Instrument to assess the quality of hospital care in the puerperium: a methodological study
ABSTRACT
OBJECTIVE: to build and validate an instrument to assess the quality of hospital care provided in the puerperium. METHOD: a methodological study for the construction and validation of an instrument to assess the quality of care in the puerperium. The instrument will be analyzed by judges and by puerperal women (target population) to verify the adequacy of the items and will undergo lexical and grammatical correction. Theoretical validation will occur from the analysis of the judges' agreement using the Kappa index (K) and the Content Validity Index (CVI), considering K≥0.80 and CVI>0.80. EXPECTED RESULTS: it is believed that the construction and validation of a specific instrument to assess the puerperium will be able to elucidate the incorporation of good practices in women's health care in the puerperium, as well as to provide women and professionals with new possibilities for the puerperium within the humanized care model.
Descriptors: Validation Study; Hospital Care; Evaluation Study; Postpartum Period.
PROBLEM SITUATION AND SIGNIFICANCE
The puerperium is a period of physical and mental transformations that begins after delivery and finishes when breastfeeding ends. This process of involution to the pre-pregnancy condition can cause more severe complications and evolve to death; however, 92% of the cases of maternal deaths in this phase are preventable, mainly at the hospital level, when related to hemorrhage, puerperal infection and hypertension(1).
In this context, the evaluation of the quality of puerperal hospital care is fundamental for monitoring possible complications. However, the indicator that assesses this type of assistance does not include intercurrences that can result in complications, nor the specific causes related to maternal deaths(1). This fact can be related to the lack of specific instruments for this measure, since the focus on assessing the quality of care offered in the puerperium was not identified, and a valid and reliable instrument that can be used to measure the quality of that assistance was not found in research studies.
Therefore, the following was chosen as research question: Does an instrument built to assess the quality of hospital care in the puerperium have valid and reliable psychometric properties? However, considering that the evaluation of the quality of hospital care in the puerperium supports planning and management, improving care and reducing maternal deaths. In this perspective, this study intends to evaluate the quality of care provided in the puerperium by creating a valid and reliable research tool for monitoring the quality of puerperal care.
OBJECTIVE
To build and validate an instrument to assess the quality of hospital care provided to women in the puerperium.
METHOD
A methodological study, developed in two stages: theoretical foundation and theoretical analysis. In the theoretical foundation stage, an instrument based on the theoretical General Systems Theory, proposed by Adevis Donabedian(2), will be developed; as well as a scoping review that will allow for the construction of the instrument items from the constitutive, operational and behavioral definitions(3).
The second stage will start with the evaluation by expert judges in the area. They may agree or disagree with the items based on the following criteria: objectivity, simplicity, clarity, relevance, precision and variety. The inclusion of the expert judges will be based on the following criteria: having published and researched on the topic and being an expert in the construction of instruments. Those with incorrect or incomplete answers will be excluded. To assess the level of agreement between the judges on a particular item, the Content Validity Index (CVI) and the Kappa Index will be used.
The relevance criterion of the study will be CVI>0.80 and Kappa>0.80. The sample will consist of 10 judges. In addition, the instrument will be subjected to lexical and grammatical correction in order to provide its adaptation to another language, if necessary. After the lexical and grammatical analysis and validation by the expert judges, the evaluation of puerperal women (target population) will be carried out. They may agree or disagree with the items based on the following criteria: “Easy-to-understand item” and “I did not understand the item” This stage will enable the evaluation by the lowest cognitive stratum of the target population.
For convenience and randomly, we will select 10 puerperal women admitted to the Flavio Ribeiro Coutinho maternity hospital, in the municipality of Santa Rita, Paraíba. The inclusion criteria for women are the following: being over 18 years old, knowing how to read and write and being in the puerperium. The exclusion criteria are as follows: puerperal complication, some medical contraindication and/or with suspected COVID-19. In this stage, the Content Validity Index and the Kappa Index will also be used. The relevance criterion will be CVI>0.80 and Kappa>0.80.
The instrument will undergo a second evaluation by the expert judges, in order to validate its final version. The method chosen for the construction and theoretical validation of this evaluation instrument followed the recommendations of Pasquali(3). It is noteworthy that this study derives from the academic doctoral research project of the Graduate Program in Nursing at the Federal University of Rio Grande do Norte (Universidade Federal do Rio Grande do Norte,UFRN), submitted to the Ethics and Research Committee (Comitê de Ética e Pesquisa, CEP) of the João Pessoa University Center(UNIPÊ-PB), in accordance with Resolution 466/2012 and obtained a favorable opinion under CAAE number 18967519.6.0000.5176.
EXPECTED RESULTS
It is hoped that the construction and validation of a specific instrument for assessing the quality of care provided in the puerperium will be able to foster the incorporation of good practices in women's health care in the puerperium, as well as providing women and professionals with new possibilities for the puerperium within the humanized care model.
REFERENCES
1. Lima MRG, Coelho ASF, Salge AKM, Guimarães JV, Costa OS, Sousa TCC, et al. Alterações maternas e desfecho gravídico–puerperal na ocorrência de óbito materno. Cad Saúde Colet [Internet] 2017 [cited 2020 Apr 10];25(3):324-331. Available from: https://www.scielo.br/pdf/cadsc/v25n3/1414-462X-cadsc-1414-462X201700030057.pdf
2. Donabedian A. Basic approaches to assessment: structure, process and
outcome. In: Explorations in Quality Assessment and Monitoring. Ann Arbor, Michigan: Health Adiministration Press; 1980.
3. Pasquali L. Instrumentos psicológicos: manual prático de elaboração. Brasília: LabPAM/IBAPP; 2010.
Received: 09/24/2020
Revised: 11/18/2020
Approved: 11/23/2020