Content validation of the Nutritional Attention Assessment Instrument in Primary Health Care
Keywords:
Evaluation studies as topic, Primary health care, Nutrition programs and policies, Nutrition policy, NutritionistsAbstract
Objective
Construct and validate the content of an instrument to evaluate the organization of nutritional care in Primary Health Care in Brazil.
Methods
This is a cross-sectional and validation study. The construction of the Nutritional Attention Assessment Instrument was based on literature review and review of official documents. The instrument was submitted to content validation using the Delphi technique in two rounds.
Results
The validation panel consisted of 29 specialists from the five Brazilian Macroregions: 13 higher education teachers/investigators, seven food and nutrition managers, four Primary Health Care professionals and five professionals knowledgeable of the subject, most of them (89.7%) working in the public service with experience of over six years. The validated instrument contains 68 questions and 10 indicators: (1) Nutritionist performance; (2) Support to the Nutritional Attention actions: infrastructure and permanent education; (3) Intersectoriality; (4) Social Control; (5) Food and Nutrition Surveillance; (6) Individual Nutritional Attention; (7) Nutritional Attention for Groups; (8) Nutritional Attention focused on prenatal care; (9) Nutritional Attention focused on postpartum/ breastfeeding and (10) Nutritional Attention focused on child health.
Conclusion
The proposed instrument is an advance which enables the establishment of evaluation processes for Nutritional Attention. It is expected that this instrument be widely used to evaluate the Nutritional Attention given in the municipalities, states and at the federal level. The results obtained with future applications may contribute to support management qualification of food and nutrition policies.
References
World Health Organization. Noncommunicable diseases. Geneva: Organization; 2018 [cited 2020 Mar 11]. Available from: http://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
Institute for Health Metrics and Evaluation. Findings from the Global Burden of Disease Study 2017. Seattle: Institute; 2018.
World Health Organization. Noncommunicable diseases country profiles 2018. Geneva: Organization; 2018.
GBD 2017 Diet Collaborators. Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2019;393(10184):1958-72. https://doi.org/10.1016/S0140-6736(19)30041-8
GBD 2017 Risk Factor Collaborators. Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1923-94. https://doi.org/ 10.1016/S0140-6736(18)32225-6
Jardim PCBV. Overweight, the cardiovascular risk of the century. Arq Bras Cardiol. 2019:113(2)185-7.
Afshin A, Forouzanfar MH, Reitsma MB, Sur P, Estep K, Lee A, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377(1):13-27. https://doi.org/10.1056/NEJMoa1614362
Ministério da Saúde (Brasil). Vigitel Brasil 2019: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico: estimativas sobre frequência e distribuição sociodemográfica de fatores de risco e proteção para doenças crônicas nas capitais dos 26 estados. Brasília: Ministério; 2020.
Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: antropometria e estado nutricional de crianças, adolescentes e adultos no Brasil. Rio de Janeiro: Instituto; 2010.
Ward ZJ, Long MW, Resch SC, Giles CM, Cradock AL, Gortmaker SL. Simulation of growth trajectories of childhood obesity into adulthood. N Engl J Med. 2017;377(22):2145-53. https://doi.org/10.1056/NEJMoa1703860
Horta BL, Victora CG, França GVA, Hartwig FP, Ong KK, Rolfe EDL, et al. Breastfeeding moderates FTO related adiposity: a birth cohort study with 30 years of follow-up. Nature. 2018;8(1):1-11. https://doi.org/10.1038/s41598-018-20939-4
Victora CG, Bahl R, Barros AJD, França GVA, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016;387(10017):475-90. https://doi.org/10.1016/S0140-6736(15)01024-7
Horta BL, Mola CL, Victora CG. Long-term consequences of breastfeeding on cholesterol, obesity, systolic blood pressure and type 2 diabetes: a systematic review and meta-analysis. Acta Paediatr Int J Paediatr. 2015;104(467):30-7. https://doi.org/ 10.1111/apa.13133
Laporte-Pinfildi ASC, Medeiros MAT. Nutritional care during prenatal and postpartum periods: a report of experiences in a city on São Paulo’s coast. Rev Nutr. 2016;29(6):947-61. https://doi.org/10.1590/1678-98652016000600016
Laporte-Pinfildi ASC, Zangirolani LTO, Spina N, Martins PA, Medeiros MAT. The nutritional care during the prenatal and postpartum: perceptions of managers of Primary Health Care. Rev Nutr. 2016;29(1):109-23. https://doi.org/10.1590/1678-98652016000100011
Mitchell LJ, Ball LE, Ross LJ, Barnes KA, Williams LT. Effectiveness of dietetic consultations in primary health care: a systematic review of randomized controlled trials. J Acad Nutr Diet. 2017;117(12):1941-62. https://doi.org/10.1016/j.jand.2017.06.364
Howatson A, Wall CR, Turner-Benny P. The contribution of dietitians to the primary health care workforce. J Prim Health Care. 2015;7(4):324-32. https://doi.org/10.1071/hc15324
Dietitians of Canada. Dietitians in primary health care. Ottawa: Dietitians of Canada; 2017 [cited 2017 Aug 29]. Available from: https://www.dietitians.ca/DietitiansOfCanada/media/Documents/Resources/DieittiansInPrimaryHealthCare-bilingual.pdf?ext=.pdf
Recine E, Carvalho MF, Leão M. O papel do nutricionista na atenção primária à saúde. Brasília: Conselho Federal de Nutricionistas; 2015 [citado 3 jun 2017]. Disponível em: https://www.cfn.org.br/wp-content/uploads/2015/11/livreto-atencao_primaria_a_saude-2015.pdf
Pereira TN, Monteiro RA, Santos LMP. Food and nutrition in primary care in Brazil. Gac Sanit. 2018;32(3):297-303. https://doi.org/10.1016/j.gaceta.2017.08.004
Ministério da Saúde (Brasil). Política Nacional de Alimentação e Nutrição. 2nd. ed. Brasília: Ministério; 2012.
Ministério da Saúde (Brasil). Portaria n. 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Brasília: Ministério; 2017 [citado 2020 Jun 29]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html
Oliveira JTC, Gabriel CG, Machado ML, Réos MF, Soar C, Venske DKR. Government-subsidized restaurants as promoters of the realization of the human right to adequate food: proposal of an evaluation model. Rev Nutr. 2019;32:e180193. https://doi.org/10.1590/1678-9865201932e180193
Pessini J, Gerage AM, Meurer ST, Barbosa AR, Lopes ACS, Benedetti TRB. Cross-cultural equivalence and psychometric proprieties of the social support scale for healthy eating habits. Rev Nutr. 2016;29(6):797-807. https://doi.org/10.1590/1678-98652016000600005
Pereira RDM, Alvim NAT. Delphi technique in dialogue with nurses on acupuncture as a proposed nursing intervention. Esc Anna Nery. 2015;19(1):174-80. https://doi.org/10.5935/1414-8145.20150024
Hohmann E, Brand JC, Rossi MJ, Lubowitz JH. Expert opinion is necessary: delphi panel methodology facilitates a scientific approach to consensus. Arthroscopy. 2018; 34(2):349-51. https://doi.org/10.1016/j.arthro.2017.11.022
Terwee CB, Prinsen CAC, Chiarotto A, Westerman MJ, Patrick DL, Alonso J, et al. COSMIN methodology for evaluating the content validity of patient-reported outcome measures: a Delphi study. Qual Life Res. 2018;27(5):1159-70. https://doi.org/10.1007/s11136-018-1829-0
Jokiniemi K, Meretoja R, Pietilä AM. Constructing content validity of clinical nurse specialist core competencies: exploratory sequential mixed-method study. Scand J Caring Sci. 2018;32(4):1428-36. https://doi.org/10.1111/scs.12588
Roller-Wirnsberger R, Masud T, Vassallo M, Zöbl M, Reiter R, Van Den Noortgate N, et al. European postgraduate curriculum in geriatric medicine developed using an international modified Delphi technique. Age Ageing. 2019;48(2):291-9. https://doi.org/10.1093/ageing/afy173
Hughes R, Begley A, Yeatman H. Consensus on the core functions of the public health nutrition workforce in Australia. Nutr Diet. 2016;73(1):103-11. https://doi.org/10.1111/1747-0080.12168
Desroches S, Lapointe A, Deschenes SM, Bissonnette-Maheux V, Gravel K, Thirsk J, et al. Dietitians’ perspectives on interventions to enhance adherence to dietary advice for chronic diseases in adults. Can J Diet Pract Res. 2015;76(3):103-8. http://doi.org/10.3148/cjdpr-2015-009
Williams KE, Sansoni J, Morris D, Thompson C. A Delphi study to develop indicators of cancer patient experience for quality improvement. Support Care Cancer. 2018;26(1):129-38. https://doi.org/10.1007/s00520-017-3823-4
Vitorino SAS, Cruz MM, Barros DC. Modeling of food and nutrition surveillance in primary health care. Rev Nutr. 2017;30(1):109-26. https://doi.org/10.1590/1678-98652017000100011
Jaime PC, Tramontt CR, Maia TM, Gabe KT, Reis LC. Content validity of an educational workshop based on the Dietary Guidelines for the Brazilian Population. Rev Nutr. 2018;31(6):593-602. https://doi.org/10.1590/1678-98652018000600008
Primo CC, Henrique LR, Bertazo QS, Resende FZ, Leite FMC, Brandão MAG. Validation of the “Interactive Breastfeeding Scale”: theoretical and empirical analysis. Esc Anna Nery. 2020;24(1):e20190207. https://doi.org/10.1590/2177-9465-ean-2019-0207
Silva AB, Piccoli AB, Pellanda LC. Knowledge and food practices questionnaire: construction and validation. J Pediatr. 2020 [in press]. https://doi.org/10.1016/j.jped.2019.11.006
Coluci MZO, Alexandre NMC, Milani D. Construction of measurement instruments in the area of health. Ciênc Saúde Coletiva. 2015;20(3):925-36. https://doi.org/10.1590/1413-81232015203.04332013
Dolan C, Glynn R, Lawlor B. A systematic review and Delphi study to ascertain common risk factors for T2DM and dementia and brain-related complications of diabetes. Can J Diabetes. 2020;44(7):628-35. https://doi.org/10.1016/j.jcjd.2020.01.004
Massaroli A, Martini JG, Lino MM, Spenassato D, Massaroli R. The delphi method as a methodological framework for research in nursing. Texto Contexto Enferm. 2017;26(4):e1110017. https://doi.org/10.15 90/0104-07072017001110017
Fernández-Ávila DG, Rojas MX, Rosselli D. The Delphi method in rheumatology research: are we doing it right? Rev Colomb Reumatol. 2020 [in press]. https://doi.org/10.1016/j.rcreue.2019.04.007
Ministério da Saúde (Brasil). Contribuições dos Núcleos de Apoio à Saúde da Família para a Atenção Nutricional. Brasília: Ministério; 2017.
Fittipaldi ALM, Barros DC, Romano VF. Matrix support in food and nutrition actions: the perspective of professionals of the Family Health Strategy. Physis. 2017;27(3):793-811. https://doi.org/10.1590/S0103-73 312017000300021
Reis LC, Jaime PC. Knowledge and perceived selfefficacy and collective efficacy of health professionals to implement the Brazilian Dietary Guidelines in Primary Health Care. Demetra. 2019;14:e39140. https://doi.org/10.12957/demetra.2019.39140
Campos GWS. Saúde pública e saúde coletiva: campo e núcleo de saberes e práticas. Ciênc Saúde Coletiva. 2000;5(2):219-30. https://doi.org/10.1590/S1413-81232000000200002.
QuestionPro Brasil. Logiciels informatiques. São Francisco: QuestionPro; 2016 [cited 2016 Nov 20]. Available from: https://www.questionpro.com/pt-br
Leite SS, Áfio ACE, Carvalho LV, Silva JM, Almeida PC, Pagliuca LMF. Construction and validation of an Educational Content Validation Instrument in Health. Rev Bras Enferm. 2018;71(Suppl 4):1635-41. https://doi.org/10.1590/0034-7167-2017-0648
Holanda FL, Marra CC, Cunha ICKO. Professional competence of nurses in emergency services: evidence of content validity. Rev Bras Enferm. 2019;72(Suppl1):66-73. https://doi.org/10.1590/0034-7167-2017-0518
Linstone HA, Turoff M. The Delphi method: techniques and applications. Boston: Addison-Wesley Educational Publishers Inc; 2002 [cited 2017 Aug 29]. Available from: https://web.njit.edu/~turoff/pubs/delphibook/delphibook.pdf
Likert R. A technique for the measturement of attittudes [thesis]. New York: New York University; 1932.
Nadler JT, Weston R, Voyles EC. Stuck in the middle: the use and interpretation of mid-points in items on questionnaires. J Gen Psychol. 2015;142(2):71-89. https://doi.org/10.1080/00221309.2014.994590
Giannarou L, Zervas E. Using Delphi technique to build consensus in practice. Int J Bus Sci Appl Manage. 2014;9(2):65-82.
Camargo RGM, Caivano S, Bandoni DH, Domene SMA. Healthy eating at school: consensus among experts. Rev Nutr. 2016;29(6):809-19. https://doi.org/10.1590/1678-98652016000600006
Pacito-Almeida AB, Santana ABN, Medeiros MAT. Nutritional Attention Assessment Instrument_Iaan [dataset]. Figshare; 2020 [cited 2020 Oct 13]. https://doi.org/10.6084/m9.figshare.13087370
Veziari Y, Kumar S, Leach M. The development of a survey instrument to measure the barriers to the conduct and application of research in complementary and alternative medicine: A Delphi study. Bmc Complement Altern Med. 2018 [cited 2020 Mar 16];18(1):335. Available from: https://bmccomplementalternmed.biomedcentral.com/articles/10.1186/s12906-018-2352-0
Lang M, Plessis E. Sensory processing disorder: perceptions on the clinical role of advanced psychiatric nurses. Health SA Gesondheid. 2019[cited 2020 Mar 11];24:1197. Available from: http://www.ncbi.nlm.nih.gov/pubmed/31934431
Zarili TFT. Avaliação de serviços de atenção básica: atualização e validação do instrumento QualiAB. Universidade Estadual Paulista: Botucatu; 2015.
Braga RD, Lucena FN, Ribeiro-Rotta RF. A multiprofessional information model for Brazilian primary care: defining a consensus model towards an interoperable electronic health record. Int J Med Inform. 2016;90:48-57.
Bolarinwa O. Principles and methods of validity and reliability testing of questionnaires used in social and health science researches. Niger Postgrad Med J. 2015;22(4):195-201. https://doi.org/10.4103/1117-1936. 173959
Jokiniemi K, Haatainen K, Meretoja R, Pietilä AM. The future of the clinical nurse specialist role in Finland. J Nurs Scholarsh. 2015;47(1):78-86.
Lee J, Lee SH, Chang GT. Expert consensus on the development of a health-related questionnaire for the pediatric field of Korean medicine: a Delphi study. Bmc Complement Med Ther. 2020;20(1):1-13.
Ministério da Saúde (Brasil). Portaria no 2.979, de 12 de novembro de 2019. Institui o Programa Previne Brasil, que estabelece novo modelo de financiamento de custeio da Atenção Primária à Saúde no âmbito do Sistema Único de Saúde, por meio da alteração da Portaria de Consolidação nº 6/GM/MS, de 28 de setembro de 2017. Brasília: Diário Oficial da União, 2020 [citado 29 jun 2020]. Disponível em: http://www.in.gov.br/en/web/dou/-/portaria-n-2.979-de-12-de-novembro-de-2019-227652180
Ministério da Saúde (Brasil). Nota Técnica no 5/2020-DESF/SAPS/MS. Brasília: Diário Oficial da União, 2020 [citado 29 jun 2020]. Dispon[ivel em: https://egestorab.saude.gov.br/image/?file=20200204_N_SEIMS0013327270-NotaTecnicaIndicadores_3604088260565235807.pdf
Massuda A. Primary health care financing changes in the Brazilian Health System: advance ou setback? Ciênc Saúde Coletiva. 2020;25(4):1181-8. http://doi.org/10.1590/1413-81232020254.01022020
Silva FMVA. Alimentação e Nutrição na Atenção Básica à Saúde: estudo a partir da avaliação externa do Programa de Melhoria do Acesso e da Qualidade na Atenção Básica: PMAQ [dissertation]. Salvador: Universidade Federal da Bahia; 2019.
Ministério da Saúde (Brasil). Instrumento de Avaliação Externa para as Equipes de Atenção Básica (Saúde da Família e Equipe Parametrizada): Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ). Brasília: Ministério; 2013.
Ministério da Saúde (Brasil). Manual do Instrumento de Avaliação da Atenção Primária à Saúde: PCAToolBrasil: 2020. Brasília: Ministério; 2020.
Roque H, Veloso A, Ferreira PL. Portuguese version of the EUROPEP questionnaire: contributions to the psychometric validation. Rev Saúde Pública. 2016;50:61. https://doi.org/10.1590/S1518-8787.20160500 06259
Wollmann L, Hauser L, Mengue SS, Agostinho MR, Roman R, Van Der Feltz-Cornelis CM, et al. Crosscultural adaptation of the Patient- Doctor Relationship Questionnaire (PDRQ-9) in Brazil. Rev Saúde Pública. 2018;52:71. https://doi.org/10.11606/s1518-8787.2018052000380
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