This is a methodological study developed from the DISABKIDS method (Disabkids Group, 2002), which presupposes the following steps: literature review and knowledge about the empirical context of reference for the construction of contents that effectively allow the assessment of the desired scenario or phenomenon.

The phases for developing the questionnaire and the respective number of participants and items of each version were systematized in Figure 3.

During the study period, the number of collaborators working in CSs was around 250 people, of which 18 participated in the feedback phase of the empirical material resulting from the 50 interviews and content validation of the first version of the questionnaire, consisting of 46 items. At this stage, the respondents were allocated to groups A, B and C and analyzed only a subset of the items, that is, group A assessed items 1 to 16, group B items 17 to 32 and group C items 33 to 46. These actions allowed the respondent to elaborate the items in another way until there was no difficulty in comprehending them. This division, proposed by the DISABKIDS manual (Disabkids Group, 2002), was performed so that each participant responded to a certain number of items, avoiding possible biases arising from possible effects such as discomfort and fatigue in the analysis of the items.

The age of the participants ranged between 27 and 53 years, with a mean of 40 years and standard deviation of 7.2 years. The level of education was high school (50%) and higher education (39%). The length of experience in the performance of activities in confined spaces ranged between 1 and 23 years, with a mean of 9.7 years and standard deviation of 7.0 years.

Content validation with the workers showed that the 18 participants understood all the items and would not ask them in another way. However, all suggested modifications, additions or removal of items. The pertinent suggestions were accepted by the researcher in agreement with the questionnaire’s elaboration committee and generated changes in the wording of 24 items and the addition of six items. A total of 22 items remained unchanged.

Regarding the evaluations of items 1 to 16, assessed by group A, suggestions for changes to items on the type of exposure to risk, from 1 to 4, were made by three of the evaluators and accepted by the researcher in agreement with the elaboration committee. They suggested including examples to detail what each type of risk is, that is, what is a biological, chemical, physical and ergonomic risk. As an example, item 1 “The biological risk for my work in confined spaces is”: was changed to “The biological risk (bacteria, fungi) for my work in confined spaces is”: As shown, after naming the risks, some examples were included in parentheses. The addition of one item was suggested – “I am aware of the risks I may encounter when working in confined spaces” – prior to the types of risks, in order to identify whether the worker is aware of their exposure to the risk. Also the addition of the item “The risk of accidents (inadequate physical arrangement, inadequate Personal Protective Equipment (PPE), unprotected machinery, poor electrical connections) for my work in confined spaces is: related to the identification of the risk of accident was suggested and added. Five items in the set remained unchanged. The wording or form of presentation was changed in 11 items and two items were added as proposed by the evaluators.

Group B evaluated items 17 to 32 and eight remained unchanged. In the others, the changes were related to word substitutions for a better understanding of the items. For example, item 17 “My work in confined space gives me security to the point of skipping procedures while performing it” was changed to “My experience working in confined spaces may lead me to disregard some steps of the performance procedure”. According to five participants, the term skipping procedures could indicate that the worker was taking actions.

In items 19, 21, 25, 26, 28, 30 and 32 there were replacement or omission of words or terms for their synonyms, aimed at ease of understanding. As an example, in item 19 “I can be assigned to perform different functions while performing my work in a confined space”: the phrase I can be assigned was substituted for I am prepared. In item 21 “Given the perception of a risky situation in a confined space, I am able to maintain self-control in order to solve the situation”, the section in order to solve the situation was excluded. In item 30 “I have difficulty recognizing my technical limits related to carrying out work in a confined space” the word difficulty was replaced by technical limitations, since the word difficulty did not express the type of difficulty according to two workers and the word recognizing was also eliminated because, according to one participant, the worker may have technical limitations for performing the activity, but may recognize their limitation.

Group C evaluated items from 33 to 46. Nine remained unchanged and four (49, 50, 51 and 52) were added at the suggestion of the evaluators and accepted by the researcher in agreement with the elaboration committee. The items added aim to assess the use of PPE and workers’ access to the work safety team. In items 35, 37, 40, 45, 46 and 47 terms or excerpts were replaced or eliminated in order to better understand the items. For item 37 “The time to perform my work is independent of the pressure exerted to finish it”, the term independent of was replaced by not dependent on. In item 45 “I am uncomfortable when I am assigned to work in a confined space” the expression “I am” was replaced with “I feel” and the word assigned was changed to scheduled. Finally, in item 46 “The use of substances, such as alcohol and drugs can harm my work in confined spaces”, the wording the use of substances was changed to the substance use and the word medicines was added.

In summary, in the first version of the questionnaire, 22 (47.8%) items were maintained, 24 items were modified (52.2%) and six items were added. Consequently, the second version of the questionnaire consisted of 52 items. After this process, the content validation phase took place with 22 judges, 16 of whom were experts in the field of study related to psychosocial risk factors and six representatives of the target population who had not participated in the previous steps.

In items 1 to 6, eight judges suggested the addition, aiming to improve the workers’ comprehension, of the term I am exposed to and new examples of the types of risk. As an example, item 2 was presented like this after the suggestions: “I am exposed to biological risks (fungi, bacteria, microbes and other agents) when performing my work in confined spaces”. Also at their suggestion, the way the Likert-type scale was presented changed for the answer options, with the space for choosing the answer in front of the text, which changed from “Never ( ), Almost never ( ), Sometimes ( ), Almost always ( ), Always ( )” to “( ) Never, ( ) Almost never, ( ) Sometimes, ( ) Almost always, ( ) Always”, standardizing the questionnaire’s response options.

Item 8 “There are well-defined assignments for my work team in confined spaces” had the wording changed at the suggestion of eight judges, as they indicated that there could be difficulty in comprehension due to it not being clear whether it was referring to the assignments of each professional of the team or the team as a whole, given that, according to NR 33, there are specific roles and assignments designated for the supervisor, the inspector and the worker. Therefore, it was presented as follows: “There are well-defined assignments for each professional in my team when performing work in confined spaces.

In seven items (10, 12, 15, 22, 31, 37 and 44) words were added. In 13 items, word replacements (13, 18, 23, 25, 26, 34, 38, 40, 43, 47, 49, 51 and 52) and preposition substitutions or punctuation placements (11, 19 and 29) were made. Finally, in four items (24, 30, 32, 36) some words were moved from one place to another in the sentence. All changes were based on the judges’ considerations, who made relevant considerations, consequently accepted, so that the worker better understood the items, even in those evaluated with scores of 3 (Needs a small review to be relevant/representative/clear/present a suitable format) or 4 (Item relevant/representative/clear/suitable format). In the items in which there were words with the possibility of identifying sex/gender, the option was added, contemplating the development of the questionnaire for female respondents, even though no female professionals took part in this study. In summary, the questionnaire presented to the judges consisted of 52 items. Of these, 36 were changed, 7 were excluded and 9 remained unchanged. Accordingly, the final version of the questionnaire at this stage had 45 items.

As described in the method, the items were evaluated according to the CVI and from the “risk factor” or “protective factor” categories. Table 1 shows the CVI values resulting from the content validation phase, according to the judges, participants from the target population and total.

Regarding the CVI values assigned by the judges and by the participants of the target population, the ICC resulted in 0.023 with CI [95%]: [-0.167; 0.238], which shows disagreement between the distributions of values. In fact, for the participants of the target population, the CVI values were 100% in 51 of the 52 items. The variability of CVI values among the judges was greater.

According to Table 1, 45 items had a CVI greater than 0.90, a level established as the minimum to verify the validity of new constructs. Seven items had an overall CVI below 0.90 and were eliminated from the questionnaire at this time.

The items excluded from the questionnaire were: (7) I have material resources to analyze the environmental risks of my work in confined spaces, with CVI = 86.4%; (39) The time to perform the work by the team in a confined space is not dependent on the pressure exerted to finish it, with CVI = 86.4%; (41) My work problems interfere with my family life, with CVI = 68.2%; (42) Inappropriate games can impair the quality of relationships at work in confined spaces, with CVI = 86.4%; (45) I can separate family problems from my work context, with CVI = 77.3%; (46) The psychosocial assessment helps to identify emotional aspects that can influence the performance of work in confined spaces, with CVI = 72.7% and (48) The use of legal or illegal substances, including medications, can impair the work in confined spaces, with CVI = 86.4%.

Regarding item 7, eight judges expressed difficulty in comprehending the type of material resource used to carry out the risk analysis. Seven judges identified item 39 as confusing and difficult for the worker to understand. Likewise, for item 41, eight judges described it as unclear and unspecific in view of the relationship with psychosocial risk factors. Item 42 was considered confusing by seven judges and they made considerations about “the way in which these games interfere in the quality of the work in a confined space”. When evaluating item 45, eight expert judges considered that the psychosocial assessment should be an evaluation questionnaire and not a psychosocial factor in itself, although the six workers in the area considered the item relevant. Finally, the evaluation of item 48 showed, according to five judges, that the worker could have difficulty understanding the wording “legal and illegal substances”.

Table 2 shows the values of the percentages of classification into the “risk factor” or “protective factor” categories, resulting from the content validation phase, according to judges and participants from the target population.

The items resulting from the content validation phase, according to the judges and participants from the target population, were also classified in the “risk factor” or “protective factor” categories. The values obtained for the ICC showed agreement between the assessments of the two groups, with ICC = 0.936 and CI [95%]: [0.892; 0.963].

The resulting 45 items were then categorized, according to the theoretical framework adopted, in the “Content” and “Context” domains. For example, the following items can be found in the content domain: “I am exposed to chemical risk (dust, gases, vapors and other agents) when performing my work in confined spaces”; “I have technical training to perform different tasks in confined spaces”; “I have difficulty memorizing the procedures required to perform my work in confined spaces. With the following items in the context domain: “My team will help me if I encounter any difficulties related to carrying out work in a confined space”, “If I observe that a colleague does not have adequate emotional conditions to carry out the work, I tell them this”, “I have difficulty expressing myself if I feel afraid while performing work in a confined space”.

The final version of the Perception of Psychosocial Risk Factors for Confined Spaces Questionnaire was divided into two domains: Content (60.0%) and Context (40.0%). The content domain has four attributes: 1. Work environment and equipment (22.2%), with 10 items; 2. Workload and pace (6.7%), with three items; 3. Task planning (31.2%), with 14 items. The Content domain has five attributes: 1. Organizational culture and function (2.2%), with one item; 2. Role in the organization (8.9%), with four items; 3. Decision and control latitude (24.4%), with 11 items; 4. Interpersonal relationship at work (2.2%), with one item and 5. Work-home interface with one item (2.2%).

The model presented in this study should be applied to about 315 workers to conduct the exploratory factor analysis so that the latent structure associated with the “perception of psychosocial risk factors” construct can be proposed and validated in future studies (Terwee et al., 2007). It should be highlighted that, in this study, some attributes of the model “Working hours” and “Career development” did not have items assigned, which does not mean that they will be excluded from the final model of the questionnaire.

This study aimed to develop and validate the content of a questionnaire for the description of psychosocial risk factors in the practice of CS workers. This process showed the importance of each step taken to prepare the version of the questionnaire, which, after content validation, was composed of 45 items distributed into eight attributes of psychosocial risk factors, three of which being associated with the “Content of work” domain and five with the “Context of work” domain.

The theoretical framework adopted describes six dimensions associated with the “Work context” domain and four with the “Work content” domain (Leka & Cox, 2008). In this study, no evidence was found associated with the “Working hours” and “Career development” attributes. The workers of the company under study have a career development plan and in the interview they did not report situations of uncertainty or stagnation. Furthermore, with regard to working hours, no reports were identified associated with shift changes, unpredictable or very long working hours, or inflexible work schedules. However, this does not mean that they will be excluded from the final model of the questionnaire.

In the “Content” domain, the attribute most perceived by the workers was “Task planning” and in the “Context” domain, the attribute most perceived was “Decision and control latitude”. According to Leka and Cox (2008), the attribute “Work planning” can be characterized as a psychosocial risk when the conditions that define the risk show, from the worker’s perception: poorly-defined work, high degree of job uncertainty, little variety/short work cycles, fragmented or meaningless work, inappropriate use of talent/skills, continual exposure to customers or groups of consumers. The attribute “Decision and control latitude” is identified as a psychosocial risk when it is associated with low participation in decision-making processes, lack of control over work and few decisions made in the work.

It is important to reflect that, according to Leka and Jain (2010), the attribute “Task planning” associated with a positive work environment is capable of providing workers with adequate use of their skills, interest and engagement in the development of their activities. Likewise, the attribute “Decision and control latitude” can provide participation in decision-making and control in the work performed, domains that are essential for carrying out activities in CSs.

The content validation carried out with the workers was of great value, considering that they were able to evaluate the items before sending them to the judges. It should also be highlighted that the execution time of activities in CSs and the experience of moments that preceded the implementation of NR 33 significantly contributed to the identification of relevant attributes by the target population. Accordingly, depending on the specificity of the construct analyzed, the performance of content validation with the target population, followed by content validation by judges is recommended, which, in the case of this study, certainly improved the method.

The absence of expanded knowledge of the work context results in the inability to comprehend how environmental, sociocultural, biological and psychological phenomena can be intimately connected both in promoting worker health and in preventing injuries and accidents resulting from exposure to psychosocial risk factors. Therefore, to advance scientific knowledge about the psychosocial risk factors to which workers are exposed in CSs, it is necessary to direct the objectives of studies from the perspective of exploring the environment in a comprehensive way. Accordingly, the construction of the questionnaire reported in this study constitutes an important advance in the labor scenario represented by CSs.

This study presents a questionnaire developed from the perceptions of employees who work in CSs and in accordance with what is recommended by NR 33 on psychosocial risk factors, providing support for the organization of integrative health care, notably prevention and health promotion with this population. In this scenario, this study was guided by reflection on the theoretical and conceptual perspectives of psychosocial risk factors, giving voice to workers, considering that they provide a view of the interface between the work content and context dimensions.

Furthermore, the difficulty in identifying or recognizing the relevance of mental health in the work environment affects the implementation of preventive and corrective measures, with interventions based on the reduction of psychosocial risk factors. Therefore, the results indicate the importance of developing and implementing management practices aimed at the participation of workers in work processes and, consequently, the questionnaire developed can support these actions. Considering the effects of the COVID-19 pandemic on workers working in CSs also emerges as a need, which still needs to be addressed in scientific studies that can add to the evidence available so far.

In terms of future perspectives, the final items of the questionnaire will be applied for workers in CSs to conducted exploratory factor analysis, verification of psychometric properties and confirmatory factor analysis, in order to make it valid and reliable so that it can be applied in different places where there is the performance of activities in CSs. In short, this methodological study contributes to the advancement of scientific knowledge, as well as the clinical practice in the context of worker health, given that the identification of psychosocial risks is as relevant as their management, considering their physical, behavioral and social consequences.