Brazilian Scale for Evaluation of Mental Health Care Needs: Development and evidence of validity

Abstract

Background Mental health disorders represent the top leading causes of burden worldwide. At this context, initiatives to identify Care Needs in Mental Health (CNMH) are urgent, to assure integral and quality care. Nonetheless, there is a gap in valid tools to support primary healthcare (PHC) professionals’ decision-making to the provision of the proper mental health care, at the right place. The present study aimed to develop and search for evidences about the validity of the Brazilian Scale for Evaluation of Mental Health Care Needs (MHcare-BR). Methods Considering CNMH as the latent variable, a group of experts developed 130 dichotomous items, which were submitted to assessment by a heterogeneous panel of judges from different regions in Brazil (n = 73). Collected data subsidized the Content Validity Ratio (CVR) calculation, which resulted in a second version of the scale comprising 43 items. Subsequently, it was applied to 879 individuals to find evidences about the internal-structure validity by using the Exploratory Factor Analysis (EFA). Dimensionality was assessed through Robust Parallel Analysis and the model was tested through cross-validation to find MHcare-BR final version. Further, the MHcare-BR’s score was subjected to normalization. Results The final version of MHcare-BR comprised 31 items, which were divided in two blocks: “self-referred” block, with 5 dimensions (social relationships; functionality; autonomy; impulsiveness and aggressiveness”; and spirituality); and “health professional evaluation” block, comprising 3 dimensions (violence; self-aggression and suicidal behavior; and caregiving plan). Model explained variance reached 62.70%. Closeness of dimensionality values pointed out a multi-dimensional model (UNICO = 0.79; ECV = 0.0.69 and MIREAL = 0.22). All indicators were within adequate and satisfactory limits, without any cross-loading, Heywood Case or collinearity/multi-collinearity issues capable of pointing out items redundancy and overlapping. Reliability indices also reached adequate levels (α = 0.82; ω = 0.80; glb = 0.93 and ORION ranging from 0.79 to 0.95, between domains). MHcare-BR’s score normalization pointed towards four CNMH strata (Low CNMH: 0 to 1; Moderate CNMH: 2 to 3; High CNMH: 4 to 6; Very High CNMH: 7 or more). Conclusions The MHcare-BR scale is a synthesized instrument, comprising users’ self-evaluation and PHC professionals’ clinical assessment. It showed satisfactory validity evidences, which were consistent, reliable and robust; capable of accurately measuring CNMH in the primary care territory, in Brazil.

Escala de Avaliação da Necessidade de Cuidado em Saúde Mental: evidências adicionais

“…In short, both the CFA and network analysis results confirm a consistent and reliable model of the instrument, in accordance with the original model 9 obtained in the exploratory factor analysis.…”

“…The preliminary version of CuidaSM, consisting of 43 items (23 in a self-referred user block and 20 in a clinical assessment block carried out by a PHC professional), as described in a previous study 9 , was applied to users registered in 11 PHC services, totaling 27 family health teams. Collection took place between November 2021 and August 2022, and was conducted by a team of previously trained researchers.…”

“…The model adjustment indices adopted were: χ 2 /df; Non- Normed Fit Index (NNFI ≥ 0.95); Comparative Fit Index (CFI ≥ 0.95); Goodness Fit Index (GFI ≥ 0.95); Root Mean Square Error of Approximation (RMSEA < 0.08) and Root Mean Square of Residuals (RMSR ≥ 0.8). The model tested in the EFA was the factorial solution found in the initial study 9 of the exploratory factor analysis.…”

“…In this sense, the Brazilian Scale for Evaluation of Mental Health Care Needs (known as CuidaSM) 9 was developed, aligned with the concept of population-based management, to facilitate the recognition of specific needs for mental health care, configuring itself as a potential tool to collaborate with PHC teams in operationalizing the basic macro-process of stratification and, consequently, in the provision and organization of care.…”

“…A previous study demonstrated evidence of validity of CuidaSM, via exploratory factor analysis, thus, this instrument is composed of 31 dichotomous items, covering five dimensions in a self-referred block (Social Relationship, Functionality, Autonomy, Impulsiveness and Aggressiveness, Spirituality) and three dimensions in a block applied by a higher-level PHC professional (Violence, Self-aggression and Suicidal Behavior, Care Plan) 9 . From its application, it is possible to classify people who use PHC into four strata of mental health care needs (MHCN) (low, moderate, high, and very high) 9 . In this context, CuidaSM supports the process of stepped care based on objective data on MHCN.…”