Disabilities in leprosy: construction and validation of instrument on knowledge and attitude of professionals

Santana, Emanuelle Malzac Freire de; Brito, Karen Krystien Gonçalves de; Andrade, Smalyanna Sgren da Costa; Antas, Ester Missas Villaverde; Nóbrega, Matheus de Medeiros; Soares, Maria Júlia Guimarães Oliveira; Oliveira, Simone Helena dos Santos

doi:10.1590/0034-7167-2020-0862

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (05) • 2021 • https://doi.org/10.1590/0034-7167-2020-0862 copy

Disabilities in leprosy: construction and validation of instrument on knowledge and attitude of professionals

Discapacidades en la lepra: construcción y validación de un instrumento sobre el conocimiento y la actitud de los profesionales.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To develop and test the content validity of the “Knowledge and Attitudes on Assessing Degrees of Physical Disability in Leprosy” instrument.

Methods:

Methodological study carried out between January and May 2019 in three stages: item generation, analysis of aggregated redundancy to the composition, and content validation, using the Delphi technique.

Results:

In the first evaluation, a relevance of ≥ 0.80 stood out for all items, except for 2.8, which was excluded. To make the instrument clearer, the sequence was renumbered from one to 32; 2.6, 3.1, and 15 were reformulated, and the others underwent modifications, except for ten and 13. After the second evaluation, all items obtained Content Validity Index > 0.90 and Kappa = 1.00.

Conclusion:

The instrument has an excellent content validity; it is inferred that it is adequate to measure the knowledge and attitudes of professionals in the assessment of physical disabilities in leprosy.

Descriptors:
Knowledge; Attitude; Leprosy; Validation Study; Health Education

Variables	First Delphi Stage
Variables	Clarity	Relevance
Questions pertaining to knowledge	CVI^* * CVI = Content Validity Index	CVI^* * CVI = Content Validity Index
1. Are you familiar with or have you heard about the simplified neurological examination form? [ ] Yes [ ] No	0.69	1
2. Regarding the simplified neurological evaluation, please check disagree, don't know, or agree on the statements below:
2.1 It is used to assist in diagnosing leprosy. [ ] Disagree [ ] Don't know [ ] Agree	0.92	1
2.2 It makes it possible to monitor the treatment of neuritis. [ ] Disagree [ ] Don't know [ ] Agree	0.84	1
2.3 It allows to classify the degree of physical disability of the individual. [ ] Disagree [ ] Don't know [ ] Agree	0.92	1
2.4 It must be performed in the craniocaudal sequence. [ ] Disagree [ ] Don't know [ ] Agree	0.69	0.84
2.5 It is recommended every two months during treatment if the individual does not report complaints. [ ] Disagree [ ] Don't know [ ] Agree	0.69	1
2.6 The ballpoint pen can replace the Semmes-Weinstein monofilaments in the assessment of sensitivity in hands and feet. [ ] Disagree [ ] Don't know [ ] Agree	0.77	0.92
2.7 The eye sensitivity test can be performed without dental floss. [ ] Disagree [ ] Don't know [ ] Agree	0.77	0.92
2.8 Anhidrosis can be observed by finding "islets" in dry areas. [ ] Disagree [ ] Don't know [ ] Agree	0.69	0.69
2.9 Septum dryness, wound, and perforation are items evaluated in the nose. [ ] Disagree [ ] Don't know [ ] Agree	0.84	1
2.10 The median, ulnar, radial, tibial, and sciatic nerves should be investigated during the palpation stage. [ ] Disagree [ ] Don't know [ ] Agree	0.46	1
2.11 The eye closing strength should be verified during eye evaluation. [ ] Disagree [ ] Don't know [ ] Agree	0.61	1
2.12 Muscle strength can be graded from 0 to 5, where 0 corresponds to muscle contraction without movement; and 5, the ability to perform the complete movement against gravity, with resistance. [ ] Disagree [ ] Don't know [ ] Agree	0.46	1
3. Regarding the degree of physical disability, please indicate disagree, don't know, or agree on the statements below:
3.1 Indicates the loss of protective sensitivity and/or visible deformity as a result of neural injury and/or blindness. [ ] Disagree [ ] Don't know [ ] Agree	0.46	1
3.2 It should be performed only at the time of diagnosis and of discharge due to cure. [ ] Disagree [ ] Don't know [ ] Agree	0.92	1
3.3 When assessing body sites, the lowest degree of disability obtained on each side of the body should prevail. [ ] Disagree [ ] Don't know [ ] Agree	0.61	1
3.4 In the presence of nerve thickening, the individual must be classified as grade 0 of physical disability. [ ] Disagree [ ] Don't know [ ] Agree	0.76	1
3.5 At degree 0 of physical disability, the individual has preserved sensitivity to the 2g monofilament (lilac). [ ] Disagree [ ] Don't know [ ] Agree	0.84	1
3.6 In degree 1 of physical disability, signs of conditions such as lagophthalmos, ectropion, entropion and/or trichiasis are present in the eyes. [ ] Disagree [ ] Don't know [ ] Agree	0.84	1
3.7 Cases with decreased corneal sensitivity should be classified as grade 1 physical disability. [ ] Disagree [ ] Don't know [ ] Agree	0.92	1
3.8 Individuals who have a mobile claw-like hand must be classified as grade 2 of physical disability. [ ] Disagree [ ] Don't know [ ] Agree	0.92	1
4. J. K. F., 60 years old, male, arrived at the dermatology clinic of the hospital with ten hypochromic and infiltrated lesions, measuring between 10 and 15 cm. Upon a face inspection, he had no complaints in the nose area, but a decrease in corneal sensitivity was found in the right eye. Upon palpation of the nerve trunks, no abnormalities were observed. Upon examination of strength, a degree of normal strength was verified for the movements of the upper limbs (abduction of the fifth finger, abduction of the thumb and of the wrist extension); and decreased strength of the left lower limb movements (hallux extension and ankle dorsiflexion). Upon inspection of the hands and feet, a left plantar ulcer was observed. The sensitivity test presented the following monofilament color scheme:	0.46	1

Based on this information, what is this individual's degree of disability? [ ] degree 0 [ ] degree 1 [ ] degree 2
5. P. G. R., 20 years old, male, arrived at the hospital dermatology clinic presenting a high and totally anesthetic lesion. While evaluating his face, dryness in the nose and absence of ocular complaints was noted. During palpation of the nerve trunks, it was found that only the median nerve of the right upper limb was thickened and painful. Upon strength examination, a normal degree was found for all movements of the upper and lower limbs (abduction of the fifth finger, abduction of the thumb and wrist extension, hallux extension and ankle dorsiflexion). The sensitivity test presented the following monofilament color scheme:	0.46	1

Based on this information, what is this individual's degree of disability? [ ] degree 0 [ ] degree 1 [ ] degree 2
6. I. A. N., 28 years old, female, arrived at the hospital's dermatology clinic with a complaint of anhidrosis in the region of the nose, hands, and feet, confirmed during the inspection stage. During palpation of the nerve trunks, thickening of the median nerve of the right upper limb and tibial nerve of the right lower limb were observed. During strength examination, a normal degree of strength was verified for all movements (abduction of the fifth finger, abduction of the thumb and wrist extension, hallux extension, and ankle dorsiflexion). The sensitivity test presented the following monofilament color scheme:	0.53	1

Based on this information, what is this individual's degree of disability? [ ] degree 0 [ ] degree 1 [ ] degree 2
7. M. H. E., 45 years old, female, arrived at the hospital's dermatology clinic presenting three lesions with a hypochromic center and brownish edges measuring approximately 5 cm to 10 cm. In the physical examination of the face, there were no changes in the nose, however, there was a decrease in the strength of ocular closure. During palpation of the nerve trunks, pain and thickening were identified in the median nerve of the right upper limb; and tibial and fibular of the left lower limb. During strength examination, there was a decreased degree of strength for the left upper limb (abduction of the fifth finger, abduction of the thumb, and of the wrist extension) and decreased for the left lower limb (extension of the hallux and dorsiflexion of the ankle). The sensitivity test presented the following monofilament color scheme:	0.53	1

Based on this information, what is this individual's degree of disability? [ ] grau 0 [ ] grau 1 [ ] grau 2

Variables	Second Delphi Stage
Variables	Clarity	Relevance
Attitude related questions	CVI^* * CVI = Content Validity Index.	CVI^* * CVI = Content Validity Index.
8. Performing the simplified neurological evaluation and determining leprosy patients' degree of physical disability is part of my assignment. [ ] Agree [ ] Disagree [ ] I don't know/don't have an opinion	0.38	1
9. Performing a simplified neurological evaluation of patients with leprosy is important to support health care planning. [ ] Important [ ] Not Important [ ] I don't know/don't have an opinion	0.45	1
10. How do you assess your ability to carry out the leprosy patient's anamnesis through simplified neurological evalutation? [ ] I'm qualified [ ] I'm not qualified [ ] I don't know/don't have an opinion	0.92	1
11. How do you assess your ability to perform nerve palpation on a leprosy patient through simplified neurological evaluation? [ ] I'm qualified [ ] I'm not qualified [ ] I don't know/don't have an opinion	0.76	1
12. How do you assess your ability to assess leprosy patients' sensitivity through simplified neurological evaluation? [ ] I'm qualified [ ] I'm not qualified [ ] I don't know/don't have an opinion	0.84	1
13. How do you assess your ability to assess leprosy patients' muscle strength through simplified neurological evaluation? [ ] I'm qualified [ ] I'm not qualified [ ] I don't know/don't have an opinion	0.92	1
14. Performing the simplified neurological evaluation of patients with leprosy in the diagnosis, every three months, at discharge for cure and/or whenever there are complaints is: [ ] Adequate [ ] Inadequate [ ] I don't know/don't have an opinion	0.53	0.92
15. Failure to perform the simplified neurological evaluation, at least twice, causes disabilities/injuries to users with leprosy. [ ] Agree [ ] Disagree [ ] I don't know/don't have an opinion	0.38	0.84

Item	Assessed requirements that needed changing	Judges' suggestions
1	Clarity	Removing "have you heard" and replace it by "for leprosy provided by the Ministry of Health"
2.1-2.12	Clarity	Insert the term "Simplified Neurological Evaluation"
2.2	Clarity	Add "and perform the reaction diagnosis"
2.3	Clarity	Add at the end of the item "proposed by the World Health Organization"
2.4	Clarity	Replace "caudal" with "podal" and insert "head, upper and lower limbs"
2.6	Clarity	Rephrase the affirmation
2.7	Clarity	Add "no flavor"
2.11	Clarity	Modify "strength of closing the eyes" by "occlusion of the eyelids with and without force"
2.12	Clarity	Replace numerical degrees with nominal terms
3.1	Clarity	Rephrase the affirmation
3.2-3.8	Clarity	Insert the term "Degree of Disability proposed by the World Health Organization"
3.2	Clarity	Modify "accomplished" by "determined"
3.3	Clarity	Modify "sites" by "segments" and "prevail" for "being noted"
3.4	Clarity	Include "only"
3.5	Clarity	Replace "2 g (lilac)" with "0.05 g (green)"
3.6	Clarity	Replace "signs are present in the eyes" with "eyes may present signs"
3.7	Clarity	Include "at least"
3.8	Clarity	Add "in one or both hands"
4-7	Clarity	Review affirmations, add "patient", "diagnosed with leprosy", right and left sides in the images, the answer option "I don't know" and the phrase "the sensitivity test is shown in the figure below according to the color scheme of the monofilaments at each assessed point:"
8, 9, 14-15	Clarity	Replace "user" with "patient"
8	Clarity	Add "from the World Health Organization"
11	Clarity	Replace "nervous" with "peripheral nerves"
12	Clarity	Add "eyes, hands, and feet"
14	Clarity	Add "disease-related"
15	Clarity	Rephrase affirmation

Requirement	Construct	CVI Second Delphi stage	Kappa Index
Relevance	Knowledge	1.00	1.00
Clarity	Knowledge	0.97	1.00
Relevance	Attitudes	1.00	1.00
Clarity	Attitudes	1.00	1.00

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[1] Corresponding author: Emanuelle Malzac Freire de Santana E-mail: manumalzac@gmail.com