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This fact will lead us to review carefully the translation process of this item, but also to investigate more in-depth the relevance or specificities of this concept in the Brazilian adolescent population.

As a result of this review process, the item on lifetime risk (see 'additional file 2 - lifetime risk item') was removed from the Bowel/Colorectal CAM.

This process included item generation, item reduction, questionnaire preparation, and questionnaire pre-testing.

After this process, the final item pool comprised 30 items, each with a five-point response scale and a recall period of 4 weeks.

This process, known as item calibration, involves administering test items to a sample of examinees representative of the sample who will be given the computer-adaptive test.

It is only through this iterative process of item analysis and improvement that pedagogically and psychometrically sound tests can be developed.

This process ensures that item parameter calibrations obtained from each group are meaningful and comparable.

This process of developing item banks for PROMIS included literature review, qualitative research including individual cognitive interviews and field-testing [ 2, 4, 21- 23].

At the end of this process, 43 items remained.

During this process, no items were eliminated, but several changes were made to the wording.

Following this process, 399 items were rejected due to a lack of relevance.

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