Percepções, atitudes, conhecimento e habilidades em práticas de saúde baseada em evidências (I-SABE): estudo de validação de instrumento
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Data
2017-09-18
Autores
Ruano, Arielly Souza Mariano
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Universidade Estadual Paulista (Unesp)
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Introdução: A busca da melhoria e sustentabilidade da qualidade da saúde, em sistemas públicos e privados, fortalece a necessidade da adoção de práticas de saúde baseadas em evidências (SBE) entre os profissionais de saúde. No Brasil, as percepções, conhecimentos e atitudes dos profissionais de saúde relacionados à SBE permanecem incertas. Conhecer como as práticas de SBE são implementadas, as barreiras e facilitadores para sua aplicação permite identificar quais são as necessidades educacionais e apoio para facilitar e promover a prática de SBE. Objetivo: Desenvolver e iniciar o processo de validação de um instrumento de pesquisa para avaliação da percepção, conhecimento e atitudes dos profissionais de saúde sobre as práticas de SBE. Método: Trata-se de estudo transversal de construção e validação de instrumento de pesquisa. Para selecionar os domínios a serem utilizados na elaboração do instrumento realizou-se a revisão da literatura científica. Utilizou-se a “Classification Rubric for Evidence Based Practice Assessment Tools in Education” (CREATE) como direcionamento para formulação do itens. Para a validação de conteúdo utilizou-se o método de Delphi, no qual, diferentes especialistas em SBE analisaram a representatividade dos itens em relação às áreas de conteúdo e à relevância dos objetivos a serem medidos. Para extração dos domínios efetuou-se a análise fatorial exploratória por meio da análise dos componentes principais. Realizou-se rotação ortogonal, segundo o método Varimax. A adequação dos dados para utilização desta análise foi verificada pelos critérios de Kaiser-Meyer-Olkin (KMO) e pelo teste de Bartlett. Na confirmação da extração do número de domínios foram seguidos os seguintes critérios: (1) eigenvalues >1; (2) exclusão das cargas fatoriais menores que 0,50 e (3) Scree Plot. A confiabilidade do instrumento foi avaliada através do coeficiente alfa de Cronbach, que fornece a medida de consistência interna do instrumento. Resultados: O instrumento de pesquisa foi denominado I-SABE e apresenta 29 itens divididos em cinco domínios (Autoconfiança, Comportamento, Atitudes, Resultados/Benefícios aos pacientes e Conhecimento/Habilidades na prática de SBE). Participaram do estudo 217 profissionais de saúde. O teste de esfericidade de Bartlett e o índice KMO foram adequados (χ2=1455,810, p<0,001; KMO=0,847). Considerando as cargas fatoriais dos itens, a convergência entre o Scree Plot e o critério de Kaiser, foram extraídos quatro domínios, explicando 59,2% da variância total. A consistência interna variou entre os domínios: Autoconfiança (α=0,76), Comportamento (α=0,30), Atitudes (α=0,644), Resultados/Benefícios ao paciente (α= 0,835). Conclusão: Considerando a amostra de profissionais de saúde testada, o instrumento I-SABE apresenta um modelo estrutural com cinco domínios essenciais para avaliar as práticas em SBE com confiabilidade adequada entre os domínios Autoconfiança, Atitudes e Resultados/benefícios em saúde.
Attempts to improve the quality of healthcare and make it sustainable in public and private systems support the implementation of evidence-based health practices (EBHP) among health professionals. In Brazil, perceptions, knowledge and attitudes of health professionals on EBHP remain uncertain. Knowing how to apply EBHP, as well as barriers and facilitators to their implementation, allows to identify the education and support necessary to facilitate and promote EBHP. Objective: To develop and start the validation process of a research instrument to assess the perception, knowledge and attitudes of health professionals on EBHP. Methods: This is a cross-sectional study for the development and validation of a research instrument. To select the domains to be used, the scientific literature was reviewed. The “Classification Rubric for Evidence Based Practice Assessment Tools in Education” (CREATE) was used as a guideline to formulate the items. To validate the content, the Delphi method was used, in which different specialists in EBHP analyzed the representativeness of the items for the content areas and the relevance of the objectives to be measured. To extract the domains, an exploratory factorial analysis was performed by analyzing the main components. An orthogonal rotation was performed by following the Varimax method. The appropriateness of data to this analysis was verified by using Kaiser-Meyer-Olkin (KMO) criteria and through Bartlett’s test. To confirm the extraction of the number of domains, the following criteria were followed: (1) eigenvalues >1; (2) factor loadings lower than 0,50 were excluded; and (3) Scree Plot. The reliability of the instrument was assessed using Cronbach's alpha coefficient, which provides the internal consistency measurement of the instrument. Results: The research instrument was named I-SABE and has 29 items divided into five domains (Self-confidence, Behavior, Attitudes, and Knowledge/Skills in EBHP). A total of 217 health professionals participated in the study. Bartlett’s sphericity test and KMO index were considered appropriate (χ2=1455.810, p<0.001; KMO=0.847). Considering the factor loadings of the items and the convergence between Scree Plot and Kaiser criterion, extracting four domains, explaining 59.2% of the total variance. The internal consistency varied between domains: Self-confidence (α=0.76), Behavior (α=0.30), Attitudes (α=0.64), Results/Benefits to patients (α=0.83). Conclusion: I-SABE provides a structural model with five essential domains to assess EBHP, obtained from the exploratory factorial analysis. It shows adequate reliability between the domains Self-confidence, Attitudes and Results/Benefits to the patient in the sample of health professionals studied.
Attempts to improve the quality of healthcare and make it sustainable in public and private systems support the implementation of evidence-based health practices (EBHP) among health professionals. In Brazil, perceptions, knowledge and attitudes of health professionals on EBHP remain uncertain. Knowing how to apply EBHP, as well as barriers and facilitators to their implementation, allows to identify the education and support necessary to facilitate and promote EBHP. Objective: To develop and start the validation process of a research instrument to assess the perception, knowledge and attitudes of health professionals on EBHP. Methods: This is a cross-sectional study for the development and validation of a research instrument. To select the domains to be used, the scientific literature was reviewed. The “Classification Rubric for Evidence Based Practice Assessment Tools in Education” (CREATE) was used as a guideline to formulate the items. To validate the content, the Delphi method was used, in which different specialists in EBHP analyzed the representativeness of the items for the content areas and the relevance of the objectives to be measured. To extract the domains, an exploratory factorial analysis was performed by analyzing the main components. An orthogonal rotation was performed by following the Varimax method. The appropriateness of data to this analysis was verified by using Kaiser-Meyer-Olkin (KMO) criteria and through Bartlett’s test. To confirm the extraction of the number of domains, the following criteria were followed: (1) eigenvalues >1; (2) factor loadings lower than 0,50 were excluded; and (3) Scree Plot. The reliability of the instrument was assessed using Cronbach's alpha coefficient, which provides the internal consistency measurement of the instrument. Results: The research instrument was named I-SABE and has 29 items divided into five domains (Self-confidence, Behavior, Attitudes, and Knowledge/Skills in EBHP). A total of 217 health professionals participated in the study. Bartlett’s sphericity test and KMO index were considered appropriate (χ2=1455.810, p<0.001; KMO=0.847). Considering the factor loadings of the items and the convergence between Scree Plot and Kaiser criterion, extracting four domains, explaining 59.2% of the total variance. The internal consistency varied between domains: Self-confidence (α=0.76), Behavior (α=0.30), Attitudes (α=0.64), Results/Benefits to patients (α=0.83). Conclusion: I-SABE provides a structural model with five essential domains to assess EBHP, obtained from the exploratory factorial analysis. It shows adequate reliability between the domains Self-confidence, Attitudes and Results/Benefits to the patient in the sample of health professionals studied.
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Saúde Baseada em Evidência, Questionário, Confiabilidade, Validade