Submitted by Automa??o e Estat?stica (sst@bczm.ufrn.br) on 2016-04-01T19:24:53Z No. of bitstreams: 1 WagnerIvanFonsecaDeOliveira_DISSERT.pdf: 1988371 bytes, checksum: a07fe40eb2121344eae3a44c3e03b924 (MD5) / Approved for entry into archive by Arlan Eloi Leite Silva (eloihistoriador@yahoo.com.br) on 2016-04-06T23:16:55Z (GMT) No. of bitstreams: 1 WagnerIvanFonsecaDeOliveira_DISSERT.pdf: 1988371 bytes, checksum: a07fe40eb2121344eae3a44c3e03b924 (MD5) / Made available in DSpace on 2016-04-06T23:16:55Z (GMT). No. of bitstreams: 1 WagnerIvanFonsecaDeOliveira_DISSERT.pdf: 1988371 bytes, checksum: a07fe40eb2121344eae3a44c3e03b924 (MD5) Previous issue date: 2015-06-09 / As Institui??es de Longa Perman?ncia para Idosos (ILPIs) s?o uma importante alternativa de cuidado em todo mundo, por?m o Brasil ainda n?o disp?e de instrumento v?lido para monitorar a qualidade dessas institui??es. Nos Estados Unidos, utiliza-se o Observable Indicators of Nursing Home Care Quality Instrument (IOQ) o qual avalia a qualidade do cuidado nas ILPIs a partir de 30 indicadores de estrutura (2 dimens?es) e processo (5 dimens?es) relacionados ? dimens?o da qualidade aten??o centrada na pessoa. Objetivou-se neste estudo adaptar transculturalmente o IOQ para avaliar a qualidade do cuidado das ILPIs no contexto brasileiro. Realizou-se a equival?ncia conceitual e de itens para avaliar a pertin?ncia e viabilidade do IOQ ? realidade nacional atrav?s do ?ndice de Validade do Conte?do (IVC) junto a um comit? de especialistas formado por 10 participantes e diretamente envolvidos com o objeto de estudo. Em seguida, cumpriu-se a equival?ncia operacional, idiom?tica e a sem?ntica concomitantemente. Esta constituiu-se em 5 fases: (1) duas tradu??es e (2) respectivas retradu??es; (3) aprecia??o formal referente ao significado referencial e geral; (4) revis?o por um segundo comit? de especialistas; (5) aplica??o do pr?-teste em tr?s ILPIs por pares de diferentes entes sociais: profissionais de sa?de, reguladores da vigil?ncia sanit?ria e potenciais consumidores. Avaliou-se a equival?ncia de mensura??o a partir do teste de alfa de Cronbach para verificar a consist?ncia interna do instrumento. Para mensurar a concord?ncia entre os pares de avaliadores, utilizou-se o ?ndice de Concord?ncia Geral (ICG) e o coeficiente Kappa. Estimou-se o cumprimento pontual e Intervalo de Confian?a 95% dos indicadores, dimens?es e construto total. O IVC apresentou resultados elevados tanto para relev?ncia (95,3%) quanto para viabilidade (94,3%) ao contexto brasileiro. Quanto ao significado referencial, observou-se similaridade variando entre 90-100% para a primeira retradu??o e 70-100% para a segunda. Com rela??o ao significado geral, a vers?o 1 foi melhor avaliada, recebendo classifica??o ?inalterado? em 80% dos itens, enquanto a vers?o 2 apresentou apenas 47%. No pr?-teste, o IOQ mostrou-se compreens?vel e de f?cil aplica??o. Obteve-se um alfa de Cronbach elevado (0,93), ICG satisfat?rio (75%) e concord?ncia substancial atrav?s do coeficiente Kappa (0,65) entre os pares de avaliadores: profissionais de sa?de, reguladores da Subcoordenadoria da Vigil?ncia Sanit?ria (SUVISA) e potenciais consumidores. ? poss?vel assumir a equival?ncia operacional realizada uma vez que se preservou o layout do instrumento original na vers?o brasileira a partir da manuten??o das caracter?sticas no modo de aplica??o, op??es de respostas, n?mero de itens, enunciados e pontua??es. O desempenho das ILPIs obteve m?dia aproximada de 87 pontos, apresentando uma varia??o de 55 a 111, considerando uma escala de 30 a 150. Piores resultados estiveram relacionados ao processo (m?dia=2,85), enquanto a estrutura obteve uma m?dia de 3,75, considerando uma escala de 1 a 5. A menor pontua??o foi alusiva ? dimens?o referente ? presta??o de cuidados (m?dia=2). Identificou-se o IOQ como sendo v?lido e confi?vel no contexto brasileiro. Sugere-se o uso para avaliar e monitorar a qualidade do cuidado nas ILPIs por profissionais de sa?de, reguladores e potenciais consumidores e evidenciar oportunidades de melhoria. / The Nursing Homes are an important alternative care in the world, but Brazil still has no valid instrument to monitor the quality these institutions. In the United States, the Observable Indicators of Nursing Home Care Quality Instrument (OIQ) is used to assess the quality of Nursing Home care using 30 indicators of structure (2 dimensions) and process (5 dimensions) related to quality person-centered care. The present study aimed at cross-culturally adapting the OIQ in order to evaluate the quality of Nursing Home care in Brazil. Conceptual and item equivalence were determined to assess the relevance and viability of OIQ in the Brazilian context, using the Content Validity Index (CVI) and a group of specialists composed of 10 participants directly involved in the object of study. Next, operational, idiomatic and semantic equivalence were carried out concurrently. This consisted of 5 phases: (1) two translations and (2) their respective back translations; (3) formal appraisal of referential and general meaning; (4) review by a second group of specialists; (5) application of the pretest at three Nursing Homes by different social entities: health professionals, sanitary surveillance regulators and potential consumers. Measurement equivalence was evaluated by the Cronbach?s alpha test to verify the internal consistency of the instrument. To measure inter-evaluator agreement, the General Agreement Index (ICG) and Kappa coefficient were used. Timely compliance and 95% Confidence Interval of indicators, dimensions and total construct were estimated. The CVI obtained high results for both relevance (95.3%) and viability (94.3%) in the Brazilian context. With respect to referential meaning, similarity was observed, ranging between 90-100% for the first back translation and 70-100% for the second. In relation to general meaning, version 1 was better, classified as ?unchanged? in 80% of the items, whereas in version 2 it was only 47%. In the pretest, the OIQ was easy to understand and apply. The following outcomes were obtained: a high Cronbach?s alpha (0.93), satisfactory ICG (75%) and substantial agreement between the pairs of evaluators (health professionals, regulators from the Superintendency of Sanitary Surveillance ?SUVISA-, and potential consumers), according to the Kappa coefficient (0.65). It?s possible take the operational equivalence held since it preserved the original layout in the Brazilian version from the maintenance in application mode, response options, number of items, statements and scores. The performance of nursing homes obtained approximate average scores of 87, a variation 55-111 considering a range from 30 to 150 points. The worst outcomes were related to process indicators with a mean of 2.8 per item, while structure was 3.75 on a scale of 1 to 5. The lowest score was obtained for the care dimension (mean 2). The OIQ version was deemed to be a valid and reliable instrument in the Brazilian context. It is recommended that health professionals, regulators and potential consumers adopt it to access and monitor the quality of Nursing Home care and demonstrating opportunities for improvement.