Propriedades psicométricas do instrumento de diagnóstico do estágio de desenvolvimento da rede de atenção à saúde bucal

Abstract

The implementation of a dental health care network is a recent process that requires evaluation. The aim of the present study was to adapt and validate an instrument to evaluate the development stage of a public dental health care network in Brazil. The original instrument, known as the Diagnostic Instrument of Stage of Development of a Health Care Network, was created by Mendes (2011). The sample comprised dentalhealthcare coordinators from 154 randomly chosen municipal districts in the state of Minas Gerais, in the Southeast of Brazil. The study consisted of four stages: (1) Adaptation of instrument (revised by an evaluation committee); (2) Pre-test with a sub-sample of the target population of the study (n= 20 municipal dental health care coordinators); (3) Field test (n=184 municipal dental healthcare coordinators); (4) Study of psychometric properties of instrument (reliability and validity). Questionnaires were sent to the coordinators by e-mail. The SPSS 19.0 program was used for statistical analysis. The present study was approved by the Research Ethics Committee of the Universidade Federalde Minas Gerais under protocol number 55044/2012. The theoretical-conceptual discussion points were considered satisfactory with respect to the conceptual, functional, item, semantic and operational equivalence of the instrument. With respect to psychometric properties relating to the reliability of the instrument, internal consistency levels weresatisfactory for both total score (Cronbachs alpha= 0.97) and domain scores (Cronbachs alpha= 0.77-0.94). Test-retest reliability revealed that the stability of the instrument was positive for both total score (Intraclass Correlation Coefficient-ICC= 0.88) and domain scores (ICC= 0.83-0.91). In relation to the validity of the instrument, concordance measurement of the items resulted in values of r= 0.25-0.81, which varied from normal toalmost perfect. In terms of discriminant validity, the total score of the instrument and the domains Population, Logistical systems and Network Governance System were capable of distinguishing between groups of coordinators according to time since graduation (p<0.05). There was, therefore, positive conceptual, functional, of items, semantic and operational equivalence between the original version and the dental health care version of the instrument. With respect to psychometric properties, the dental health care version performed satisfactorily for reliability (internal consistence and test-retest stability), validity construct and discriminant validity, and therefore the use of the instrument as an additional parameter in studies to evaluate the stage of development of adental health care network can be recommended.