Content validation of an instrument for identifying violence against children

Methodological study consisting of two stages: the first was the development of the instrument from the literature review; the second was content validation, with evaluation of the instrument by 25 experts. For analysis, were adopted Kappa coefficient ≥0.61, and content validity index ≥0.75.

Results

In the first round, of 62 items, it was necessary to reformulate the content of 23 items. After adjustments suggested by the experts, the instrumented had 50 items in the second round. Of these, only one had Kappa> 0.61 (Kappa = 0.50). The lack of agreement among experts resulted in the exclusion of this item in the third round.

Conclusion

The instrument showed satisfactory content validity index and can be used to identify signs of suspected violence and help health professionals in child care.

Nursing assessment; Child; Nursing care; Pediatric nursing; Violence

Items from the first version of the instrument	CVI/Kappa
Contusion or hematoma in the shape of a hand, belt or stick; or marks of tooth or nails	0.76/0.43
Contusion or hematoma in any non-bone body part (such as head, neck, face, buttocks, torso or arms)	0.80/0.48
Hematoma or red or purple spots	0.80/0.48
Injuries with appearance of an adult human bite.	0.80/0.48
Discharge, secretion, bleeding, injury, scars or genital ulcers	0.88/0.67
Open anus during examination.	0.84/0.58
Sexualized behavior (like speaking and demonstrating sexual knowledge, drawing genitalia, simulation of sexual activity with another child)	0.88/0.67
Precocious sexual behavior.	0.84/0.58
Frequent absences in school activities	0.88/0.67
Little or no school attendance without clinical conditions that justify it.	0.92/0.77
Father/caregiver’s refusal to seek a health professional for child care, or no permission for the own child looking for a health professional.	0.84/0.58
Parents/caregivers do not seek health services when the child needs care; they cannot administer the treatment prescribed for the child; or often do not accompany the child in health services.	0.96/0.88
The child has not been receiving adequate monitoring of immunization, treatment for tooth decay, growth and development.	0.88/0.67

Items from the first version of the instrument	CVI/Kappa
Severe or unusual injuries.	0.68/0.28
Intracranial injury or subdural hemorrhage in the absence of a large accidental trauma.	0.76/0.43
Signs of cervical spine injury in the absence of accidental trauma confirmation.	0.84/0.58
Intra-abdominal or thoracic injuries in the absence of large accidental trauma and/or external hematoma.	0.84/0.58
Controlling behavior with parents/caregivers.	0.84/0.58

Items from the first version of the instrument	CVI/Kappa	Suggestions from experts (n)	Justification
Strong change in behavior or emotional state neither expected for the child’s age nor explained by a stressful situation (such as parental divorce). Examples: crying, psychomotor agitation, tics, stuttering, urination, sleep disturbances, fear, apathy, low self-esteem, introversion, destructive or self-destructive behavior, aggressive behavior (unusual), attempted suicide.	0.76/0.43	Include the arrival of a sibling.⁽¹⁾	For most children, the arrival of a new sibling is considered a period of developmental crisis and can cause changes in behavior or emotional state.⁽²³⁾
Excessively nice behavior (unusual) with strangers, including health professionals (looking for affection).	0.80/0.50	The use of demonstration of lack of affection would demonstrate the emotional neglect by caregivers.⁽¹⁾	Neglect is also characterized by disregard for the child’s well-being in relation to affection, indicating the need for a thorough investigation of the family situation.⁽¹²⁾
Burns: in covered areas of the body or posterior regions (such as palm of hands, soles, buttocks, back); in shape of a utensil (such as cigarette or iron); in shape of a glove or sock; bilateral; symmetrical.	0.80/0.50	In this item, consider any type of burn that cannot be justified, regardless of shape or location.⁽¹⁾	Physical violence can be practiced through slaps, pinches, kicks and by throwing objects, which causes injuries, trauma, burns and mutilations.⁽¹²⁾
Dissociation (depersonalization and amnesia).	0.84/0.58	Describe the terms for a better understanding of professionals using the instrument.⁽¹⁾	The concepts of dissociative experiences are complex and require clarity even for mental health professionals.⁽²⁴⁾
Encopresis (repeated defecation, including in inappropriate places) or enuresis (lack of control of sphincters) without the identification of stressful situations (such as mourning or parental divorce).	0.84/0.58	Specify if it occurs frequently or if it is punctual.⁽¹⁾	The onset of encopresis and enuresis is often indicative of violence.⁽²⁵⁾
The use of children to meet the needs of adults (parental alienation).	0.84/0.58	Define the concept of parental alienation.⁽¹⁾	The term is most often used in the legal sphere and relates to the emotional and behavioral consequences suffered by the child victim of the father’s or mother’s conduct, who act in a way to make the child reject the former spouse after separation.⁽¹²⁾

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author. Luciana da Silva Revorêdo. Campus Universitário, 59072-070, Natal, RN, Brazil. lucianasrevoredo@gmail.com