Construção e validação de Escala de Qualidade da Assistência Hospitalar no Puerpério (EQUAP)
Introduction: the puerperium is a period of physical and mental changes that begins after birth and ends when breastfeeding ends. This process of involution to the pre-pregnancy condition can cause more severe complications and evolve to death; however, 92% of maternal deaths in this phase are pr...
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| Formato: | doctoralThesis |
| Idioma: | pt_BR |
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Universidade Federal do Rio Grande do Norte
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| Endereço do item: | https://repositorio.ufrn.br/handle/123456789/32771 |
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| Resumo: | Introduction: the puerperium is a period of physical and mental changes that begins after birth
and ends when breastfeeding ends. This process of involution to the pre-pregnancy condition
can cause more severe complications and evolve to death; however, 92% of maternal deaths in
this phase are preventable, especially at the hospital level, when related to bleeding, puerperal
infection, and hypertension. In this context, the evaluation of the quality of puerperal hospital
care is fundamental for the monitoring of possible complications. However, the indicator that
evaluates this type of care does not contemplate the complications susceptible to complications,
nor the specific causes related to maternal deaths. Objective: to construct and validate a scale
for assessing the quality of hospital care in the puerperium. Method. a methodological study
developed in two stages: theoretical foundation and theoretical analysis. In the theoretical
foundation stage, an instrument based on the General Systems Theory, proposed by Adevis
Donabedian, and a scope review that allowed the construction of the instrument items from the
constitutive, operational and behavioral definitions were developed. The second stage began
with the evaluation of expert judges in the field. They agreed or disagreed with the items based
on the following criteria: objectivity, simplicity, clarity, relevance, accuracy, and variety. The
inclusion of expert judges was based on the following criteria: having published and researched
on the topic and being an expert in instrument construction. Those who submitted incorrect or
incomplete answers were excluded. The Content Validity Index (CVI) and the Kappa Index
were used to evaluate the level of agreement between the judges about a given item. The study's
relevance criteria were CVI>0.80 and Kappa>0.61. The sample consisted of ten judges. In
addition, the instrument was submitted to a lexical and grammatical correction in order to allow
its adaptation to another language. After lexical and grammatical analysis and validation by
expert judges, the evaluation of puerperal women (target population) was performed. They
agreed or disagreed with the items based on the following criteria: A (easy to understand), B
(medium understanding) and C (did not understand the item). This step allowed the evaluation
by the lowest cognitive stratum of the target population. Ten puerperal women admitted to the
Flávio Ribeiro Coutinho Maternity in the municipality of Santa Rita, Paraíba, were randomly
selected by convenience. Inclusion criteria for the women were: being over 18 years old,
knowing how to read and write, and being in the puerperium. The exclusion criteria were: puerperal complication, some medical contraindication and/or with suspected COVID-19. At
this stage, the Content Validity Index and Kappa Index were also used. The pertinence criterion
was CVI>0.80 and Kappa>0.61. The instrument went through a second evaluation by expert
judges to validate the final version of the instrument. The method chosen for the construction
and theoretical validation of this evaluation instrument followed Pasquali's recommendations.
It is noteworthy that this study was submitted to the Research Ethics Committee (REC) of the
Federal University of Rio Grande do Norte (UFRN), in accordance with Resolution No.
466/2012, and obtained a favorable opinion under CAAE number 18967519.6.0000.5176.
Results: At the end of this stage, eight items were removed from the instrument, 11 were
unified, and three had their wording modified. After the lexical and grammatical correction, the
scale was submitted to the analysis of the target audience, and presented CVI ≥ 0.9 in all items,
except for items 16, 24, 34, 37, 38, which presented CVI < 80, were reformulated and were not
removed. Finally, a second round was performed with the participation of judges and the scale
obtained a CVI ≥0.9 in all items. The scale for assessing the quality of hospital care provided
in the puerperium is presented with theoretical validity, mean CVI = 0.99, with 49 items in
total, 17 in the structure dimension, 23 in the process dimension, and nine in the result
dimension. It is concluded that the scale for assessing the quality of hospital care provided in
the puerperium has theoretical validity. |
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