Desenvolvimento e validação de escala de rastreamento de renúncia à vida no idoso não institucionalizado
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Data
2022-02-23
Autores
Silva, Sabrina Piccinelli Zanchettin
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Universidade Estadual Paulista (Unesp)
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OBJETIVO: Construir e avaliar as propriedades psicométricas da escala de rastreamento de renúncia à vida do idoso não institucionalizado. MÉTODO: Trata-se de pesquisa metodológica e translacional, com geração de conjunto de itens a partir de dois modelos teóricos decorrentes de análises qualitativas, por Teoria Fundamentada nos Dados, de experiências de dois grupos amostrais de idosos na comunidade, feminino e masculino, com depressão, baixo apoio social e cognição preservada, sinalizando-os entre dimensões de segurança e risco de renúncia à vida. Para a construção do instrumento, seguiram-se as etapas: (1) determinar claramente o que se pretende medir; (2) gerar conjunto de itens iniciais; (3) determinar o formato para medição; (4) dispor do conjunto de itens iniciais, revisado por especialistas; (5) considerar a inclusão de itens validados; (6) submeter conjunto de itens a uma amostra de participantes; (7) avaliar os itens. Para análise dos itens, empregaram-se as validades de conteúdo e de face, primeiro por comitê de juízes especialistas, seguido de pré-teste com a população-alvo. Utilizou-se o Índice de Validade de Conteúdo (IVC) para avaliar a concordância entre opiniões dos juízes. Para análise das propriedades psicométricas, aplicou-se a escala a 300 idosos dos municípios do estado de São Paulo, das regiões de Bauru e Marília, São Paulo, Brasil, no período de setembro a novembro de 2020. Utilizou-se Análise Fatorial Confirmatória (AFC) para aferir a validade de constructo e obteve-se a validade de critério por correlação entre a Escala de Rastreamento de Renúncia à Vida no Idoso e a Escala de Depressão Geriátrica, quanto à sensibilidade e à especificidade, por Curva ROC. Para avaliar a confiabilidade da escala, empregou-se o coeficiente alfa de Cronbach e o Coeficiente de Correlação Intraclasse (ICC). Mediu-se a estabilidade do instrumento através do teste-reteste e a Teoria de Resposta ao Item (TRI) para análise de cada item. RESULTADOS: Partiu-se de escala do tipo Likert com 81 itens, agrupados em três dimensões (autogovernabilidade; comprometimento com a saúde; engajamento com o projeto de vida), decorrentes de pesquisa qualitativa com a experiência de idosos(as) adscritos à Unidades Saúde da Família, rastreados com estado cognitivo preservado, depressão moderada a grave e baixo apoio social. Essa primeira versão foi submetida à análise do painel de especialistas que, juntamente com cálculo de IVC e submissão da escala ao pré-teste com 43 idosos, reduziu-a a 53 itens, ou seja, redução de 28 itens, tipo Likert com três opções de resposta, organizados em duas dimensões. A aplicação dessa versão da escala para uma amostra de 300 idosos possibilitou a exclusão de 27 itens por meio da AFC, a partir do critério de carga fatorial padronizada < 0,4. Após, optou-se por manter o instrumento com uma ou duas dimensões. Conferiram-se propriedades psicométricas da escala: Ômega de McDonald de 0,902; Coeficiente alfa de Cronbach de 0,90, com estabilidade temporal (ICC de 0,80), em relação à escala de Depressão Geriátrica, a área sob a curva encontrada foi de 0,797, com especificidade de 0,68 e sensibilidade de 0,80, no melhor ponto de corte encontrado – 35. A TRI evidenciou que os itens têm bom coeficiente de discriminação ao modelo, com exceção dos itens, 18, 24 e 25, sendo o item 7 com maior índice. Mostrou também que todos os itens têm aderência ao modelo. DISCUSSÃO: As propriedades psicométricas da escala de renúncia à vida no idoso apontam para uma ferramenta consistente e viável, que poderá promover avanços na assistência à saúde das pessoas idosas e da equipe de saúde da Atenção Primária à Saúde (APS). Reitera-se a importância de mais estudos que possam validar as propriedades psicométricas, para consolidação da escala na atuação profissional na APS. Ressalta-se que a escala proposta se destina a idosos residindo na comunidade, não podendo considerar os resultados apresentados em outras populações. CONCLUSÃO: Apesar de ainda requerer outras pesquisas para validar as propriedades psicométricas e a confiabilidade da escala, tal estudo é pioneiro para a prevenção de suicídio de idosos na comunidade, por instrumentalizar a equipe de saúde da APS para o rastreamento (busca ativa) daqueles em situação de renúncia à vida, dando-lhes oportunidade de acesso a tratamentos e cuidados no âmbito da saúde mental.
OBJECTIVE: To construct and evaluate the psychometric properties of the noninstitutionalized elderly person's renunciation of life screening scale. METHOD: This is a methodological and translational research, with the generation of a set of items from two theoretical models resulting from qualitative analyses, by Grounded Theory, of the experiences of two sample groups of elderly people in the community, female and male, with depression, low social support and preserved cognition, signaling them between dimensions of security and risk of giving up life. For the construction of the instrument, the following steps were followed: (1) clearly determine what is to be measured; (2) generate a set of initial items; (3) determine the format for measurement; (4) have the initial set of items, reviewed by experts; (5) consider including validated items; (6) submit a set of items to a sample of participants; (7) evaluate the items. For item analysis, content and face validity were used, first by a committee of expert judges, followed by a pre-test with the target population. The Content Validity Index (CVI) was used to assess the agreement between the judges' opinions. To analyze the psychometric properties, the scale was applied to 300 elderly people from the municipalities of the state of São Paulo, in the regions of Bauru and Marília, São Paulo, Brazil, from September to November 2020. Confirmatory Factor Analysis was used (AFC) to assess the construct validity and the criterion validity was obtained by correlation between the Life Renunciation Screening Scale in the Elderly and the Geriatric Depression Scale, regarding sensitivity and specificity, by ROC curve. To assess the reliability of the scale, Cronbach's alpha coefficient and the Intraclass Correlation Coefficient (ICC) were used. Instrument stability was measured through test-retest and Item Response Theory (IRT) for analysis of each item. RESULTS: A Likert-type scale was used with 81 items, grouped into three dimensions (self-governance; commitment to health; engagement with the life project), resulting from qualitative research with the experience of elderly people assigned to the Health Units of the Family, screened with preserved cognitive status, moderate to severe depression, and low social support. This first version was submitted to the analysis of the expert panel which, together with the CVI calculation and submission of the scale to the pre-test with 43 elderly people, reduced it to 53 items, that is, a reduction of 28 items, Likert type with three options response, organized into two dimensions. The application 10 of this version of the scale to a sample of 300 elderly people made it possible to exclude 27 items using the CFA, based on the criterion of standardized factor loading < 0.4. Afterwards, it was decided to keep the instrument with one or two dimensions. Psychometric properties of the scale were verified: McDonald's Omega of 0.902; Cronbach's alpha coefficient of 0.90, with temporal stability (ICC of 0.80), in relation to the Geriatric Depression scale, the area under the curve found was 0.797, with a specificity of 0.68 and a sensitivity of 0.80, at the best cut-off point found – 35. The IRT showed that the items have a good coefficient of discrimination to the model, with the exception of items 18, 24 and 25, with item 7 having the highest index. It also showed that all items adhere to the model. DISCUSSION: The psychometric properties of the renunciation of life scale in the elderly point to a consistent and viable tool, which can promote advances in the health care of the elderly and the health team of primary health care. The importance of further studies that can validate the psychometric properties is reiterated, for the consolidation of the scale in professional performance in Primary Health Care (PHC). It is noteworthy that the proposed scale is intended for elderly people living in the community, and cannot consider the results presented in other populations. CONCLUSION: Although further research is still required to validate the psychometric properties and reliability of the scale, this study is a pioneer in the prevention of suicide among the elderly in the community, as it provides the PHC health team with tools to track (actively search) those in need. a situation of renunciation of life, giving them the opportunity to access treatments and care within the scope of mental health.
OBJECTIVE: To construct and evaluate the psychometric properties of the noninstitutionalized elderly person's renunciation of life screening scale. METHOD: This is a methodological and translational research, with the generation of a set of items from two theoretical models resulting from qualitative analyses, by Grounded Theory, of the experiences of two sample groups of elderly people in the community, female and male, with depression, low social support and preserved cognition, signaling them between dimensions of security and risk of giving up life. For the construction of the instrument, the following steps were followed: (1) clearly determine what is to be measured; (2) generate a set of initial items; (3) determine the format for measurement; (4) have the initial set of items, reviewed by experts; (5) consider including validated items; (6) submit a set of items to a sample of participants; (7) evaluate the items. For item analysis, content and face validity were used, first by a committee of expert judges, followed by a pre-test with the target population. The Content Validity Index (CVI) was used to assess the agreement between the judges' opinions. To analyze the psychometric properties, the scale was applied to 300 elderly people from the municipalities of the state of São Paulo, in the regions of Bauru and Marília, São Paulo, Brazil, from September to November 2020. Confirmatory Factor Analysis was used (AFC) to assess the construct validity and the criterion validity was obtained by correlation between the Life Renunciation Screening Scale in the Elderly and the Geriatric Depression Scale, regarding sensitivity and specificity, by ROC curve. To assess the reliability of the scale, Cronbach's alpha coefficient and the Intraclass Correlation Coefficient (ICC) were used. Instrument stability was measured through test-retest and Item Response Theory (IRT) for analysis of each item. RESULTS: A Likert-type scale was used with 81 items, grouped into three dimensions (self-governance; commitment to health; engagement with the life project), resulting from qualitative research with the experience of elderly people assigned to the Health Units of the Family, screened with preserved cognitive status, moderate to severe depression, and low social support. This first version was submitted to the analysis of the expert panel which, together with the CVI calculation and submission of the scale to the pre-test with 43 elderly people, reduced it to 53 items, that is, a reduction of 28 items, Likert type with three options response, organized into two dimensions. The application 10 of this version of the scale to a sample of 300 elderly people made it possible to exclude 27 items using the CFA, based on the criterion of standardized factor loading < 0.4. Afterwards, it was decided to keep the instrument with one or two dimensions. Psychometric properties of the scale were verified: McDonald's Omega of 0.902; Cronbach's alpha coefficient of 0.90, with temporal stability (ICC of 0.80), in relation to the Geriatric Depression scale, the area under the curve found was 0.797, with a specificity of 0.68 and a sensitivity of 0.80, at the best cut-off point found – 35. The IRT showed that the items have a good coefficient of discrimination to the model, with the exception of items 18, 24 and 25, with item 7 having the highest index. It also showed that all items adhere to the model. DISCUSSION: The psychometric properties of the renunciation of life scale in the elderly point to a consistent and viable tool, which can promote advances in the health care of the elderly and the health team of primary health care. The importance of further studies that can validate the psychometric properties is reiterated, for the consolidation of the scale in professional performance in Primary Health Care (PHC). It is noteworthy that the proposed scale is intended for elderly people living in the community, and cannot consider the results presented in other populations. CONCLUSION: Although further research is still required to validate the psychometric properties and reliability of the scale, this study is a pioneer in the prevention of suicide among the elderly in the community, as it provides the PHC health team with tools to track (actively search) those in need. a situation of renunciation of life, giving them the opportunity to access treatments and care within the scope of mental health.
Descrição
Palavras-chave
Idoso, Depressão, Suicidio, Escala de avaliação comportamental, Avaliação geriátrica, Aged, Depression, Suicide