Instrumentos para evaluar la calidad de los servicios en enfermedades crónicas: revisión de alcance

Sousa, Gutembergue Santos de; Silva, Fabiane Verônica da; Longhi, Fabiana Gulin; Cortela, Denise da Costa Boamorte; Silva, Pãmela Rodrigues De Souza; Ferreira, Silvana Margarida Benevides

doi:10.1590/1518-8345.7168.4292

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Revista Latino-Americana de Enfermagem

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Artículo de Revisión • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7168.4292 copiar

Instrumentos para evaluar la calidad de los servicios en enfermedades crónicas: revisión de alcance^* * Artículo parte de la tesis de doctorado “Validação de instrumento para avaliação das ações de controle da hanseníase em crianças e adolescentes”, presentada en la Universidade Federal do Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brasil.

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Objetivo:

mapear la literatura científica sobre la validación de instrumentos para evaluar la calidad de los servicios prestados en la atención primaria de salud para enfermedades crónicas relacionadas con la hipertensión arterial sistémica, diabetes mellitus, lepra y tuberculosis.

Método:

revisión de alcance, siguiendo el método del Instituto Joanna Briggs y descrito de acuerdo con el Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Se incluyeron 13 bases de datos y literatura gris. La selección de los estudios se realizó previa eliminación de duplicados y evaluación individual y pareada. Los datos se extrajeron basándose en un guión elaborado y se presentaron en cuadros y tablas.

Resultados:

el análisis de 28 estudios seleccionados mostró que la mayoría era de Brasil, seguidos de China y Malasia. Casi la mitad de los instrumentos validados eran genéricos, y los específicos cubrían la evaluación de diabetes mellitus y lepra. Los tipos de validación realizados fueron de contenido y de constructo.

Conclusión:

existe la necesidad de construir instrumentos específicos debido a la escasez de estudios sobre el proceso de validación de instrumentos para evaluar la calidad de los servicios prestados por la atención primaria de salud para enfermedades crónicas.

Descriptores:
Estudio de Validación; Evaluación de Programas e Instrumentos de Investigación; Encuestas y Cuestionarios; Enfermedad Crónica; Investigación sobre Servicios de Salud; Métodos

Destacados:

(1) Instrumentos validados para la evaluación de servicios en enfermedades crónicas.

(2) Posibilidad de realizar nuevos estudios de adaptaciones del PCAT y PACIC.

(3) No se identificó evaluación para niños menores de 18 años con enfermedades crónicas.

(4) Uso de un instrumento genérico para evaluar enfermedades crónicas específicas.

Base de datos	Estrategia de búsqueda
PubMed	((“Health Personnel”[Mesh] OR “Health Personnel”) OR (“Health Manager”) OR (“Patients”[Mesh] OR Patients OR Patient)) AND ((“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND ((“Health Evaluation”) OR (“Quality of Health Care”[Mesh] OR “Quality of Health Care”))) AND (“Primary Health Care”[Mesh] OR “Primary Health Care” OR “Primary Healthcare” OR “Primary Care”)
CINAHL	(((MH “Health Personnel”) OR “Health Personnel”) OR ((MH “Patients”) OR (Patient OR Patients))) AND ((MH “Validation Studies”) OR (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”)) AND ((“Health Evaluation”) OR ((MH “Quality of Health Care”) OR “Quality of Health Care”)) AND ((MH “Primary Health Care”) OR “Primary Health Care”)
EMBASE	(‘health care personnel’/exp OR ‘health care personnel’ OR ‘patient’/exp OR patient) AND (‘validation study’/exp OR ‘validation study’) AND (‘health care quality’/exp OR ‘health care quality’ OR ‘health evaluation’) AND (‘primary health care’/exp OR ‘primary health care’)
Scopus	TITLE-ABS-KEY ((“Health Personnel” OR “Health Manager” OR Patient) AND (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND (Evaluation OR “Quality of Health”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care”))
Web of Science	(“Health Personnel” OR “Health Manager” OR Patient) AND (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND (Evaluation OR “Quality of Health”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care”)
PsycINFO	(“Health Personnel” OR “Health Manager” OR Patient) AND (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND (Evaluation OR “Quality of Health”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care”)
Infolep	(“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”)
Cochrane Library	(“Patients” OR “Health Personnel” OR “Health Manager”) AND (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND (“Quality of Health Care” OR Evaluation) AND (“Primary Health Care”) = in Title Abstract Keyword
CAPES Catálogo de Teses e Dissertações	Validação AND Avaliação AND “Atenção Primária à Saúde”
DART - EBSCO Open Dissertation	(“Health Personnel” OR “Health Manager” OR Patient) AND (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care”)
Networked Digital Library of Theses and Dissertations (NDLTD)	(“Health Personnel” OR “Health Manager” OR Patient) AND (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND (Evaluation OR “Quality of Health”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care”)
BDTD - Biblioteca Digital Brasileira de Teses e Dissertações - IBICT - Instituto Brasileiro de Informação em Ciência e Tecnologia	Validação AND Avaliação AND “Atenção Primária à Saúde”
ACS Guide to Scholarly Communication	(“Health Personnel” OR “Health Manager” OR Patient) AND (“Validation Study” OR “Validation Studies” OR “Validation Tool” OR “Validation Tools” OR “Validation Instruments” OR “Validation Instrument”) AND (“Primary Health Care” OR “Primary Healthcare” OR “Primary Care”)

Variables	n*	%^†
Tipo de revista de publicación
Nacional	06	21,4
Internacional	22	78,6
País de realización del estudio
Alemania	02	07,1
Brasil	07	25,0
China	03	10,7
Francia	02	07,1
Países Bajos	02	07,1
Malasia	03	10,7
Otros^‡	09	32,3
Enfermedad crónica evaluada por el instrumento de investigación
Instrumento genérico^§	13	46,4
Hipertensión	03	10,7
Diabetes	05	17,9
Lepra	05	17,9
Tuberculosis	02	07,1
Población estudiada
< de 18 años	00	00,0
> de 18 años	19	68,0
Profesionales de la salud	07	25,0
Gestores	02	07,0
Tipo de validación adoptada ^\|\|
Adaptación transcultural	14	50,0
Validación de contenido	19	67,9
Validación aparente	06	21,4
Validación semántica	18	64,3
Validación de constructo	23	82,1
Cálculo de la consistencia interna del instrumento
Sí	26	92,9
No	02	07,1
Cálculo de la confiabilidad del instrumento
Sí	13	46,4
No	15	53,6
Tipo de escala adoptada
Dicotómica	01	3,6
Likert de 3 puntos	01	3,6
Likert de 4 puntos	04	14,3
Likert de 5 puntos	16	57,1
Otros^¶	06	21,4
Instrumentos identificados
Adaptaciones del PACIC**	08	28,5
Adaptaciones del PCAT^††	08	28,5
Otros instrumentos diversos	12	43,0

Enfermedad crónica	Principales hallazgos
Diabetes	Instrumentos desarrollados originalmente20Wei X, Barnsley J, Zakus D, Cockerill R, Glazier R, Sun X. Assessing continuity of care in a community diabetes program: initial questionnaire development and validation. J Clin Epidemiol. 2008;61(9):925-31. https://doi.org/10.1016/j.jclinepi.2007.12.010 https://doi.org/10.1016/j.jclinepi.2007.... ^),(25Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes . 2015;13:64. https://doi.org/10.1186/s12955-015-0254-0 https://doi.org/10.1186/s12955-015-0254-... y adaptados transculturalmente19Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract. 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... ^),(30Maindal HT, Sokolowski I, Vedsted P. Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire. Eur J Public Health. 2012;22(1):31-6. https://doi.org/10.1093/eurpub/ckq188 https://doi.org/10.1093/eurpub/ckq188... ^),(37Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract . 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... .
	Presentó la continuidad del cuidado19Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract. 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... ^),(25Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes . 2015;13:64. https://doi.org/10.1186/s12955-015-0254-0 https://doi.org/10.1186/s12955-015-0254-... , la prevención y promoción de la salud20Wei X, Barnsley J, Zakus D, Cockerill R, Glazier R, Sun X. Assessing continuity of care in a community diabetes program: initial questionnaire development and validation. J Clin Epidemiol. 2008;61(9):925-31. https://doi.org/10.1016/j.jclinepi.2007.12.010 https://doi.org/10.1016/j.jclinepi.2007.... ^),(30Maindal HT, Sokolowski I, Vedsted P. Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire. Eur J Public Health. 2012;22(1):31-6. https://doi.org/10.1093/eurpub/ckq188 https://doi.org/10.1093/eurpub/ckq188... y el cuidado37Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract . 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... como fenómenos de interés.
	El público objetivo y los participantes del estudio fueron la población adulta25Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes . 2015;13:64. https://doi.org/10.1186/s12955-015-0254-0 https://doi.org/10.1186/s12955-015-0254-... , adulta mayor19Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract. 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... ^),(37Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract . 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... y profesionales de la salud20Wei X, Barnsley J, Zakus D, Cockerill R, Glazier R, Sun X. Assessing continuity of care in a community diabetes program: initial questionnaire development and validation. J Clin Epidemiol. 2008;61(9):925-31. https://doi.org/10.1016/j.jclinepi.2007.12.010 https://doi.org/10.1016/j.jclinepi.2007.... ^),(30Maindal HT, Sokolowski I, Vedsted P. Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire. Eur J Public Health. 2012;22(1):31-6. https://doi.org/10.1093/eurpub/ckq188 https://doi.org/10.1093/eurpub/ckq188... .
	Se utilizó la técnica de validación de constructo convergente/divergente20Wei X, Barnsley J, Zakus D, Cockerill R, Glazier R, Sun X. Assessing continuity of care in a community diabetes program: initial questionnaire development and validation. J Clin Epidemiol. 2008;61(9):925-31. https://doi.org/10.1016/j.jclinepi.2007.12.010 https://doi.org/10.1016/j.jclinepi.2007.... ^),(25Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes . 2015;13:64. https://doi.org/10.1186/s12955-015-0254-0 https://doi.org/10.1186/s12955-015-0254-... ^),(37Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract . 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... .
	Presentó alfa de Cronbach mayor a 0,819Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract. 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... ^),(25Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes . 2015;13:64. https://doi.org/10.1186/s12955-015-0254-0 https://doi.org/10.1186/s12955-015-0254-... ^),(30Maindal HT, Sokolowski I, Vedsted P. Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire. Eur J Public Health. 2012;22(1):31-6. https://doi.org/10.1093/eurpub/ckq188 https://doi.org/10.1093/eurpub/ckq188... ^),(37Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract . 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... .
	Los instrumentos presentaron propiedades psicométricas consideradas válidas, siendo adecuados para su uso en estudios científicos19Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract. 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... ^)-(20Wei X, Barnsley J, Zakus D, Cockerill R, Glazier R, Sun X. Assessing continuity of care in a community diabetes program: initial questionnaire development and validation. J Clin Epidemiol. 2008;61(9):925-31. https://doi.org/10.1016/j.jclinepi.2007.12.010 https://doi.org/10.1016/j.jclinepi.2007.... ^),(25Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes . 2015;13:64. https://doi.org/10.1186/s12955-015-0254-0 https://doi.org/10.1186/s12955-015-0254-... ^),(30Maindal HT, Sokolowski I, Vedsted P. Adaptation, data quality and confirmatory factor analysis of the Danish version of the PACIC questionnaire. Eur J Public Health. 2012;22(1):31-6. https://doi.org/10.1093/eurpub/ckq188 https://doi.org/10.1093/eurpub/ckq188... ^),(37Abdul-Razak S, Ramli AS, Badlishah-Sham SF, Haniff J; EMPOWER-PAR Investigators. Validity and reliability of the patient assessment on chronic illness care (PACIC) questionnaire: the Malay version. BMC Fam Pract . 2018;19(1):119. https://doi.org/10.1186/s12875-018-0807-5 https://doi.org/10.1186/s12875-018-0807-... .
Lepra	Los instrumentos fueron adaptados del instrumento original denominado Primary Care Assessment Tool42Villa TCS, Ruffino-Netto A. Performance assessment questionnaire regarding TB control for use in primary health care clinics in Brazil. J Bras Pneumol. 2009;35(6):610-2. https://doi.org/10.1590/S1806-37132009000600014 https://doi.org/10.1590/S1806-3713200900... ^)-(45Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Evaluation of the Primary Care in leprosy control: proposal of na instrument for users. Rev Esc Enferm USP. 2014;48(6):1054-61. https://doi.org/10.1590/S0080-623420140000700013 https://doi.org/10.1590/S0080-6234201400... .
	Los estudios fueron realizados en población adulta40Zeugfang D, Wisetborisut A, Angkurawaranon C, Aramrattana A, Wensing M, Szecsenyi J, et al. Translation and validation of the PACIC+ questionnaire: the Thai version. BMC Fam Pract . 2018. https://doi.org/10.1186/s12875-018-0801-y https://doi.org/10.1186/s12875-018-0801-... ^),(44Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Instrumento para avaliação das ações de controle da hanseníase na Atenção Primária. Rev Bras Enferm. 2014;67(3):339-46. https://doi.org/10.5935/0034-7167.20140044 https://doi.org/10.5935/0034-7167.201400... , con los Agentes Comunitarios de Salud43Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Validação do instrumento de avaliação do desempenho da atenção primária nas ações de controle da hanseníase (PCAT - hanseníase): versão profissionais. HU Rev. 2019;44(3):311-23. https://doi.org/10.34019/1982-8047.2018.v44.25618 https://doi.org/10.34019/1982-8047.2018.... , con profesionales de la salud42Villa TCS, Ruffino-Netto A. Performance assessment questionnaire regarding TB control for use in primary health care clinics in Brazil. J Bras Pneumol. 2009;35(6):610-2. https://doi.org/10.1590/S1806-37132009000600014 https://doi.org/10.1590/S1806-3713200900... y con gestores45Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Evaluation of the Primary Care in leprosy control: proposal of na instrument for users. Rev Esc Enferm USP. 2014;48(6):1054-61. https://doi.org/10.1590/S0080-623420140000700013 https://doi.org/10.1590/S0080-6234201400... .
	Se realizó validación semántica y evaluación de preguntas en cuanto a claridad, comprensión y adecuación de los ítems40Zeugfang D, Wisetborisut A, Angkurawaranon C, Aramrattana A, Wensing M, Szecsenyi J, et al. Translation and validation of the PACIC+ questionnaire: the Thai version. BMC Fam Pract . 2018. https://doi.org/10.1186/s12875-018-0801-y https://doi.org/10.1186/s12875-018-0801-... ^),(42Villa TCS, Ruffino-Netto A. Performance assessment questionnaire regarding TB control for use in primary health care clinics in Brazil. J Bras Pneumol. 2009;35(6):610-2. https://doi.org/10.1590/S1806-37132009000600014 https://doi.org/10.1590/S1806-3713200900... ^)-(45Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Evaluation of the Primary Care in leprosy control: proposal of na instrument for users. Rev Esc Enferm USP. 2014;48(6):1054-61. https://doi.org/10.1590/S0080-623420140000700013 https://doi.org/10.1590/S0080-6234201400... .
	Los instrumentos tuvieron su constructo evaluado mediante análisis factorial43Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Validação do instrumento de avaliação do desempenho da atenção primária nas ações de controle da hanseníase (PCAT - hanseníase): versão profissionais. HU Rev. 2019;44(3):311-23. https://doi.org/10.34019/1982-8047.2018.v44.25618 https://doi.org/10.34019/1982-8047.2018.... o la técnica de validación espejo con otro instrumento42Villa TCS, Ruffino-Netto A. Performance assessment questionnaire regarding TB control for use in primary health care clinics in Brazil. J Bras Pneumol. 2009;35(6):610-2. https://doi.org/10.1590/S1806-37132009000600014 https://doi.org/10.1590/S1806-3713200900... ^),(44Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Instrumento para avaliação das ações de controle da hanseníase na Atenção Primária. Rev Bras Enferm. 2014;67(3):339-46. https://doi.org/10.5935/0034-7167.20140044 https://doi.org/10.5935/0034-7167.201400... ^)-(45Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Evaluation of the Primary Care in leprosy control: proposal of na instrument for users. Rev Esc Enferm USP. 2014;48(6):1054-61. https://doi.org/10.1590/S0080-623420140000700013 https://doi.org/10.1590/S0080-6234201400... .
	La confiabilidad del instrumento se calculó mediante test/retest40Zeugfang D, Wisetborisut A, Angkurawaranon C, Aramrattana A, Wensing M, Szecsenyi J, et al. Translation and validation of the PACIC+ questionnaire: the Thai version. BMC Fam Pract . 2018. https://doi.org/10.1186/s12875-018-0801-y https://doi.org/10.1186/s12875-018-0801-... ^),(42Villa TCS, Ruffino-Netto A. Performance assessment questionnaire regarding TB control for use in primary health care clinics in Brazil. J Bras Pneumol. 2009;35(6):610-2. https://doi.org/10.1590/S1806-37132009000600014 https://doi.org/10.1590/S1806-3713200900... ^)-(45Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Evaluation of the Primary Care in leprosy control: proposal of na instrument for users. Rev Esc Enferm USP. 2014;48(6):1054-61. https://doi.org/10.1590/S0080-623420140000700013 https://doi.org/10.1590/S0080-6234201400... .
	Los instrumentos presentaron propiedades psicométricas consideradas válidas, siendo adecuados para su uso en estudios científicos40Zeugfang D, Wisetborisut A, Angkurawaranon C, Aramrattana A, Wensing M, Szecsenyi J, et al. Translation and validation of the PACIC+ questionnaire: the Thai version. BMC Fam Pract . 2018. https://doi.org/10.1186/s12875-018-0801-y https://doi.org/10.1186/s12875-018-0801-... ^),(42Villa TCS, Ruffino-Netto A. Performance assessment questionnaire regarding TB control for use in primary health care clinics in Brazil. J Bras Pneumol. 2009;35(6):610-2. https://doi.org/10.1590/S1806-37132009000600014 https://doi.org/10.1590/S1806-3713200900... ^)-(45Lanza FM, Vieira NF, Oliveira MMC, Lana FCF. Evaluation of the Primary Care in leprosy control: proposal of na instrument for users. Rev Esc Enferm USP. 2014;48(6):1054-61. https://doi.org/10.1590/S0080-623420140000700013 https://doi.org/10.1590/S0080-6234201400... .

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[1] Autor de correspondencia: Gutembergue Santos de Sousa E-mail: gutenf@yahoo.com.br https://orcid.org/0000-0003-3672-4388