The health care needs of physically, hearing or visually impaired people: a methodological study

Sâmara Sirdênia Duarte do Rosário Belmiro1, Francisco Arnoldo Nunes de Miranda1, Izabella Bezerra de Lima Moura1, Simone Regina de Carvalho1, Isabelle Katherine Fernandes Costa1
1Rio Grande do Norte Federal University


Aim: To evaluate the health care needs of people with disabilities (PWD), hearing or visually impaired, through the development and construction of an instrument validated by the Delphi technique. Methods: This is a methodological development study held in three specialized institutions for disabled people in Mossoró, RN, between 2014 and 2017. The study has 2 stages: I - Identification of the health care needs of PWD through an integrative literature review; II - Development and validation of the Assessment Tool for the Health Care Needs of Physically, Hearing or Visually Impaired People (ATHCN-PWDPHV) with regard to its content and reliability, and applicability of the tool in people with disabilities. The first two will be based on the opinions of assessors and the Content Validity Index, and the last on the Alpha Cronbach. SPSS software will run chi-squared and Fisher's exact tests in order to perform a descriptive analysis. It is hoped that the findings will contribute to the health planning of PWD.

Descriptors: Disabled persons; Validation studies; Health services needs and demand; Delphi Technique.


People with disabilities (PWD), have, throughout their history experienced episodes of abandonment, denial of rights, stigma and prejudice. In this context, they face problems regarding healthcare assistance, such as difficulties in reaching, not only healthcare services, but also healthcare staff, laboratories and medications. In addition, they also have to face behavioural and architectural barriers. These factors lead to health needs that are not fulfilled and which will damage their life quality(1).

Health needs are historical and socially constructed, and take into consideration both individual and collective demands. They are grouped into four major categories: the need for a response when facing poor living conditions; having assured access to all life improving, extending technology; the need to bond with a healthcare professional or healthcare staff; and the need of self-sufficiency and self-care when choosing "their way to live"(2).

In this study, needs are considered as something different when compared to those biological and technical ones existing in healthcare institutions. To this end, the study can be justified because in the healthcare area there is a lack of knowledge of a validated tool specifically used to assess the health needs of a PWD, which is an adverse factor in the quality of healthcare attention offered to this population group. Through identifying these health needs, this aims to change the health conditions of PWD through effective intervention.

This study is important because of its social impact potential, and takes into consideration the development and validation of a tool that will contribute to the planning of actions, and to better healthcare assistance offered to PWD. This study will make it possible to improve both the health work process dedicated to PWD and the actions developed at other care levels.


The validity indexes of the Assessment Tool for Health Care Needs of Physically, Hearing or Visually Impaired People (ATHCN-PWDPHV) are satisfactory when the Content Validity Ratio (CVR) > 0,80 with p< 0,5 and Cronbach's Alpha is >0,70.


To evaluate the health care needs of people with disabilities (PWD), hearing or visual, through the development and construction of an instrument validated by the Delphi technique.


This is a methodological development study(3) using the Delphi technique. It was held with assessors and PWD of three specialized institutions for disabled people located in Mossoró, RN, between 2014 and 2017.

According to figure 1, two stages will take place during the study. In the first stage, G1, an integrative review of literature will be done in order to identify the health needs of the PWD and subsequently to develop the ATHCN-PWDPHV. The criteria established for the review are: manuscripts about tools used to identify the health needs of PWD, published in English, Portuguese or Spanish between 2005-2015, available in a full version, and free of charge. By using a research protocol, searches will be made in the following electronic databases: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Latin-american and Caribbean Health Sciences - LILACS) and Medical Literature Analysis and Retrieval System Online (MEDLINE).

The second stage will be performed once by convenience sampling; due to the study's characteristics, what matters is the homogeneity of the participants and the quality of the answers regarding the relevance of the tool being developed(3). The second phase foresees three steps:

Step I - development of the ATHCN-PWDPHV tool through an integrative literature review and according to a taxonomy of the health needs(2);

Step II (G2) - validation of the ATHCN-PWDPHV by 30 assessors with a Masters or a Ph.D. in healthcare, who have defended their theses, published papers about the theme, and have professional experience in PWD healthcare of at least one year. Those who work only with intellectually disabled people or who have not published any papers about the theme within five years of the date of recruitment will be excluded from the research. By using the CVR, the Delphi technique will be used for content validation. Reliability will be estimated by Cronbach's alpha.

Step III (G3) - Using the ATHCN-PWDPHV tool in people who meet the following criteria: people who are physically, hearing or visually disabled, with different degrees of impairment; who are over 18 years old, registered/enrolled and a regular attendant of the participant institutions of the study during the data collection period. People who are intellectually disabled or have multiple disabilities will be excluded from the research. In order to determine the sample size, the calculation for finite populations was used. SPSS software will run chi-squared and Fisher's exact tests in order to perform a descriptive analysis.

The project was approved by the Ethics Committee, CAAE (Certificate of Presentation for Ethical Consideration) nº 39639014.3.0000.5537, in compliance with Resolution 466/12 of the National Health Council.

figure 1

Figure 1- Study stages flowchart Mossoró, RN, 2014

Source: Research data


  1. Bense OM, Mesquita AJRC. Necessidades de saúde da pessoa com deficiência: a perspectiva dos sujeitos por meio de histórias de vida. Interface (Botucatu) (Online)[Internet]. 2012 Mar [Cited 2016 apr 04]; 16(40):219-234. Available from:
  2. Cecilio LCO, Matsumoto NF. Uma taxonomia operacional de necessidade de saúde. In: Pinheiro R, Ferla AA, Mattos RA, organizadores. Gestão em Redes: tecendo os fios da integralidade em saúde. Rio de Janeiro: Abrasco; 2006. p.37-50.
  3. Pasquali L. Psicometria. Rev Esc Enferm USP (Online)[Internet]. 2009 [Cited 2016 apr 04]; 43(Esp):992-999. Available from:

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Received: 04/29/2016 Revised: 07/08/2016 Approved: 07/08/2016