Health professionals’ attitudes towards people experiencing homelessness in Portugal

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.