Cultural adaptation and validation of the <i>Strategies to end seclusion restraint</i> module of the <i>QualityRights ToolKit</i>*

Zanardo, Ana Beatriz Rizzo; Ventura, Carla Aparecida Arena

doi:10.1590/1518-8345.5638.3520

Ana Beatriz Rizzo Zanardo

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

Scholarship holder at the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil.

http://orcid.org/0000-0002-6944-3905

Carla Aparecida Arena Ventura ^**Corresponding author: Carla Aparecida Arena Ventura. E-mail: caaventu@eerp.usp.br

Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil.

http://orcid.org/0000-0003-0379-913X

*Corresponding author: Carla Aparecida Arena Ventura. E-mail: caaventu@eerp.usp.br

Associate Editor

Maria Lúcia do Carmo Cruz Robazzi.

Authors’ contribution

Study concept and design: Ana Beatriz Rizzo Zanardo, Carla Aparecida Arena Ventura. Obtaining data: Ana Beatriz Rizzo Zanardo, Carla Aparecida Arena Ventura. Data analysis and interpretation: Ana Beatriz Rizzo Zanardo, Carla Aparecida Arena Ventura. Statistical analysis: Ana Beatriz Rizzo Zanardo, Carla Aparecida Arena Ventura. Drafting the manuscript: Ana Beatriz Rizzo Zanardo, Carla Aparecida Arena Ventura. Critical review of the manuscript as to its relevant intellectual content: Ana Beatriz Rizzo Zanardo, Carla Aparecida Arena Ventura. All authors approved the final version of the text.

Conflict of interest

The authors have declared that there is no conflict of interest.

Characteristics of Study Participants (Committee of Judges)	% of respondents (N=7)
Age (years old)
31	14.3	Mean	42.3
33	14.3	Median	43.0
36	14.3	Standard Deviation	9.2
43	14.3	Minimum	31
47	14.3	Maximum	53
53	28.6
Sex
Female	100.0
Profession
Lawyer	14.3
Nurse	42.9
Nurse and University Professor	14.3
Psychologist	28.6
Time since graduation (years)
7	14.3	Mean	19.1
10	14.3	Median	19.0
13	14.3	Standard deviation	9.5
19	14.3	Minimum	7
25	14.3	Maximum	31
29	14.3
31	14.3
Current working time (years)
0.08	14.3	Mean	12.05
0.25	14.3	Median	6
4	14.3	Standard deviation	12.55
6	14.3	Minimum	0.08
18	14.3	Maximum	31
25	14.3
31	14.3
Title/Degree
Master’s	28.6
Doctorate	57.1
Post-doctorate	14.3
Do you work in the area of interest?
Yes	100.0
What is the area of interest?
Teaching	14.3
Mental health	71.4
Mental Health/Scholar	14.3
Participation in training courses
Yes	100.0
Amount of participation
2	14.3	Mean	9.3
3	14.3	Median	8.0
5	14.3	Standard deviation	6.9
8	14.3	Minimum	2
10	14.3	Maximum	20
17	14.3
20	14.3
Article publication in the last 5 years
Yes	100.0
Number of articles published
2	28.6	Mean	6.6
6	14.3	Median	7.0
7	14.3	Standard deviation	3.8
8	28.6	Minimum	2
13	14.3	Maximum	13
Presentation of works in the last 5 years
Yes	100.0
Number of presentations
2	14.3	Mean	21.1
3	14.3	Median	8.0
6	14.3	Standard deviation	36.8
8	14.3	Minimum	2
12	14.3	Maximum	104
13	14.3
104	14.3

Characteristics of Health Professionals participating in the study	% of respondents (N=7)
Age (years old)
25	14.3	Mean/Median	35.9/35.0
27	14.3	Standard deviation	8.5
32	14.3	Minimum	25
35	14.3	Maximum	48
41	14.3
43	14.3
48	14.3
Sex
Female	85.7
Male	14.3
Profession
Social Worker	14.3
Nurse	28.6
Psychiatric Nurse	14.3
Psychologist Occupational therapist	28.6 14.3
Time since graduation (years)
2	14.3	Mean/Median	11.3/12.0
4	14.3	Standard deviation	7.5
10	14.3	Minimum	2
12	28.6	Maximum	25
14	14.3
25	14.3
Time working/worked in the mental health (years)
0.50	14.3	Mean/Median	9.58/9
0.58	14.3	Standard deviation	8.79
5	14.3	Minimum	0.5
9	14.3	Maximum	24
10	14.3
18	14.3
24	14.3
Title/Degree
Bachelor’s and Teaching Degree	14.3
Specialization/Residency	42.9
Doctorate	28.6
Specialization/Residency and master’s degree	14.3
Do you work in the area of interest
No answer	14.3
Yes	85.7
What is the area of interest?
Research	14.3
Mental health	71.4
No answer	14.3
Participation in training courses
Yes	85.7
No	14.3
Amount of participation
0	14.3	Mean/Median	3.9/3.0
1	14.3	Standard deviation	3.6
3	28.6	Minimum	0
4	14.3	Maximum	11
5	14.3
11	14.3
Article published in the last 5 years
Yes	42.9
No	57.1
Number of articles published
0	57.1	Mean/Median	1.3/0.0
2	28.6	Standard deviation	1.9
5	14.3	Minimum	0
		Maximum	5
Presentation of works in the last 5 years
Yes	42.7
No	57.1
Number of presentations
0	57.1	Mean/Median	1.6/0.0
2	14.3	Standard deviation	2.1
4	14.3	Minimum	0
5	14.3	Maximum	5

Judge/Assessment in each question (Q1; Q2...)	J1	J2	J3	J4	J5	J6	J7	CVI*	*Approval percentage per* item**
Q1 - Is the objective evident, facilitating the understanding of the material?	1	1	1	1	1	1	1	1.0	100%
Q2 - Does the content address information related to mental disorders and human rights?	1	1	1	1	1	1	1	1.0	100%
Q3 - Is the material proposal suitable to the objectives?	1	1	1	1	1	1	1	1.0	100%
Q4 - Is the information passed on within a clear context?	1	1	1	1	1	1	1	1.0	100%
Q5 - Is the reading level suitable for the reader’s understanding?	1	1	1	1	1	1	0	0.86	86%
Q6 - Does the vocabulary use common words?	1	0	1	1	1	1	0	0.71	71%
Q7 - Is learning facilitated by topics?	1	1	1	1	1	1	1	1.0	100%
Q8 - Are the illustrations relevant?	0	1	1	1	1	-1	1	0.71	71%
Q9 - Is the material organization suitable?	1	1	1	1	1	1	1	1.0	100%
Q10 - Are the font size and font suitable?	1	1	1	1	1	1	1	1.0	100%
Q11 - Are the desired behavior patterns well modeled or demonstrated?	1	1	1	1	1	1	0	0.86	86%
Q12 - Is there motivation to change behavior?	1	1	1	1	1	1	1	1.0	100%
Q13 - Is the material culturally suitable to the logic, language, and experience of the target audience?	1	1	1	1	1	1	0	0.86	86%
Q14 - Does it present culturally suitable examples?	1	0	1	1	1	1	1	0.86	86%
Total Approval								0.92	92%
Health Professionals/Assessment on each question (Q1; Q2...)	P1	P2	P3	P4	P5	P6	P7	CVI	*Approval percentage per* item**
Q1 - Is the objective evident, facilitating the understanding of the material?	1	1	1	1	1	1	0	0.86	86%
Q2 - Does the content address information related to mental disorders and human rights?	1	1	1	1	1	1	0	0.86	86%
Q3 - Is the material proposal suitable to the objectives?	1	1	1	1	1	1	0	0.86	86%
Q4 - Is the information passed on within a clear context?	1	1	1	1	1	1	0	0.86	86%
Q5 - Is the reading level suitable for the reader’s understanding?	1	1	1	1	1	1	0	0.86	86%
Q6 - Does the vocabulary use common words?	1	1	1	1	1	1	0	0.86	86%
Q7 - Is learning facilitated by topics?	1	1	1	1	1	1	0	0.86	86%
Q8 - Are the illustrations relevant?	1	1	1	1	1	1	0	0.86	86%
Q9 - Is the material organization suitable?	1	1	1	1	1	1	1	1.0	100%
Q10 - Are the font size and font suitable?	1	1	1	1	1	1	1	1.0	100%
Q11 - Are the desired behavior patterns well modeled or demonstrated?	1	1	1	1	1	1	0	0.86	86%
Q12 - Is there motivation to change behavior?	1	1	1	1	1	1	0	0.86	86%
Q13 - Is the material culturally suitable to the logic, language, and experience of the target audience?	1	1	1	1	1	1	0	0.86	86%
Q14 - Does it present culturally suitable examples?	1	1	1	1	1	1	0	0.86	86%
Total Approval								0.88	88%

Main suggestions of the judges (J1; J2...) in FV2*	Main suggestions of health professionals (P1; P2...) in FV3^†
(...) I suggest reflecting on the vocabulary/language presented, mainly in the initial topics. (J7)	Continuous reading becomes tiresome, but it becomes interesting and enlightening for items. The translation was performed very well, and reading is possible without reservations. (P3)
It would be interesting to invest in mental maps to facilitate the understanding of elementary and middle-level professionals. (J2)	The final graphic assists in understanding the material as a whole. (P4)
The material does not contain illustrations (photos, images, and figures). However, considering the tables and flowchart that appear as illustrations, we can consider them relevant. Link images can also be considered relevant. (J1)	I found the reading only a little extensive, tables and summary helped in the synthesis and overview of the set (P6)
I did not see the need for illustrations of the material, in addition to the QualityRights initiative symbol. (J6)	I believe that just by reading it becomes difficult, motivating the practical experience with this material would be richer. (...) Very rich material, but the reading becomes tiresome and extensive. (P4)
It would be interesting to include clearer and more frequent examples in the Brazilian reality. (J2)	I could attach real Brazilian cases to exemplify the topics and approach culturally. (P5)
The material content is very rich!!! (...) I believe that the topic of the module that will imply greater implementation challenges will be Topic 4- “Challenging assumptions about seclusion and restraint”, as it involves everyday beliefs and situations of health services related to experiences of violence, anchored in fear and dangerousness and justified by the desire to protect. It may be interesting to encourage, indeed, the exposure of own examples, using exercises with strategies that involve more sensitivity, emotions. (J5)	The material is excellent, it can be adapted to various target audiences, bringing the discussion of a topic of extreme importance in mental health services in Brazil. (P2)

[1] *Corresponding author: Carla Aparecida Arena Ventura. E-mail: caaventu@eerp.usp.br

Brasil

Brasil

Cultural adaptation and validation of the Strategies to end seclusion restraint module of the *QualityRights ToolKit**

Abstract

Objective

Method

Results

Conclusion

Brasil

Brasil

Cultural adaptation and validation of the Strategies to end seclusion restraint module of the QualityRights ToolKit*

Abstract

Objective

Method

Results

Conclusion

Cultural adaptation and validation of the Strategies to end seclusion restraint module of the *QualityRights ToolKit**