Elaboración y validación de una cartilla sobre diabetes para los Agentes Sanitarios

se trata de un estudio metodológico desarrollado en siete etapas: Estudio bibliográfico; Preparación de la cartilla; Cálculo de las fórmulas de legibilidad y aprehensibilidad; Validación de la cartilla por el comité de jueces; Discusión entre expertos; Validación de la cartilla por el público objetivo; y Discusión final entre los expertos. Diez jueces realizaron la validación vía e-Surv; y la prueba cara a cara, cinco Agentes Sanitarios, considerando el Coeficiente de Validez de Contenido mínimo de 0,80.

Resultados:

la cartilla tuvo un Coeficiente de Validez de Contenido promedio de 0,97 en la validación del comité de jueces, y las imágenes obtuvieron el 96,67% de aprobación. En la prueba cara a cara, los Agentes Sanitarios consideraron que el material era claro y apropiado para la función.

Conclusiones:

la cartilla se diseñó y se validó en cuanto a su contenido y a su relevancia y los Agentes Sanitarios podrán usarla en acciones de educación sobre la diabetes.

Descriptores:
Estudios de Validación; Materiales para Enseñanza; Agentes Sanitarios; Diabetes Mellitus; Promoción de la Salud

Steps	Description of the steps
1^st Step: Bibliographic review	- Review on the main publications of the Ministry of Health and on the electronic databases LILACS and MEDLINE/Pubmed
2^nd Step: Development of the educational material	- The content of the booklet was elaborated based on the researched literature and on a validated instrument applied to the Community Health Workers of Belo Horizonte ⁽¹⁴14 Cordeiro EM. Validação de instrumento de avaliação do conhecimento dos agentes comunitários de saúde no acompanhamento às pessoas com diabetes (Diabetes-ACS). (Dissertação). Belo Horizonte: Instituto de Ensino em Pesquisa da Santa Casa BH; 2017. ⁾. - Illustrations and layout were created especially for the booklet by a graphic designer, who used the programs Corel Draw^®X8 and Illustrator Draw^®version 3.3.77.
3^rd Step: Calculation of Readability and Comprehensibility Scores	- Calculation of the Flesch Reading Ease Score, Flesch Kincaid and Coleman Liau Index.
4^th Step: Validation by the Committee of Judges	- Validation of the booklet by the Committee of Judges through the e-Surv Online Platform - Calculation of Content Validity Coefficient, considering a minimum value of 0.80
5^th Step: Discussion between experts on the subject (nurses and physicians)	- Meetings of experts to evaluate the suggestions of the judges and make the applicable modifications to the booklet
6^th Step: Validation of the booklet by the target audience	- Face-to-face testing with Community Health Workers
7^th Step: Final discussion between experts	- Meetings of experts to evaluate the suggestions of the Community Health Workers and make the applicable modifications to the booklet.

Item	Theme	CVC_i - Clarity	CVC_i - Relevance	Pej
Cover	----	1.00	1.00	0.00000000010
Page 6	Importance of the CHW	0.98	1.00	0.00000000010
Page 7	Function of the CHW	0.93	0.95	0.00000000010
Page 8	What is diabetes?	1.00	1.00	0.00000000010
Page 9	Risk factors for diabetes	0.90	1.00	0.00000000010
Page 10	Tests for diabetes	0.90	1.00	0.00000000010
Page 11	What is the capillary blood glucose test?	0.93	1.00	0.00000000010
Page 12	What is hyperglycemia?	0.90	1.00	0.00000000010
Page 13	What is hypoglycemia?	0.98	1.00	0.00000000010
Page 14	Insulin storage	0.83	0.95	0.00000000010
Page 15	Disposal of materials	0.93	0.95	0.00000000010
Page 16	Benefits of physical activity	0.98	1.00	0.00000000010
Page 17	Frequency of appointments	0.95	0.95	0.00000000010
Page 18	Vaccines for people with diabetes	0.98	1.00	0.00000000010
Page 19	Body parts affected by diabetes	0.98	1.00	0.00000000010
Page 20	How to prevent diabetes complications	0.95	1.00	0.00000000010
Page 21	Foot care	1.00	1,00	0.00000000010
Page 22	Important to know!	0.93	1.00	0.00000000010
Total CVC		0.94	0.99	---

Item	Judges suggestions	Suggestions accepted
Item	Judges suggestions	Yes	No
Cover	- Add images that correspond to diabetes on the cover.	X
Cover	- Remove the image of people and add images that "resemble" diabetes.	X
Page 6	- Replace the word "treatment" with "follow up".	X
Page 7	- Perform an active search for patients who did not attend appointments.		X
Page 7	- The pictures look great, but what about replacing "SUS" with "PSF" in the text of the last picture?		X
Page 8	- Replace the word "or" with "and/or".	X
Page 9	- Add "baby weighing more than 4 pounds at birth".	X
Page 9	- Remove "prediabetes".		X
Page 12	- Remove the image from the phrase "What is hyperglycemia?".	X
	- Replace "easily tired" with "fatigue".	X
	-Reformulate the phrases regarding hyperglycemia values for age groups.	X
Page 14	- Replace the phrase: "temperature between 15ºC and 30ºC or between 2ºC and 8ºC in the fridge" with the phrase: "temperature up to 30ºC or in the fridge".	X
	- Replace "closed insulin" with "unused insulin".	X
	- Add that, when transporting, ice should not be in direct contact with insulin.	X
	- Add that insulin should not be placed in the freezer.	X
Page 16	- Replace the image of children playing with people jogging.	X
Page 17	- Replace "diabetes foot examination" with "foot examination".	X
Page 22	- Replace the image of the person lying on the couch with an image of a person sitting watching television.	X

Item	Opinion	Modification
Page 13 What is hypoglycemia? It is glucose lower than 70 mg/dL.	"But is it under 70 for everyone?" (CHW4) "For adults and children, for everyone is it 70?" (CHW2)	What is hypoglycemia? It is glucose lower than 70 mg/dL for all ages.
General evaluation of the booklet	"We can understand it when we read." (CHW2) "I liked it a lot." (CHW5) "It is very good." (CHW1) "It is clear." (CHW5) "When can you release the booklet for us?" (CHW3) "Can you send it to us today?" (CHW4)	No modification
Which version is better: online or print?	"For everyday life I think the print version is better." (CHW2) "Yeah, if we had a tablet, it would be easier." (CHW1) "If the phone is good, you can also look at the PDF." (CHW5) "It would be a good option for them to buy the tablet so we can see the booklet, right." (CHW3)	No modification

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[1] Corresponding author: Tatiane Géa-Horta. Email: geahorta@yahoo.com.br