Design and validation of an evaluation instrument on knowledge of schoolchildren about breastfeeding

Martins, Fernanda Demutti Pimpão; Pontes, Cleide Maria; Javorski, Marly; Gomes, Liliana Ferreira; Barros, Alessandra Carla Ricardo de; Leal, Luciana Pedrosa

doi:10.1590/1982-0194201700068

Acessibilidade / Reportar erro

Brasil

Acta Paulista de Enfermagem

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Acta Paul Enferm. 30 (5) • Sep-Oct 2017 • https://doi.org/10.1590/1982-0194201700068 copy

Design and validation of an evaluation instrument on knowledge of schoolchildren about breastfeeding

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To validate an evaluation instrument of knowledge of schoolchildren about breastfeeding.

Methods:

A method research developed in three stages: design of the instrument, validation of the content with 22 judges and validation of appearance with 10 schoolchildren from the primary school. Data were analyzed by absolute frequencies, standard-deviations, binomial test and content validity index - CVI. Observations of judges were analyzed and when necessary items of the instrument were changed.

Results:

In content validation, the first version of the instrument had 32 items and most of them were considered adequate by judges and the I-CVI achieved was equal or above than 0.80. After changes, the instrument was composed by 21 items. In validation of the appearance, most of items achieved I-CVI equal or above 0.80.

Conclusion:

The instrument content and appearance were validated. The instrument created and validated in this study could be used to evaluate knowledge of schoolchildren about breastfeeding.

Keywords
Breast feeding; Validation studies; School health; Education, primary and secondary

Item	Content and illustration	p-value^* * p-value;	p^ binomial test;	Clarity, understand and adequacy of language	p-value^* * p-value;	p^ binomial test;	Clarity^* ***** clarity - number of judges that judge the item such as very clear /quite clear; I-CVI - Item-Level Content Validity Index	Presence of instrument	p-value^* * p-value;	p^ binomial test;	I-CVI
1.	9(40.9%)	<0.001	0.409	22(100.0%)	1.000	1.000	19(86.4%)	21(95.4%)	0.972	0.954	1.00
2.	12(54.5%)	<0.001	0.545	20(90.9%)	0.863	0.909	17(77.3%)	22(100.0%)	1.000	1.000	0.95
3.	11(50.0%)	<0.001	0.500	21(95.4%)	0.972	0.954	19(86.4%)	22(100.0%)	1.000	1.000	1.00
4.	15(68.2%)	0.036	0.681	19(86.4%)	0.661	0.863	19(86.4%)	20(90.9%)	0.863	0.909	0.91
5.	19(86.4%)	0.661	0.863	20(90.9%)	0.863	0.909	20(90.9%)	22(100.0%)	1.000	1.000	1.00
6.	19(86.4%)	0.661	0.863	20(90.9%)	0.863	0.909	19(86.4%)	21(95.4%)	0.972	0.954	0.91
7.	16(72.7%)	0.099	0.727	19(86.4%)	0.661	0.863	18(81.8%)	20(90.9%)	0.863	0.909	0.91
8.	16(72.7%)	0.099	0.727	18(81.8%)	0.424	0.818	17(77.3%)	22(100.0%)	1.000	1.000	1.00
9.	19(86.4%)	0.661	0.863	17(77.3%)	0.226	0.772	17(77.3%)	21(95.4%)	0.972	0.954	0.95
10.	18(81.8%)	0.424	0.818	19(86.4%)	0.661	0.863	19(86.4%)	22(100.0%)	1.000	1.000	1.00
11.	20(90.9%)	0.863	0.909	22(100.0%)	1.000	1.000	22(100.0%)	21(95.4%)	0.972	0.954	0.95
12.	20(90.9%)	0.863	0.909	19(86.4%)	0.661	0.863	19(86.4%)	21(95.4%)	0.972	0.954	0.95
13.	20(90.9%)	0.863	0.909	21(95.4%)	0.972	0.954	20(90.9%)	21(95.4%)	0.972	0.954	0.95
14.	17(77.3%)	0.226	0.772	19(86.4%)	0.661	0.863	19(86.4%)	16(72.7%)	0.099	0.727	0.64
15.	18(81.8%)	0.424	0.818	21(95.4%)	0.972	0.954	19(86.4%)	20(90.9%)	0.863	0.909	0.86
16.	16(72.7%)	0.099	0.727	15(68.2%)	0.036	0.681	14(63.6%)	8(36.4%)	<0.001	0.363	0.36
17.	16(72.7%)	0.099	0.727	14(63.6%)	0.011	0.636	11(50.0%)	12(54.5%)	<0.001	0.545	0.50
18.	18(81.8%)	0.424	0.818	21(95.4%)	0.972	0.954	20(90.9%)	22(100.0%)	1.000	1.000	0.95
19.	19(86.4%)	0.661	0.863	16(72.7%)	0.099	0.727	14(63.6%)	17(77.3%)	0.226	0.772	0.77
20.	20(90.9%)	0.863	0.909	20(90.9%)	0.863	0.909	18(81.8%)	18(81.8%)	0.424	0.818	0.82
21.	20(90.9%)	0.863	0.909	21(95.4%)	0.972	0.954	21(95.4%)	18(81.8%)	0.424	0.818	0.73
22.	19(86.4%)	0.661	0.863	20(90.9%)	0.863	0.909	20(90.9%)	18(81.8%)	0.424	0.818	0.73
23.	16(72.7%)	0.099	0.727	16(72.7%)	0.099	0.727	14(63.6%)	8(36.4%)	<0.001	0.363	0.36
24.	16(72.7%)	0.099	0.727	16(72.7%)	0.099	0.727	15(68.2%)	10(45.4%)	<0.001	0.454	0.41
25.	14(63.6%)	0.011	0.636	16(72.7%)	0.099	0.727	15(68.2%)	9(40.9%)	<0.001	0.409	0.36
26.	19(86.4%)	0.661	0.863	22(100.0%)	1.000	1.000	21(95.4%)	22(100.0%)	1.000	1.000	0.95
27.	18(81.8%)	0.424	0.818	20(90.9%)	0.863	0.909	20(90.9%)	20(90.9%)	0.863	0.909	0.82
28.	17(77.3%)	0.226	0.772	20(90.9%)	0.863	0.909	19(86.4%)	17(77.3%)	0.226	0.772	0.73
29.	18(81.8%)	0.424	0.818	21(95.4%)	0.972	0.954	20(90.9%)	17(77.3%)	0.226	0.772	0.77
30.	19(86.4%)	0.661	0.863	20(90.9%)	0.863	0.909	20(90.9%)	21(95.4%)	0.972	0.954	0.95
31.	20(90.9%)	0.863	0.909	22(100.0%)	1.000	1.000	22(100.0%)	22(100.0%)	1.000	1.000	0.91
32.	19(86.4%)	0.661	0.863	22(100.0%)	1.000	1.000	21(95.4%)	22(100.0%)	1.000	1.000	1.00

Item	Commentaries/suggestions of judges	Change
1.	Replace “just after birth” to “within the first hour after birth”. Illustration: to improve correct position of the baby for breastfeeding; better representation of women in labor.	Yes. Yes.
2.	To focus on benefits for the baby. Suggestion: Breast milk helps the baby to grown strong and healthy since the first day after birth. Illustration: to show a woman breastfeeding; the picture needs to show a healthy baby; the stethoscope should be removed.	Yes. Yes.
3.	Suggestion: to breastfeeding is good for the mother because it protects her from diseases. Illustration: to shown a women breastfeeding, the happiness expression of the woman during breastfeeding should be improved, the stethoscope and the nurse's cap should be removed.	No. Yes.
4.	Replace “come back faster” to “recover faster”. Illustration: give more emphasis to the body of the women before and after delivery and her relationship with breastfeeding.	Yes. Yes.
5.	Remove the phrase “can” from the statement to sounds more positive. Illustration: to show a woman breastfeeding.	Yes. Yes.
6.	Include the prase “breast milk is ready to be used”. Use the word “free” instead of “cheaper”. Illustration: remove the image of the money, include the image of cow in the milk carton, the milk container should be enlarged and the image of the cow needs to be more visible.	Yes. Partially.
7.	Replace “nature” to “environment”. Illustration: remove symbol of waste recycle. Include the word “trash” in the waste can. Include images of bottle-feeding, pacifier, milk carton and milk container in the trash. Include the illustration on the background that resemble nature (green grass, trees, etc).	Yes. Yes.
8.	Include the phrase “breast milk is complete”. Include illustration of woman breastfeeding and beside her the image of three bottle-feeding with the label: water, juice, and tea.	Yes. Yes.
9.	Include the phrase “the baby who is breastfed has no specific time for feeding, he/she needs to be breastfed many times a day, even at night.” Illustration: Exclude the watch. Enlarge the illustration about day and night, the sun and the stars should be brighter.	Yes. Yes.
10.	Review the order of the item. Replace “can” to “must”. Illustration: Include the image older baby with more hair and wearing a t-shirt.	Yes. Yes.
11.	Replace “better” to “unique”.	Yes.
12.	The statement regarding discouragement of pacifier use should be softened. Illustration: Pacifier with sign of prohibited should be placed by the side of the baby not in the baby's face.	Yes. Yes.
13.	The statement regarding discouragement of bottle-feeding use should be softened. Illustration: Bottle-feeding should be placed by the side of the baby not in the baby's hand.	Yes. Yes.
14.	Information is similar to the one in item 5. Little relevant, the baby cries for many reasons and the mother's lap can calm down the child, but not necessarily only the mother. The exclusion of the item is suggested.	Excluded.
15.	Unnecessary item, because information is already in the item 06. The exclusion of the item is suggested.	Excluded.
16.	Unnecessary item. The issue related with bottle-feeding is included in item 13. Current wording can lead to error. The exclusion of the item is suggested.	Excluded.
17.	Unnecessary item. The child can still have a concerning related with body. Current wording can lead to error. The exclusion of the item is suggested.	Excluded.
18.	Item is quite general. Public space should be defined, for example, a square. Illustration: Include two images (all with seated woman breastfeeding a baby), one at home, other in a bench in the street/square.	Yes. Yes.
19.	The item should be reviewed. He could be not happy, but should help her partner during breastfeeding. It is important to highlight the support from the father given to the mother. Illustration: happiness expression of the father needs improvement.	Yes. Yes.
20.	Replace “to clean the house” to “house duties”. Illustration: The happiness of the father should be more emphasized. The image should be improved and it should give the idea of floor sweeping.	Yes. Yes.
21.	The item does not make evident the knowledge, but the opinion, which is not relevant to the study. Participation of grandparents is also not clear. Illustration: All members of family seated on the sofa, grandparents should be smiling (happy).	Partially. Merged with item 22. Yes.
22.	The item is irrelevant. This item should be revised along with item 21. In general, the mother and mother-in-law of the lactating woman are those who help. The instrument is too long. No more than 20 questions should be include. The exclusion of the item is suggested.	Excluded.
23.	The item is irrelevant. Text is negative and not pedagogical. The content about pacifier is already approach in item 12. The exclusion of the item is suggested.	Excluded.
24.	The item is irrelevant. Text is negative and not pedagogical. The content about the artificial milk and bottle-feeding was previous approached. The exclusion of the item is suggested.	Excluded.
25.	The item is irrelevant. Text is negative and not pedagogical. The content about provide water, juice or tea for the baby is already approach in item 8. The exclusion of the item is suggested.	Excluded.
26.	Commentary: the item should be kept if the help of grandparents to breastfeeding woman is not showed as an obligation. Illustration should contain grandmother helps the woman to breastfed, and the grandfather should be on other side, observing the scene.	No. Yes.
27.	Irrelevant item. Depending on age and understanding degree of children the item should not be considered relevant.	No.
28.	It is difficult to know the degree of understanding/maturity of children for the activity, and it can sound as an imposition. The exclusion of the item is suggested.	Excluded.
29.	It is difficult to know the degree of understanding/maturity of children for the activity, and it can sound as an imposition. The exclusion of the item is suggested.	Excluded.
30.	Suggestion to replace “happy with breastfeeding” to “support breastfeeding”. Illustration: Happiness expression of all characters should be improved. Include an image of a girl along with a boy.	No. Yes.
31.	Item 32 already includes the role of the nurse. Replace the word “nurse” to “health professional”. The maintenance of one of the two items is suggested (31 or 32). Illustration: Remove the nurse’ cap. The drawing of the coat should be improved. The coat should be buttoned.	Partially. Merged with item 32. Yes.
32.	The item 31 already includes the role of nurse. Replace the word “nurse” to “health professional”. The exclusion of the item is suggested.	Excluded.

Item	Understanding of illustration		Understanding of the phase		Need of changing in illustration and/or phrase		I - CVI
Item	Yes	No	Yes	No	Yes	No	I - CVI
1.	10	0	9	1	0	10	0.90
2.	10	0	10	0	0	10	1.00
3.	9	1	9	1	0	10	0.70
4.	9	1	9	1	0	10	0.70
5.	10	0	10	0	1	9	0.90
6.	10	0	10	0	1	9	1.00
7.	10	0	10	0	0	10	1.00
8.	10	0	10	0	0	10	1.00
9.	9	1	10	0	0	10	0.90
10.	10	0	10	0	1	9	0.90
11.	10	0	10	0	0	10	1.00
12.	10	0	10	0	0	10	1.00
13.	10	0	10	0	0	10	1.00
14.	10	0	10	0	1	9	0.90
15.	10	0	10	0	1	9	1.00
16.	10	0	10	0	0	10	1.00
17.	10	0	10	0	0	10	1.00
18.	10	0	10	0	0	10	1.00
19.	10	0	10	0	0	10	0.90
20.	10	0	10	0	0	10	1.00
21.	10	0	10	0	0	10	1.00

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Corresponding author Cleide Maria Pontes, Av. Prof. Moraes Rego, 1235, 50670-420, Recife, PE, Brazil. cmpontes18@gmail.com