.1590/bjpt-rbf.2014.01... . Studies recommend a minimum sample of 50 participants to test the reliability measure²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... . Test-retest reliability was assessed using the intraclass correlation coefficient (ICC_(3,1)), with ICC values greater than 0.70²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... indicating reliability.

Measurement error

Measurement error means the systematic and random error of a participant’s score that is not assigned to real changes in the construct being measured²⁰20. Mokkink LB, Prinsen CA, Bouter LM, Vet HCW, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105-13. https://doi.org/10.1590/bjpt-rbf.2014.0143
https://doi.org/10.1590/bjpt-rbf.2014.01... , which requires a minimum sample of 50 participants²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... . This psychometric property was estimated by calculating the standard error of measurement (SEM) at baseline, using the following formula: SEM = SD*√(Cronbach’s alpha-1), where SD is the standard deviation of all the participants’ baseline scores²⁶26. Juul T, Søgaard K, Davis AM, Roos EM. Psychometric properties of the Neck OutcOme Score, Neck Disability Index, and Short Form-36 were evaluated in patients with neck pain. J Clin Epidemiol. 2016;79:31-40. https://doi.org/10.1016/j.jclinepi.2016.03.015
https://doi.org/10.1016/j.jclinepi.2016.... . Minimal detectable change (MDC) with 90% confidence was calculated by the following formula: MDC = 1,64*SD*√ (2 (1-R)), where R is the test-retest ICC value and SD the standard deviation of all the participants’ baseline scores. A change equal to or greater than the MDC, before and after an intervention, indicates that there has been a real change at the individual level²⁶26. Juul T, Søgaard K, Davis AM, Roos EM. Psychometric properties of the Neck OutcOme Score, Neck Disability Index, and Short Form-36 were evaluated in patients with neck pain. J Clin Epidemiol. 2016;79:31-40. https://doi.org/10.1016/j.jclinepi.2016.03.015
https://doi.org/10.1016/j.jclinepi.2016.... .

Construct validity

Construct validity reflects the degree to which an instrument score is consistent with hypotheses, based on the assumption that the instrument measures the construct under assessment²⁰20. Mokkink LB, Prinsen CA, Bouter LM, Vet HCW, Terwee CB. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) and how to select an outcome measurement instrument. Braz J Phys Ther. 2016;20(2):105-13. https://doi.org/10.1590/bjpt-rbf.2014.0143
https://doi.org/10.1590/bjpt-rbf.2014.01... . This psychometric property was tested between COPSOQ II-Br and JCQ, which also assesses psychosocial aspects, and NMQ, as musculoskeletal symptoms are closely related to psychosocial aspects. Musculoskeletal pain is common in the working population and has been associated with high work demands and low control²⁷27. Hauke A, Flintrop J, Brun E, Rugulies R. The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress. 2011;25(3):243-56. https://doi.org/10.1080/02678373.2011.614069
https://doi.org/10.1080/02678373.2011.61... .

Spearman’s correlation coefficient (r_s) was calculated to assess the construct validity between the JCQ scales²²22. Alves MGM, Chor D, Faerstein E, Lopes CS, Werneck GL. Versão resumida da “job stress scale”: adaptação para o português. Rev Saude Publica. 2004;38(2):164-71. https://doi.org/10.1590/S0034-89102004000200003
https://doi.org/10.1590/S0034-8910200400... and dimensions of the COPSOQ II-Br. The relation between symptoms in the neck and lower back in the past 12 months and seven days using the NMQ²³23. Barros ENC, Alexandre NMC. Cross-cultural adaptation of the Nordic musculoskeletal questionnaire. Int Nurs Rev. 2003;50(2):101-8. https://doi.org/10.1046/j.1466-7657.2003.00188.x
https://doi.org/10.1046/j.1466-7657.2003... and the dimensions of COPSOQ II-Br was assessed by point-biserial correlation coefficient (r_pb). We also tested the Spearman’s (r_s) correlation between the number of areas with musculoskeletal symptoms in the past 12 months and seven days and the dimensions of COPSOQ II-Br. Correlation coefficients greater than 0.70 were considered strong, between 0.70 and 0.50 moderate, and less than 0.50 weak²⁴24. Terwee CB, Bot SD, Boer MR, Windt DAWM, Knol DL, Dekker J, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60(1):34-42. https://doi.org/10.1016/j.jclinepi.2006.03.012
https://doi.org/10.1016/j.jclinepi.2006.... .

Regarding the expected relationship between the tested instruments, we formulated the following hypotheses: 1) there will be a significant and positive correlation between the dimension “Demands at work” of COPSOQ II-Br and the “Demand” scale of JCQ; 2) there will be a significant and positive correlation between the dimensions “Influence and development” and “Meaning and commitment” of COPSOQ II-Br and the “Control” scale of JCQ; 3) there will be a significant and positive correlation between the dimensions “Interpersonal relationships” and “Leadership” of COPSOQ II-Br and the “Social support” scale of JCQ; 4) there will be a significant and positive correlation between the dimensions “Demands at work”, “Work family conflict” and “Burnout and stress” of COPSOQ II-Br and musculoskeletal symptoms; 5) there will be a significant and negative correlation between the dimensions “Interpersonal relationships”, “Job satisfaction” and “General health” of COPSOQ II-Br and musculoskeletal symptoms.

The data were analyzed using SPSS software version 22.0 (SPSS Inc, Chicago, IL, EUA).

RESULTS

Sample Characteristics

Our study sample comprised mostly women (71%), with mean age of 40 years (SD: 11), married/living with a partner, with more than 15 years of study and up to 2 years working in the same company. Table 1 presents the complete sociodemographic characteristics of the sample.

Cross-Cultural Adaptation Process

We kept the format of the original questionnaire, with minor changes. Discrepancies were resolved by consensus between translators and by the expert committee.

We conducted two pre-tests. In the first, a sample of 30 workers from education (50%) and cleaning services (50%), with high and low level of education, respectively, answered the instrument. Workers (57% of the sample) had difficulty in answering question 4A due to semantics. Since the percentage of doubt exceeded 20%²⁷27. Hauke A, Flintrop J, Brun E, Rugulies R. The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress. 2011;25(3):243-56. https://doi.org/10.1080/02678373.2011.614069
https://doi.org/10.1080/02678373.2011.61... , the requestion was reprhased (from “Do you have a high degree of influence in relation to your work?” to “Do you have a high degree of influence in decisions about your work?”). A sample of 30 workers from the education, cleaning and maintenance/repair services, 15 women (50%) and 15 men (50%) with high and low level of education (50% in each group), participated in the second pre-test. At this stage, workers encountered difficulties only with questions 1A, 4A, 10A. As only 7% of workers had doubts on each question, no redesign was necessary²⁷27. Hauke A, Flintrop J, Brun E, Rugulies R. The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress. 2011;25(3):243-56. https://doi.org/10.1080/02678373.2011.614069
https://doi.org/10.1080/02678373.2011.61... . Based on the results of the pre-test, we finally proposed a short version of COPSOQ II culturally adapted to Brazilian Portuguese (COPSOQ II-Br)^aa Gonçalves JS. Os aspectos psicossociais no trabalho [tese]. São Carlos: Universidade Federal de São Carlos; 2019 [cited 2021 Jun 19]. Available from: https://repositorio.ufscar.br/handle/ufscar/11763 .

Psychometric Properties

Structural validity

PCA identified 11 factors, which represent approximately 50% of the variance (Table 2). The “Demands at work” domain comprised 6 questions and the factorial solution contained a factor (KMO = 0.72). “Work Organization and content” extracted two factors (KM = 0.70), the first being “Influence and development” and the second, “Meaning and commitment”. The “Interpersonal relationships and leadership” domain also obtained a solution with two factors (KMO = 0.87) (“Interpersonal relationships” and “Leadership”). Scree plot suggested the structure with two factors for “Work-individual interface” (KMO = 0.57). In this domain, the “Job satisfaction” dimension consisted of only one question, while the “Work family conflicts” dimension had two questions. “Values at the workplace” consisted of four questions and the factorial solution contained a factor (KMO = 0.79). Scree plot also suggested the structure with two factors for “Health and wellness” (KMO = 0.77). For this domain, the “General health” dimension comprised one question and the “Burnout and stress” dimension consisted of four questions. For the “Offensive behaviours” domain, factor analysis obtained one factor.

Internal consistency

For ten of the 11 dimensions of COPSOQ II-Br, the Cronbach’s alpha values varied between 0.70 and 0.87; for one dimension, the Cronbach’s alpha value was less than 0.70 (“Offensive behaviours”, Cronbach’s α = 0.54) (Table 3).

Floor and Ceiling Effect

Most dimensions of the COPSOQ II-Br short version presented acceptable floor and ceiling effects, except for the floor effect in the “Work family conflicts” dimension (26.1%) and, for the ceiling effect in the dimensions “Meaning and commitment” (27.5%) and “Job satisfaction” (22.3%) (Table 3).

Test-retest reliability and measurement error

All 11 dimensions showed acceptable reliability, with ICC_(3,1) between 0.71 and 0.81. The SEM ranged from 0.6 to 2.2, being lower for the dimensions “Offensive behaviors” and “Work family conflicts”, and higher for the dimensions “Demands at work”, “Interpersonal relationships” and “Influence and development”.

Minimal detectable change (MDC) ranged from 0.8 to 5.9 indicating, for example, that a change in the “Interpersonal relationships” dimension score must be at least 6 points to represent a real change for the individual (Table 4).

Construct validity

The analysis revealed significant and positive correlations between the dimensions of the COPSOQ II-Br and the JCQ scales. The point-biserial correlation coefficient between the presence of musculoskeletal symptoms and the dimensions of the COPSOQ II-Br were significantly and positively correlated for three dimensions (“Demands at work”, “Work family conflits” and “Burnout and stress”). We also found a significant and negative correlation between the presence of musculoskeletal symptoms and the dimensions “Interpersonal relationships”, “Job satisfaction” and “General health” of COPSOQ II-Br. These results confimed all the hypotheses formulated (Table 5).

DISCUSSION

The present study cross-culturally adapted the short version of the COPSOQ II into Brazilian Portuguese and analyzed its psychometric properties.

The exploratory factor analysis revealed a questionnaire structure composed of seven domains and 11 dimensions (40 questions). The Brazilian study on the medium version of COPSOQ I obtained a structural model with four domains, 17 dimensions and 53 questions¹⁸18. Silva MA, Wendt GW, Argimon IIL. Propriedades psicométricas das medidas do Questionário Psicossocial de Copenhague I (COPSOQ I), versão curta. REGE Rev Gestão. 2017;24:348-59.. The study by Lima et al¹⁹19. Lima IAX, Parma GOC, Cotrim TMCP, Moro ARP. Psychometric properties of a medium version of the Copenhagen Psychosocial Questionnaire (COPSOQ II) for southern Brazil. Work. 2019;62(2):175-84. https://doi.org/10.3233/WOR-192853
https://doi.org/10.3233/WOR-192853... . about the Spanish medium version of COPSOQ-ISTAS21 II (six domains, 21 dimensions and 70 questions) resulted in 13 dimensions and 70 questions¹⁹19. Lima IAX, Parma GOC, Cotrim TMCP, Moro ARP. Psychometric properties of a medium version of the Copenhagen Psychosocial Questionnaire (COPSOQ II) for southern Brazil. Work. 2019;62(2):175-84. https://doi.org/10.3233/WOR-192853
https://doi.org/10.3233/WOR-192853... . Our study, therefore, presents an acceptable structural validity result, respecting the original theoretical model of COPSOQ¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... .

Regarding internal consistency, the results showed that the Cronbach’s alpha values, in general, reached those recommended in the literature (above 0.70), excepting the “Offensive behaviours” dimension. These findings are in agreement with the results of other studies⁸8. Moncada S, Utzet M, Molinero E, Llorens C, Moreno N, Galtés A, et al. The Copenhagen Psychosocial Questionnaire II (COPSOQ II) in Spain: a tool for psychosocial risk assessment at the workplace. Am J Ind Med. 2014;57(1):97-107. https://doi.org/10.1002/ajim.22238
https://doi.org/10.1002/ajim.22238... .

As for the floor and ceiling effect, our results for the floor effect are similar to those found in the original Danish study¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... and in the study that cross-culturally adaptated the instrument to Portuguese in Portugal¹⁴14. Rosário S, Azevedo LF, Fonseca JA, Nienhaus A, Nübling M, Costa JT. The Portuguese long version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II): a validation study. J Occup Med Toxicol. 2017;12:24. https://doi.org/10.1186/s12995-017-0170-9
https://doi.org/10.1186/s12995-017-0170-... , both evaluating the long version of COPSOQ. Both studies found acceptable floor effects (less than 15%) for all dimensions, except for “Work family conflicts”. Our values for the ceiling effect, in turn, differ from studies in the literature¹⁴14. Rosário S, Azevedo LF, Fonseca JA, Nienhaus A, Nübling M, Costa JT. The Portuguese long version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II): a validation study. J Occup Med Toxicol. 2017;12:24. https://doi.org/10.1186/s12995-017-0170-9
https://doi.org/10.1186/s12995-017-0170-... ,¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... , as two dimensions presented this effect. This finding can be explained by the type of worker included in the sample, since teachers, managers and administrative positions tend to score higher for these dimensions¹⁵15. Kristensen TS, Hannerz H, Hogh A, Borg V. The Copenhagen Psychosocial Questionnaire - a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438-49. https://doi.org/10.5271/sjweh.948
https://doi.org/10.5271/sjweh.948... .

The test-retest reliability measurements showed that all dimensions had good consistency (0.71 to 0.81), result similar to those found by Aminian et al.¹³13. Aminian M, Dianat I, Miri A, Asghari-Jafarabadi M. The Iranian version of the Copenhagen Psychosocial Questionnaire (COPSOQ) for assessment of psychological risk factors at work. Health Promot Perspect. 2017;7(1):7-13. https://doi.org/10.15171/hpp.2017.03
https://doi.org/10.15171/hpp.2017.03... (0.75 to 0.89) and Rosário et al.¹⁴14. Rosário S, Azevedo LF, Fonseca JA, Nienhaus A, Nübling M, Costa JT. The Portuguese long version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II): a validation study. J Occup Med Toxicol. 2017;12:24. https://doi.org/10.1186/s12995-017-0170-9
https://doi.org/10.1186/s12995-017-0170-... (0.71 to 0.93).

Studies that tested the psychometric properties of COPSOQ show good results in terms of internal consistency⁸8. Moncada S, Utzet M, Molinero E, Llorens C, Moreno N, Galtés A, et al. The Copenhagen Psychosocial Questionnaire II (COPSOQ II) in Spain: a tool for psychosocial risk assessment at the workplace. Am J Ind Med. 2014;57(1):97-107. https://doi.org/10.1002/ajim.22238
https://doi.org/10.1002/ajim.22238... and test-retest reliability¹³13. Aminian M, Dianat I, Miri A, Asghari-Jafarabadi M. The Iranian version of the Copenhagen Psychosocial Questionnaire (COPSOQ) for assessment of psychological risk factors at work. Health Promot Perspect. 2017;7(1):7-13. https://doi.org/10.15171/hpp.2017.03
https://doi.org/10.15171/hpp.2017.03... ,¹⁴14. Rosário S, Azevedo LF, Fonseca JA, Nienhaus A, Nübling M, Costa JT. The Portuguese long version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II): a validation study. J Occup Med Toxicol. 2017;12:24. https://doi.org/10.1186/s12995-017-0170-9
https://doi.org/10.1186/s12995-017-0170-... , but most of them evaluated the first version of the questionnaire (COPSOQ I)⁹9. Nübling M, Stößel U, Hasselhorn HM, Michaelis M, Hofmann F. Measuring psychological stress and strain at work - evaluation of the COPSOQ questionnaire in Germany. Psychosoc Med. 2006;3:Doc05., in its medium⁸8. Moncada S, Utzet M, Molinero E, Llorens C, Moreno N, Galtés A, et al. The Copenhagen Psychosocial Questionnaire II (COPSOQ II) in Spain: a tool for psychosocial risk assessment at the workplace. Am J Ind Med. 2014;57(1):97-107. https://doi.org/10.1002/ajim.22238
https://doi.org/10.1002/ajim.22238... ,¹⁰10. Alvarado R, Marchetti N, Villalón M, Hirmas M, Pastorino MS. Adaptación y análisis psicométrico de un cuestionario para evaluar riesgos psicosociales en el trabajo en Chile: versión media del COPSOQ. Rev Chil Salud Publica. 2009;13(1):7-16.,¹²12. Pournik O, Ghalichi L, TehraniYazdi A, Tabatabaee SM, Ghaffari M, Vingard E. Measuring psychosocial exposures: validation of the Persian of the Copenhagen Psychosocial Questionnaire (COPSOQ). Med J Islam Repub Iran. 2015;29:221.,¹⁸18. Silva MA, Wendt GW, Argimon IIL. Propriedades psicométricas das medidas do Questionário Psicossocial de Copenhague I (COPSOQ I), versão curta. REGE Rev Gestão. 2017;24:348-59.,¹⁹19. Lima IAX, Parma GOC, Cotrim TMCP, Moro ARP. Psychometric properties of a medium version of the Copenhagen Psychosocial Questionnaire (COPSOQ II) for southern Brazil. Work. 2019;62(2):175-84. https://doi.org/10.3233/WOR-192853
https://doi.org/10.3233/WOR-192853... and long⁹9. Nübling M, Stößel U, Hasselhorn HM, Michaelis M, Hofmann F. Measuring psychological stress and strain at work - evaluation of the COPSOQ questionnaire in Germany. Psychosoc Med. 2006;3:Doc05.,¹⁴14. Rosário S, Azevedo LF, Fonseca JA, Nienhaus A, Nübling M, Costa JT. The Portuguese long version of the Copenhagen Psychosocial Questionnaire II (COPSOQ II): a validation study. J Occup Med Toxicol. 2017;12:24. https://doi.org/10.1186/s12995-017-0170-9
https://doi.org/10.1186/s12995-017-0170-... versions, making adaptations in the instrument⁸8. Moncada S, Utzet M, Molinero E, Llorens C, Moreno N, Galtés A, et al. The Copenhagen Psychosocial Questionnaire II (COPSOQ II) in Spain: a tool for psychosocial risk assessment at the workplace. Am J Ind Med. 2014;57(1):97-107. https://doi.org/10.1002/ajim.22238
https://doi.org/10.1002/ajim.22238... .

The present study assessed construct validity by the correlations between the dimensions of the COPSOQ II-Br and the JCQ scales. These findings are in accordance with the COPSOQ proposal, which addresses, among others, the Karasek theory with equivalent questions in the questionnaire¹⁵15. Kristensen TS, Hannerz H, Hogh A, Borg V. The Copenhagen Psychosocial Questionnaire - a tool for the assessment and improvement of the psychosocial work environment. Scand J Work Environ Health. 2005;31(6):438-49. https://doi.org/10.5271/sjweh.948
https://doi.org/10.5271/sjweh.948... ,¹⁶16. Pejtersen JH, Kristensen TS, Borg V, Bjorner JB. The second version of the Copenhagen Psychosocial Questionnaire. Scand J Public Health. 2010;38(3 Suppl):8-24. https://doi.org/10.1177/1403494809349858
https://doi.org/10.1177/1403494809349858... .

The association between COPSOQ II-Br and musculoskeletal symptoms presetend adequate results, in agreement with other studies in the literature that noted the association between these psychosocial aspects and musculoskeletal symptoms²⁷27. Hauke A, Flintrop J, Brun E, Rugulies R. The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress. 2011;25(3):243-56. https://doi.org/10.1080/02678373.2011.614069
https://doi.org/10.1080/02678373.2011.61... . Interestingly, in our study, some of the dimensions showed a negative correlation with the presence of musculoskeletal symptoms, i. e., the greater the presence of these psychosocial aspects in the workplace the lower the proportion of symptoms.

Hauke et al.²⁷27. Hauke A, Flintrop J, Brun E, Rugulies R. The impact of work-related psychosocial stressors on the onset of musculoskeletal disorders in specific body regions: a review and meta-analysis of 54 longitudinal studies. Work Stress. 2011;25(3):243-56. https://doi.org/10.1080/02678373.2011.614069
https://doi.org/10.1080/02678373.2011.61... found that psychosocial working conditions such as low social support, job control, decision-making power, job satisfaction and high job demands, were associated with increased risk of lower back and neck/shoulder pain. A cross-sectional study conducted in Brazil, in turn, showed that low social support, high psychological demand and low job control increased the prevalence of multiregional symptoms²⁹29. Fernandes RCP, Pataro SMS, Carvalho RB, Burdorf A. The concurrence of musculoskeletal pain and associated work-related factors: a cross sectional study. BMC Public Health. 2016;16:628. https://doi.org/10.1186/s12889-016-3306-4
https://doi.org/10.1186/s12889-016-3306-... . Thus, the results obtained in this study were consistent with the literature findings.

Some limitations of this study concern aspects related to data collection. First, the online questionnaire had a low response rate (15%) when compared to the in-person format (75%). Second, the sample lacked balance regarding sex, which may have influenced the responses. Finally, the study did not include industry and retail workers, sectors that should be investigated in future studies.

Therefore, this study was able to culturally-adapt the short version of COPSOQ II into Brazilian Portuguese and test its psychometric measures, whose results were considered suitable for using the instrument to assess the health of the population of Brazilian workers.

REFERENCES

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