Family vulnerability scale: Evidence of content and internal structure validity

Abstract

Introduction Territory view based on families’ vulnerability strata allows identifying different health needs that can guide healthcare at primary care scope. Despite the availability of tools designed to measure family vulnerability, there is still a need for substantial validity evidence, which limits the use of these tools in a country showing multiple socioeconomic and cultural realities, such as Brazil. The primary objective of this study is to develop and gather evidence on the validity of the Family Vulnerability Scale for Brazil, commonly referred to as EVFAM-BR (in Portuguese). Methods Items were generated through exploratory qualitative study carried out by 123 health care professionals. The data collected supported the creation of 92 initial items, which were then evaluated by a panel of multi-regional and multi-disciplinary experts (n = 73) to calculate the Content Validity Ratio (CVR). This evaluation process resulted in a refined version of the scale, consisting of 38 items. Next, the scale was applied to 1,255 individuals to test the internal-structure validity by using the Exploratory Factor Analysis (EFA). Dimensionality was evaluated using Robust Parallel Analysis, and the model underwent cross-validation to determine the final version of EVFAM-BR. Results This final version consists of 14 items that are categorized into four dimensions, accounting for an explained variance of 79.02%. All indicators were within adequate and satisfactory limits, without any cross-loading or Heywood Case issues. Reliability indices also reached adequate levels (α = 0.71; ω = 0.70; glb = 0.83 and ORION ranging from 0.80 to 0.93, between domains). The instrument scores underwent a normalization process, revealing three distinct vulnerability strata: low (0 to 4), moderate (5 to 6), and high (7 to 14). Conclusion The scale exhibited satisfactory validity evidence, demonstrating consistency, reliability, and robustness. It resulted in a concise instrument that effectively measures and distinguishes levels of family vulnerability within the primary care setting in Brazil.

Escala de Vulnerabilidade Familiar: evidências de validade na atenção primária à saúde

“…A prior study described the development of the EVFAM-BR 12 and presented evidence of its content validity and internal structure using an exploratory qualitative study with PHC health professionals. The 38-item scale version showed satisfactory evidence of content validity 12 and was applied to patients of 11 basic health units (UBS): one in the North region (Roraima), one in the Northeast region (Pernambuco), two in the Central West region (Mato Grosso), five in the Southeast region (São Paulo and Minas Gerais), and two in the South region (Paraná).…”

“…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), Tucker-Lewis index (TLI), root mean square error of approximation (RMSEA ≤ 0.08), and root mean square of residuals (RMSR ≤0.8). The model tested in the AFC was the factorial solution found in the initial study of the EFA 12 .…”

“…In PAS, a scale for stratifying family vulnerability has been developed and validated, so that it can be standardized nationwide in PHC 12 , in agreement with the organization process of population-based management. The Family Vulnerability Scale (EVFAM-BR) 12 has 14 items divided into four dimensions (income, health care, family, and violence), answered with yes or no by a family member.…”

“…In PAS, a scale for stratifying family vulnerability has been developed and validated, so that it can be standardized nationwide in PHC 12 , in agreement with the organization process of population-based management. The Family Vulnerability Scale (EVFAM-BR) 12 has 14 items divided into four dimensions (income, health care, family, and violence), answered with yes or no by a family member. Every positive answer to an item adds one point to the final score of the family vulnerability classification: low vulnerability (score of 0 to 4), moderate vulnerability (score of 5 to 6), and high vulnerability (score of 7 to 14).…”

“…A prior study 12 described the EVFAM-BR development and validity stages using exploratory factor analysis (EFA). However, for validity of an instrument with enough robust evidence to support its recommendation, additional evidence must be investigated.…”