Cultural adaptation and specifics of the Fit & Strong! program in Portugal.

Fit & Strong! is a physical activity/behavior change evidence-based intervention for persons with osteoarthritis (OA) that was developed and tested in USA. This article describes the development of a new culturally adapted Portuguese version of Fit & Strong!, reviews the methods used, and describes the new features of the Portuguese program. Six steps were implemented for the cultural adaptation: training the Portuguese research team, materials translation, needs assessment which includes literature review, focus group with older adults with lower extremity joint pain, interviews with experts about Fit & Strong! format and content, program instructor training, and pilot study and program implementation. At the conclusion of the pilot, debriefing interviews were held with participants and instructors to obtain their opinions about the program. Thematic content analysis and SWOT analysis were used to analyze the qualitative data. Findings indicated needed changes to the original Fit & Strong! program protocol. In the Manuals, language was simplified and more pictures added to be suitable for people with lower level of literacy. Also, practical examples described in Manuals were adjusted or substituted to better fit the Portuguese culture. As a description of Portuguese organizations in the field, Thermal Spa and Mediterranean diet were added to the Manual. We recommend using two instructors to address individual challenges during the sessions. The Portuguese version of Fit & Strong! introduces all the necessary changes to become a relevant new intervention program to raise quality of life of patients with OA in Portugal.