An Instrument for Perceiving Ethical Problems in Primary Healthcare: Psychometric Parameters and Ethical Components

Abstract

Ethical issues in primary (health) care (PC) are common and are confronted daily. In the scarce literature that was available, Zoboli and Silva developed an instrument (IPE-APS) for perceiving ethical conflicts. Two empirical ex post facto studies to gather psychometric evidence for the instrument were outlined. In the first study, 88 nurses and physicians from Brazil's Family Health (Saúde da Família-SF) responded to the IPE-APS, and the results confirmed its validity and accuracy. In total, 14 items were grouped in Factor I (relationship/responsibility), which was described as having human rights and deontological nature (Cronbach's alpha = 0.92), and 11 items were grouped in Factor II, which was described as having a labor structure nature (Cronbach's alpha = 0.90). In the second study, 207 SF professionals in Goiânia, Goiás responded to the IPE-APS. The results showed that Factor I had a high factorial congruence index (0.98), which revealed high similarity and showed that the instrument displayed practical validity to identify and assess ethical problem perception in PC.

Adaptação do inventário de problemas éticos para o contexto da saúde da criança

“…The IPE-APS was applied in three Brazilian regions: in the Southeast, (13) Central-West (14) and Northeast, (15) and also in the city of Porto-Portugal. (9) In its original version, the instrument consists of 38 items, distributed in three dimensions of the construct ethical problems: (1) EP in the relations with users and family, containing 18 items, refers to issues that happen in the health professionals' daily relation with the USF users; (2) EP in the team's relationships, containing eight items, involves the demands in the interpersonal relationships of the USF team; (3) EP in the relations with the organization and the health system, involving aspects of SUS management, consisting of 12 items.…”

“…(10)(11)(12) After assessing the layout of the instrument used in the most recent study, (14) it could be observed that some changes were made in the original format. These changes were included in Pilot I to facilitate its completion.…”

“…(16) The application form (self-completion) was also maintained and the mean completion time was lower than in other studies that used the IPE-APS. (14,15) Nevertheless, the lack of studies and measures of CH problems in PHC made it difficult to discuss and compare the adaptation of the IPE-APS. This problem is not restricted to the child population though.…”

Dimensional Validity of the Inventory of Ethical Problems in Primary Health Care in the Context of Children's Health

“…There is still no consensus on appropriate instruments to measure EPs in health contexts and, particularly in PHC, the construction of these tools is hampered by the scarcity of publications on ethics and bioethics at this care level and when compared to the production of studies within the hospital setting [3][4]6 .…”

“…In Brazil, content validity, using the Delphi technique, was performed with 9 professionals who were experts in PHC 10 . The analysis of construct validity using Exploratory Factor Analysis (EFA) was performed in two studies 6,11 using varimax rotation and showed factorial loads above 0.32 and 0.52 for all the component items, with internal consistency values of 0.87 and 0.91. In Europe, a cross-cultural adaptation was carried out, with the translation of this instrument into Portuguese (from Portugal) and later application in 91 primary care physicians and nurses in the city of Porto, Portugal 12 .…”