Elaboração e validação de conteúdo de um instrumento para identificação de violência contra criança

Abstract

The role of multidisciplinary health teams is key for the early prevention and identification of situations of violence. However, there is still great difficulty among professionals regarding the tracking of child abuse. Thus, there is need for a validated instrument that can be used by health professionals in a practical and objective way in the tracking of neglect and ill-treatment in infants in routine clinical practice. The aim of this study was to develop and validate the contents of an instrument for identifying violence against children. This is a methodological study consisting of two stages: the first was the development of the instrument from the literature review; the second was the content validation with evaluation of the instrument by 25 experts in the first phase, 22 in the second, and 21 in the third phase. In order to promote a multidimensional investigation of violence through a comprehensive understanding of human beings and contextualized in the phenomenon, was used the bio-ecological theory of human development. In this sense, the objective of the questionnaire is to track signs of abuse and ill-treatment of the four natures of violence - physical, psychological, sexual, neglect/abandonment - by means of the following dimensions: behavioral signs of the child; signs of physical violence; Munchausen syndrome by proxy (induction of symptoms and diseases in children by parents/caregivers); signs of sexual violence; and signs of neglect. For analysis, were adopted Kappa coefficient ≥0.61 and content validity index (CVI) ≥0.75. In the first round, of the 62 items, 39 (62.90%) showed Kappa ≥0.61 and content validity index ≥0.79. In the others (n = 23; 37.10%) were found low Kappa indexes, hence there were reformulations. The instrument received Kappa overall evaluation of 0.62, and content validity index of 0.85, which are considered good results. In the second round after the adjustments suggested by the experts, the instrument included 50 items in total. Of these, 49 had content validity index between 0.81 and 1.00, and Kappa between 0.61 and 0.99. Only an item had Kappa >0.61 (K = 0.50; CVI = 0.81). The lack of agreement among experts resulted in the exclusion of this item in a third round. The instrument was evaluated positively, reaching Kappa of 0.85, and content validity index of 0.95 in the second Delphi phase. In the last phase, the overall indices of Kappa and content validity of the instrument were 0.98 and 0.99, respectively. The instrument presented satisfactory content validity index and can be used to identify signs of suspected violence and help health professionals in child care.