Banca de DEFESA: TÁCITO ZAILDO DE MORAIS SANTOS

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : TÁCITO ZAILDO DE MORAIS SANTOS
DATE: 28/06/2023
TIME: 14:30
LOCAL: Remoto
TITLE:

CONTEXTUALIZATION, DEVELOPMENT, OPERATIONALIZATION, AND PRELIMINARY VALIDATIONS OF THE ADHERE QUESTIONNAIRE: ADHERENCE TO MEASURES FOR THE PREVENTION AND CONTROL OF INFECTIOUS RESPIRATORY DISEASES IN BRAZIL.

KEY WORDS:

Surveys and questionnaires; prevention & control; adherence; respiratory tract infections; health knowledge, attitudes, practice

PAGES: 200
BIG AREA: Ciências da Saúde
AREA: Fisioterapia e Terapia Ocupacional
SUMMARY:

ABSTRACT

 

Background: The COVID-19 pandemic highlighted the issue of individual and population adherence to internationally recommended measures for the prevention and control of infectious respiratory diseases. However, low compliance with recommended preventive behaviors and the scarcity of tools to assess this construct in the same population has challenged managers and researchers. Given all the possible clinical, economic, and psychosocial implications, preventive measures at the population level, integrated into public health policies, can mean effective efforts and assertive decision-making. Objectives: To develop and test the preliminary validity of an instrument for the Brazilian population, capable of measuring, through barriers and facilitators, the level of adherence to recommended measures for the prevention and control of infectious respiratory diseases. Methods:  To contemplate our objectives, we carried out two studies. Study 1 included a systematic review (SR) that followed the Cochrane recommendations for the global qualitative synthesis of themes and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The themes emerging in the SR elicited the content for the initial generation of instrument items. In turn, the Health Beliefs Model (HBM) and the Capacity, Opportunity, and Motivation Model (COM-B) frameworks contributed to classifying the items in preliminary dimensions. Study 2 comprised the development of the questionnaire and initial validations of ADHERE. For the initial construction of the items, in addition to the SR results, in-depth interviews were conducted with representatives of the target population, following the recommendations of the PRO Good Research Practices Task Force Report (ISPOR 1). Next, a panel of experts tested the face and content validity of the questionnaire before conducting a quantitative pre-test with the target population in the Survey format. The quantitative pre-test followed the modified e-Delphi Method, as well as the recommendations of the COSMIN methodology for content validity and the PRO Good Research Practices Task Force Report (ISPOR 2). An Exploratory Factor Analysis (EFA) considering the varimax rotation model investigated the factor structure of the ADHERE questionnaire considering a coefficient of 0.45. In turn, we used Cronbach's Alpha Coefficient to assess the internal consistency of the data. Finally, the items retained in the factorial analysis were submitted to a qualitative pre-test with new representatives of the target population in the format of cognitive interviews (Debriefing). The planning and execution of the step followed the recommendations described in the PRO Good Research Practices Task Force Report: Part 2 - Assessing Respondent Understanding (ISPOR 2) Results: The systematic review included 71 studies and identified 37 findings of barriers and 23 of facilitators, classified into ten themes and dimensions of the frameworks used (COM-B and HBM). The results of the systematic review and in-depth interviews allowed us to build our initial item bank. In the theoretical construct validation (content and face), a panel of experts evaluated 68 preliminary items, following the modified e-Delphi method, during three rounds and anonymously. The judgment of the items used the Jotform® platform and considered clarity, objectivity, relevance, feasibility, and scope as criteria. After the panel of experts, 138 representatives of the target population evaluated the remaining 61 items via Jotform® in the survey format. Respondents rated clarity, relevance, and comprehensiveness dichotomously and anonymously. With a cut-off of relevance established as ≥ 70% of the evaluations, we eliminated eight items due to lack of direct or indirect relevance and four due to redundancy, totaling 49 items after the content validation step. Cronbach's alpha coefficient indicated high internal consistency for the scale with 34 items (α=0.94). Subsequently, the results of the Kaiser-Meyer-Olkin test (KMO=0.80) and Barlett's test of sphericity (χ²= 3488.09; p<0.001) indicated an adequate adjustment of the data, enabling the EFA. After this analysis, the version I of the ADHERE questionnaire had 34 items grouped into four factors, considering a coefficient of 0.45, which explained 42% of the total variance. The four factors (Factor one, two, three, and four) gathered ten, ten, nine, and five items, respectively. The identified factors were: self-perception of personal and environmental barriers (α=0.89), self-efficacy (α=0.87), health policies (α=0.86) and personal interactions (α=0.80). After this step, we included 16 participants in the qualitative pre-test, obtaining a higher proportion of people with a basic level of education. At the end of this analysis, the 34 items remained after adjustments and changes in the operationalization of scales. The item evaluation process at this stage allowed adjustments to the wording of 18 items and modifications to the 5-item scale format. Therefore, the questionnaire incorporated three contexts for the Likert Scale: practices, attitudes, and knowledge, and markers of frequency, agreement, and knowledge, respectively. Conclusions: From the complete validation of the ADHERE questionnaire, its use can generate reliable reports and help policymakers to plan, monitor, review, modify, and implement health education interventions centered on the individual and community. Given this, it is essential to develop new approaches to the ADHERE instrument, considering that a significant portion of our population is not literate, lives in remote regions, and does not have access to or has a limited understanding of the use of electronic resources. That said, continuous validation and updating of the questionnaire is also necessary to ensure its relevance over time.

COMMITTEE MEMBERS:
Presidente - 2291421 - KARLA MORGANNA PEREIRA PINTO DE MENDONCA
Interna - 2319151 - TATIANA SOUZA RIBEIRO
Externa ao Programa - 2446479 - LILIAN LIRA LISBOA - UFRNExterna à Instituição - BRENDA NAZARÉ GOMES ANDRIOLO - UEPA
Externa à Instituição - ISABEL CRISTINA VASCONCELOS DE OLIVEIRA - UFPB