Instrumentos para avaliação da qualidade de serviços em doenças crônicas: revisão de escopo

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:10.1590/1518-8345.7168.4294

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Brasil

Revista Latino-Americana de Enfermagem

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Brasil

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Sumário

Artigo de Revisão • Rev. Latino-Am. Enfermagem 32 • 2024 • https://doi.org/10.1590/1518-8345.7168.4294 copiar

Instrumentos para avaliação da qualidade de serviços em doenças crônicas: revisão de escopo^* * *Artigo extraído da tese de doutorado “Validação de instrumento para avaliação das ações de controle da hanseníase em crianças e adolescentes”, apresentada à Universidade Federal do Mato Grosso, Faculdade de Enfermagem, Cuiabá, MT, Brasil.

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo:

mapear a literatura científica sobre a validação de instrumentos para a avaliação da qualidade dos serviços prestados na atenção primária à saúde em doenças crônicas relacionadas com hipertensão arterial sistêmica, diabetes mellitus, hanseníase e tuberculose.

Método:

revisão de escopo, seguindo o método do Instituto Joanna Briggs e descrito de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews. Foram incluídas 13 bases de dados e literatura cinzenta. A seleção dos estudos foi realizada após a remoção de duplicatas e avaliação individual e em pares. Os dados foram extraídos com base em um roteiro elaborado e apresentados em forma de quadros e tabelas.

Resultados:

a análise de 28 estudos selecionados mostrou que a sua maioria era do Brasil, seguidos pela China e Malásia. Quase a metade dos instrumentos validados eram genéricos, e os específicos eram sobre avaliação em diabetes mellitus e hanseníase. Os tipos de validação realizados foram de conteúdo e de construto.

Conclusão:

há necessidade de construção de instrumentos específicos devido à escassez de estudos sobre o processo de validação de instrumentos para a avaliação da qualidade dos serviços prestados pela atenção primária à saúde em doenças crônicas.

Descritores:
Estudo de Validação; Avaliação de Programas e Instrumento de Pesquisa; Inquéritos e Questionários; Doença Crônica; Pesquisa sobre Serviços de Saúde; Método

Destaques:

(1) Instrumentos validados para a avaliação de serviços em doenças crônicas.

(2) Possibilidade de realização de novos estudos de adaptações do PCAT e PACIC.

(3) Não foi identificada avaliação para menores de 18 anos com doenças crônicas.

(4) Uso de um instrumento genérico para avaliar doenças crônicas específicas.

Base de dados	Estratégia de busca
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”)

Variáveis	n*	%^†
Tipo de revista de publicação
Nacional	06	21,4
Internacional	22	78,6
País de realização do estudo
Alemanha	02	07,1
Brasil	07	25,0
China	03	10,7
França	02	07,1
Holanda	02	07,1
Malásia	03	10,7
Outros^‡	09	32,3
Doença crônica avaliada pelo instrumento de pesquisa
Instrumento genérico^§	13	46,4
Hipertensão	03	10,7
Diabetes	05	17,9
Hanseníase	05	17,9
Tuberculose	02	07,1
População estudada
< de 18 anos	00	00,0
> de 18 anos	19	68,0
Profissionais de saúde	07	25,0
Gestores	02	07,0
Tipo de validação adotada ^\|\|
Adaptação transcultural	14	50,0
Validação de conteúdo	19	67,9
Validação de face	06	21,4
Validação semântica	18	64,3
Validação de construto	23	82,1
Cálculo da consistência interna do instrumento
Sim	26	92,9
Não	02	07,1
Cálculo da confiabilidade do instrumento
Sim	13	46,4
Não	15	53,6
Tipo de escala adotada
Dicotômica	01	3,6
Likert de 3 pontos	01	3,6
Likert de 4 pontos	04	14,3
Likert de 5 pontos	16	57,1
Outros^¶	06	21,4
Instrumentos identificados
Adaptações do PACIC**	08	28,5
Adaptações do PCAT^††	08	28,5
Outros instrumentos diversos	12	43,0

Doença crônica	Principais achados
Diabetes	Instrumentos desenvolvidos 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-... e 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-... .
	Apresentou a continuidade do 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-... , a prevenção e promoção da saúde20Wei 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... e o 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 fenômenos de interesse.
	Teve como público-alvo e participantes do estudo a população 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 e idosa19Abdul-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-... e profissionais de saúde20Wei 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... .
	Utilizou a técnica de validação de construto 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-... .
	Apresentou alfa de Cronbach superior 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-... .
	Os instrumentos apresentaram propriedades psicométricas consideradas válidas, estando aptos para serem utilizados em estudos 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-... .
Hanseníase	Os instrumentos foram adaptados do 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... .
	Os estudos foram realizados na população 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... , com Agentes Comunitários de Saúde43Lanza 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.... , com profissionais de saúde42Villa 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... e com 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... .
	Foram realizadas validação semântica e avaliação das questões quanto à clareza, compreensão e adequação dos itens40Zeugfang 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... .
	Os instrumentos tiveram o seu construto avaliado através da análise fatorial43Lanza 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.... ou da técnica de validação em espelho com outro 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... .
	Foi calculada a confiabilidade do instrumento através do teste/reteste40Zeugfang 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... .
	Os instrumentos apresentaram propriedades psicométricas consideradas válidas, estando aptos para serem utilizados em estudos 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 correspondente: Gutembergue Santos de Sousa E-mail: gutenf@yahoo.com.br https://orcid.org/0000-0003-3672-4388