DIMENSIONAL VALIDITY OF THE INVENTORY OF ETHICAL PROBLEMS IN PRIMARY HEALTH CARE IN THE CONTEXT OF CHILDREN'S HEALTH

Santos, Deisy Vital dos; Freitas, Kátia Santana; Rosa, Darci de Oliveira Santa; Zoboli, Elma Lourdes Campos Pavone; Miranda, Juliana de Oliveira Freitas

doi:10.1590/1980-265X-TCE-2020-0422

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Original Article • Texto contexto - enferm. 30 • 2021 • https://doi.org/10.1590/1980-265X-TCE-2020-0422 copy

DIMENSIONAL VALIDITY OF THE INVENTORY OF ETHICAL PROBLEMS IN PRIMARY HEALTH CARE IN THE CONTEXT OF CHILDREN'S HEALTH

VALIDEZ DIMENSIONAL DEL INVENTARIO DE PROBLEMAS ÉTICOS EN LA ATENCIÓN PRIMARIA DE SALUD EN EL CONTEXTO DE SALUD DEL NIÑO

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to assess the dimensional validity and reliability of the Inventory of Ethical Problems in Primary Health Care adapted to the children's health context.

Method:

a cross-sectional study with 101 nurses from the Family Health Strategy Units in a city of the Brazilian Northeast region. Data collection was carried out between May 2016 and June 2017. Construct validity was assessed by means of exploratory factor analysis and reliability by verifying internal consistency using Cronbach's alpha coefficient.

Results:

the factor analysis revealed the multidimensionality of the Inventory of Ethical Problems in Primary Health Care-Children's Health. It consisted of 19 items, distributed into 4 factors: Factor 1 - Organization of the health system; Factor 2 - Professional Ethics; Factor 3 - Teamwork; and Factor 4 - Parents (or guardians) autonomy expression. Overall internal consistency by Cronbach's alpha and for the factors was moderate to satisfactory.

Conclusion:

factor analysis revealed that the inventory has a multidimensional structure with 4 factors. The study showed evidence of validity and reliability that recommends the application of the IPE-APS to the context of children's health.

DESCRIPTORS:
Validation studies; Family health nurses; Problem solving; Bioethics; Children's health

Characteristics	Frequency (%) or mean [standard deviation]
Gender
Male	05 (5%)
Female	96 (95%)
Age	35.5 [±8.79]
Time of training (years)	8.0 [±6.7]
Time working in FHS^* (years)	5.1 [±4.3]
Time of experience in childcare (years)	5.7 [±5.3]
Location of the FHS where they work
Urban area	77 (76.2%)
Rural area	24 (23.8%)

Items		Factorial load				ITC^*	α if item is removed
Items		1	2	3	4
Factor 1 - Organization of the health system
38	There is no rear removal service in the BHU.^†	0.655				0.485	0.719
35	Difficulties regarding return and reliability of the laboratory test results	0.609				0.548	0.702
37	The BHU^† is unable to provide emergency care to children.	0.581				0.522	0.701
36	The BHU^† does not provide family health teams with conditions to support children's home visits.	0.520				0.514	0.707
28	Lack of support from intersectoral actions to discuss and solve ethical problems they encounter in their children's health practice.	0.520				0.417	0.725
32	Private health service professionals disregard the diagnostic or therapeutic course of action carried out by the professionals of the family health team.	0.503				0.347	0.738
34	Difficulties in the referral and counter-referral system for consultations with specialists and complementary tests for the children.	0.502				0.458	0.717
Factor 2 - Professional Ethics
4	The FHS^‡ professionals make inappropriate or wrong prescriptions for the children		0.666			0.312	0.414
12	The CHA^§ tells their neighbors information they get from work about children and their families		0.540			0.282	0.459
9	The professionals request diagnostic tests for the child without informing the parents (or guardians) what is being requested and why		0.534			0.365	0.315
Factor 3 - Teamwork
19	The professionals of the FHS^‡ team work with lack of commitment and involvement in children's health care			0.713		0.573	0.567
26	The BHU employees raise doubts about the FHS^‡ professionals' conduct			0.642		0.471	0.508
31	The FHS^‡ physician refuses to see children who do not have a medical appointment scheduled for the day, which ends up restricting their access to the BHU^†			0.606		0.412	0.617
21	There is disrespect among the FHS^‡ team members			0.566		0.426	0.551
Factor 4 - Expression of parents (or guardians) autonomy
17	The parents (or guardians) refuse to follow medical instructions or undergo tests that the physicians and nurses have indicated for the children				0.615	0.448	0.493
15	The parents (or guardians) refuse prescribed treatment to the child because they believe in divine healing				0.586	0.384	0.528
7	During the medical or nursing consultation, the parents (or guardians) request exams, medications or other inappropriate or unnecessary procedures for the child				0.550	0.376	0.528
25	The parents (or guardians) ask one of the FHS^‡ members to deny the access to any information related to the child's health to any other member of the family, even in situations where the participation of the entire family in care is required				0.532	0.266	0.576
16	Minors seek the BHU^† and ask the team for tests, medications or other procedures, without parental consent and/or knowledge				0.532	0.322	0.551
	Cronbach's Alpha	0.74	0.50	0.62	0.59		Overall α = 0.767
	Variance%	16.36	6.20	6.06	5.31
	Cumulative Variance%	17.87	24.07	30.13	35.44

Factors	Operational definition	Item in original version	Item in adapted version
1 - Organization of the health system	Ethical problems related to organizational issues in the health system, which are not under the nurse's control (structure, management, resources, articulation).	28, 32, 34, 35, 36, 37, 38	2, 19, 1, 16, 8, 12, 10
2 - Professional ethics	Ethical problems related to the professional ethics of the members that make up the family health strategy (confidentiality, malpractice, communication)	4, 9, 12	6, 7, 15
3 - Teamwork	Ethical problems related to different professional profiles that create obstacles to teamwork in PHC (commitment, respect, trust, flexibility)	19, 21, 26, 31	4, 11, 14, 13
4 - Expression of the parents (or guardians) autonomy	Ethical problems linked to the expression of parental autonomy to decide on the issues involving the child's life (treatment, confidentiality, children's decision) and how the professional deals with this ethical issue.	7, 15, 16, 17, 25	17, 3, 18, 5, 9

Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[1] CORRESPONDING AUTHOR
Deisy Vital dos Santos deisy@ufrb.edu.br