Family Vulnerability Scale: validityevidence in primary health care

Authors

DOI:

https://doi.org/10.11606/s1518-8787.2023057005329

Keywords:

Health Vulnerability, Family Characteristics, Validation Study, Primary Health Care, Population Health Management

Abstract

OBJECTIVE: Investigate evidence of validity of the Family Vulnerability Scale (EVFAM-BR) as an instrument to support population-based management in primary health care (PHC), in the scope of Health Care Planning (PAS).
METHODS: This is a psychometric study to assess any additional evidence of the internal structure of EVFAM-BR using confirmatory factor analysis (CFA) and network analysis (NA).
A preliminary version of the scale with 38 items was submitted to patients of PHC facilities that use the PAS methodology, distributed across the five regions of Brazil. For the primary CFA data, factor loadings and predictive power (R2) of the item were used. Seven model adjustment indices were adopted and reliability was measured by three indicators, using Bayesian estimation.
RESULTS: The preliminary version of the scale was applied to 1,255 patients. Using the AFC, factor loadings ranged from 0.66 to 0.90 and R2 from 0.44 to 0.81. Both the primary indicators and the model adequacy indices presented satisfactory and consistent levels. According to the NA, the items were appropriately associated with their peers, respecting the established dimensions, thus demonstrating sustainability and stability of the proposed model.
CONCLUSIONS: The evidence of validity presented by EVFAM-BR indicates, for the first time in Brazil, a concise instrument that is able to assertively measure family vulnerability, potentially supporting population-based management.

References

Giovanella L. Atenção básica ou atenção primária à saúde? Cad Saude Publica. 2018 Aug;34(8):e00029818. https://doi.org/10.1590/0102-311x00029818

Mendes EV, Matos MA, Evangelista MJ, Barra RP. A construção social da Atenção Primária à Saúde. 2nd ed. Brasília, DF: CONASS; 2019.

Conselho Nacional de Secretários de Saúde. Planificação da Atenção à Saúde: um instrumento de gestão e organização da atenção primária à saúde e da atenção ambulatorial especializada nas redes de atenção à saúde. Brasília, DF: CONASS; 2018 [citado em 3 nov 2022]. (Conass documenta 31)Disponível em: https://www.conass.org.br/biblioteca/caderno-conass-documenta-n-31/

Evangelista MJ, Guimarães AM, Dourado EM, Vale FL, Lins MZ, Matos MA, et al. O planejamento e a construção das redes de atenção à saúde no DF, Brasil. Cien Saude Colet. 2019;24(6):2115-24. https://doi.org/10.1590/1413-81232018246.08882019

Mendes EV. As redes de atenção à saúde. Brasília, DF: Organização Pan-Americana da Saúde; 2011 [citado 3 nov 2022]. Disponível em https://www.conass.org.br/biblioteca/as-redes-de-atencao-a-saude/

Ayres JR, Calazans GJ, Saletti Filho HC, França I Junior. Risco, vulnerabilidade e práticas de prevenção e promoção da saúde. In: Campos GWS, Bonfim JRA, Minayo MCS, Akerman M, Drumond Junior M, Carvalho YM, organizadores. Tratado de saúde coletiva. São Paulo: Hucitec; 2016. p. 399-442.

Ayres JR, França I Junior, Calazans GJ, Saletti Filho HC. O conceito de vulnerabilidade e as práticas de saúde: novas perspectivas e desafios. Czeresnia D, Freitas CM, editores. Promoção da saúde: conceitos, reflexões, tendências. Rio de Janeiro: Fiocruz; 2003. p. 117-39.

Ayres JR, Paiva V, França I Jr, Gravato N, Lacerda R, Della Negra M, et al. Vulnerability, human rights, and comprehensive health care needs of young people living with HIV/AIDS. Am J Public Health. 2006 Jun;96(6):1001-6. [https://doi.org/10.2105/AJPH.2004.060905

Nichiata LY, Bertolozzi MR, Takahashi RF, Fracolli LA. A utilização do conceito “vulnerabilidade” pela enfermagem. Rev Latino-Am Enferm.2008;6(5):923-28. https://doi.org/10.1590/S0104-11692008000500020

Savassi LC, Lage JL, Coelho FL. Sistematização de um instrumento de estratificação de risco familiar: escala de risco familiar de Coelho-Savassi. J Manag Prim Health Care. 2012;3(2):179-85. https://doi.org/10.14295/jmphc.v3i2.155.

Amendola F, Alvarenga MR, Latorre MD, Oliveira MA. Índice de vulnerabilidade a incapacidades e dependência (IVF-ID), segundo condições sociais e de saúde [Internet]. Cien Saude Colet. 2017 Jun;22(6):2063-71. https://doi.org/10.1590/1413-81232017226.03432016

Souza EL, Eshriqui I, Rebustini F, Masuda ET, Paiva Neto FT, Lima RM, et al. Family Vulnerability Scale: evidence of content and internal structure validity. PLOS ONE. 2023;18(10):e280857. https://doi.org/10.1371/journal.pone.0280857. eCollection 2023

American Educational Research Association, American Psychological Association, National Council on Measurement in Education, The standards for educational and psychological testing. Washington, DC: American Psychological Association; 2014.

Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019 Jul;95:103208. https://doi.org/10.1016/j.jbi.2019.103208

Crobach LJ. Coefficient alpha and the internal structure of tests [Internet]. Psychometrika. 1951;16(3):297-334. https://doi.org/10.1007/BF02310555.

Woodhouse B, Jackson PH. Lower bounds for the reliability of the total score on a test composed of non-homogeneous items: II: A search procedure to locate the greatest lower bound. Psychometrika. 1977;42(4):579-91. https://doi.org/10.1007/BF02295980.

McDonald RP. Test theory: a unified treatment. New York: Psychology Press; 2013.

Pfadt JM, Bergh DV, Sijtsma K, Wagenmakers EJ. A tutorial on Bayesian single-test reliability analysis with JASP. Behav Res Methods. 2022;55:1069-78. https://doi.org/10.3758/s13428-021-01778-0

Mullarkey MC, Marchetti I, Beevers CG. Using Network Analysis to identify central symptoms of adolescent depression. J Clin Child Adolesc Psychol. 2019;48(4):656-68. https://doi.org/10.1080/15374416.2018.1437735

Epskamp S, Borsboom D, Fried EI. Estimating psychological networks and their accuracy: a tutorial paper. Behav Res Methods. 2018 Feb;50(1):195-212. https://doi.org/10.3758/s13428-017-0862-1

Yuan GF, Shi W, Elhai JD, Montag C, Chang K, Jackson T, et al. Gaming to cope: applying network analysis to understand the relationship between posttraumatic stress symptoms and internet gaming disorder symptoms among disaster-exposed Chinese young adults. Addict Behav. 2022 Jan;124:107096. https://doi.org/10.1016/j.addbeh.2021.107096

Borsboom D. Possible futures for network psychometrics. Psychometrika. 2022 Mar;87(1):253-65. https://doi.org/10.1007/s11336-022-09851-z

Marsman M, Rhemtulla M. Guest editors’ introduction to the special issue “network psychometrics in action”: methodological innovations inspired by empirical problems. Psychometrika. 2022 Mar;87(1):1-11. https://doi.org/10.1007/s11336-022-09861-x

Marsman M, Borsboom D, Kruis J, Epskamp S, Bork R, Waldorp LJ, et al. An introduction to network psychometrics: relating ising network models to item response theory models. Multivariate Behav Res. 2018;53(1):15-35. https://doi.org/10.1080/00273171.2017.1379379

Newman M. Networks: an introduction. Oxford: Oxford University Press; 2010.

Zhao T, Liu H, Roeder K, Lafferty J, Wasserman L. The huge package for high-dimensional undirected graph estimation in R. J Mach Learn Res. 2012 Apr;13:1059-62.

Meinshausen N, Bühlmann P. High-Dimensional Graphs and Variable Selection with the Lasso. Ann Stat. 2006;34(3):1436-62. https://doi.org/10.1214/009053606000000281

Friedman J, Hastie T, Tibshirani R. Sparse inverse covariance estimation with the graphical lasso. Biostatistics. 2008 Jul;9(3):432-41. https://doi.org/10.1093/biostatistics/kxm045

Fruchterman TM, Reingold EM. Graph drawing by force-directed placement. Softw Pract Exp. 1991;21(11):1129-1164. DOI . https://doi.org/10.1002/spe.4380211102.

Valente TW. Network interventions. Science. 2012 Jul;337(6090):49-53. https://doi.org/10.1126/science.1217330

Robinaugh DJ, Millner AJ, McNally RJ. Identifying highly influential nodes in the complicated grief network. J Abnorm Psychol. 2016 Aug;125(6):747-57. https://doi.org/10.1037/abn0000181

Pollard B, Dixon D, Dieppe P, Johnston M. Measuring the ICF components of impairment, activity limitation and participation restriction: an item analysis using classical test theory and item response theory. Health Qual Life Outcomes. 2009 May;7(41):41. https://doi.org/10.1186/1477-7525-7-41

Petrillo J, Cano SJ, McLeod LD, Coon CD. Using classical test theory, item response theory, and Rasch measurement theory to evaluate patient-reported outcome measures: a comparison of worked examples. Value Health. 2015 Jan;18(1):25-34. https://doi.org/10.1016/j.jval.2014.10.005

Alvarenga WA, Nascimento LC, Rebustini F, Santos CB, Muehlan H, Schmidt S, et al. Evidence of validity of internal structure of the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12) in Brazilian adolescents with chronic health conditions. Front Psychol. 2022 Sep;13:991771. https://doi.org/10.3389/fpsyg.2022.991771

Ministério da Saúde (BR). Portaria Nº 2.436, de 21 de setembro de 2017. Aprova a Política Nacional de Atenção Básica, estabelecendo a revisão de diretrizes para a organização da Atenção Básica, no âmbito do Sistema Único de Saúde (SUS). Brasília, DF: Ministério da Saúde; 2017 [citado 15 nov 2022]. Disponível em: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2017/prt2436_22_09_2017.html

Nações Unidas Brasil. Objetivos de desenvolvimento sustentável. Brasília, DF: Casa ONU Brasil; 2023 [citado 14 nov 2022]. Disponível em: https://brasil.un.org/pt-br/sdgs

Peres J, Mendes KL, Wada RS, Sousa MD. Relação entre classificações de risco utilizadas para organização da demanda em saúde bucal em município de pequeno porte de São Paulo, Brasil. Cien Saude Colet. 2017 Jun;22(6):1905-11. https://doi.org/10.1590/1413-81232017226.00702016

Nakata PT, Koltermann LI, Vargas KR, Moreira PW, Duarte ER, Rosset-Cruz I. Classificação de risco familiar em uma Unidade de Saúde da Família. Rev Lat Am Enfermagem. 2013;21(5). https://doi.org/10.1590/S0104-11692013000500011

Ministério da Saúde (BR). e-SUS APS. Brasília, DF: Ministério da Saúde; 2022 [citado 14 nov 2022]. Disponível em: https://sisaps.saude.gov.br/esus/

Published

2023-12-01

How to Cite

Souza, E. L. de, Rebustini, F., Eshriqui, I., Paiva Neto, F. T. de, Masuda, E. T., Lima, R. M., & Bonfim, D. (2023). Family Vulnerability Scale: validityevidence in primary health care. Revista De Saúde Pública, 57(Supl.3), 1-11. https://doi.org/10.11606/s1518-8787.2023057005329