Creation and content validity of a scale for assessing adherence to good practices for COVID-19

Meneguin, Silmara; Pollo, Camila Fernandes; Garuzi, Miriane; Morais, José Fausto de; Reche, Mariana Cristina; Melchiades, Ediana Preisler; Coró, Cintia; Segalla, Amanda Vitória Zorzi

doi:10.1590/0034-7167-2021-0223

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (5) • 2022 • https://doi.org/10.1590/0034-7167-2021-0223 copy

Creation and content validity of a scale for assessing adherence to good practices for COVID-19

Construcción y validación de contenido de escala para evaluar adherencia a buenas prácticas para COVID-19

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

to create a scale for assessing the adherence of healthcare providers to good practices for COVID-19 in the hospital setting and determine its content and face validity.

Methods:

A methodological study was developed in three sequential phases: creation of items and domains based on a literature review and administration of the questionnaire to 16 nursing professionals; assessment of content and face validity by experts; and semantic analysis.

Results:

The 51-item scale was submitted to the evaluation of seven experts. Items with a content validity index ≥ 0.83 were maintained. During the semantic analysis performed by the administration of the scale to 37 healthcare providers, no suggestions for changes were made and the comprehension rate was 87%.

Conclusions:

the 47-item instrument with three dimensions (personal, organizational, and psychosocial) achieved satisfactory content and face validity, meeting the parameters established in the literature.

Descritptors:
Validation Study; Coronavirus Infection; Protocols; Nursing; Reproducibility

Items	1	2	3	4
Dimension: personal factors
1. I perform hand sanitizing with liquid soap and water [...]	1.00	1.00	1.00	1.00
5. I remove PPE and discard it as infectious waste [...]	1.00	1.00	1.00	1.00
8. I use some type of PPE (mask, gown, protective eyewear, etc.) [...]	0.86	0.86	0.86	1.00
9. I consider all materials contaminated that were [...]	1.00	1.00	0.86	1.00
14. I feel my energy drained at the end of the shift [...]	1.00	1.00	1.00	1.00
18. I change my facial mask whenever it [...]	1.00	1.00	1.00	1.00
20. I perform the positive and negative seal test [...]	1.00	0.86	1.00	1.00
24. I use an N95/PFF2 or equivalent respiratory protection mask in procedures with the risk of the generation of aerosols
28. I remove garments in the following order when still in the room/box [...]	1.00	1.00	1.00	1.00
36. I feel influenced by the opinions of my work colleagues	1.00	0.57	0.57	1.00
38. I do not use adornments (rings, bracelets, watch) when providing care [...]	1.00	1.00	1.00	1.00
43. I sanitize my hands five established times: before touching the patient, before performing a procedure, after risk of exposure [...]	1.00	1.00	1.00	1.00
46. I use standard precautions with all patients regardless [...]	1.00	0.86	0.86	1.00
49. I do not believe that I may become contaminated by the new coronavirus [...]	1.00	0.86	0.86	1.00
Dimension: Organizational factors
2. Before entering the room/box with precaution, adequate conditions [...]	1.00	1.00	1.00	1.00
4. I received orientations from the institution on how to use, remove [...]	1.00	1.00	1.00	1.00
7. My work schedule respects the break time established [...]	1.00	0.86	1.00	1.00
10. Stethoscopes, sphygmomanometer, thermometers, bedpans [...]	1.00	1.00	1.00	1.00
12. In rooms that do not have private bathrooms, the preference is [...]	0.86	0.86	0.86	1.00
13. The principles of the use of standard precautions for the control [...]	1.00	1.00	1.00	1.00
15. After death, orifices (oral, nasal and rectal) are plugged/blocked still in the unit to avoid [...]	1.00	1.00	1.00	1.00
17. For patients who are in isolation for the prevention of [...]	1.00	1.00	1.00	1.00
21. The institution provides surgical masks for symptomatic patients with cough, sneezing or other cold signs or symptoms at the entrances [...]	1.00	1.00	1.00	1.00
23. During invasive procedures in patients infected or suspected [...]	1.00	1.00	1.00	1.00
25. Suspected or confirmed cases of infection by COVID-19 are lodged in a private, well-ventilated (windows open) room [...]	1.00	0.86	1.00	1.00
27. For patients with COVID-19, all materials for invasive procedures are organized/prepared outside of the room or isolation area	1.00	0.86	1.00	1.00
29. I do not use PPE adequately due to the excessive daily workload [...]	0.86	0.86	1.00	1.00
30. For patients with COVID-19 on mechanical ventilation, the closed aspiration system is preferably used	1.00	1.00	1.00	1.00
31. When changing the bedding, I follow the orientation to handle it as little as possible to avoid the dispersion of particles	1.00	1.00	0.86	1.00
32. The institution provides gowns of different types depending on the clinical condition of the patient. [...]	1.00	0.86	1.00	1.00
34. Waste from care provided to patients with a suspicion of or confirmation of COVID-19 [...]	1.00	1.00	1.00	1.00
35. The institution provides private clothing for working exclusively in areas of patients with COVID-19	1.00	1.00	1.00	1.00
37. A minimum of one meter of distance is maintained between the beds of patients with a suspicion or confirmation of COVID-19 [...]	1.00	1.00	1.00	1.00
40. The institution provides training at the service for all professionals (in-house or outsourced) for the prevention [...]	1.00	1.00	1.00	1.00
41. When putting on garments to provide care for patients with COVID-19, I perform hand sanitizing, followed by the placement of a disposable gown [...]	1.00	1.00	1.00	1.00
44. Health professionals who provide care directly to patients with a suspicion or confirmation of infection by COVID-19 [...]	1.00	1.00	1.00	1.00
45. I make use of protective eyewear or a face shield to provide care for patients with a confirmation or suspicion of COVID-19	1.00	1.00	1.00	1.00
47. Upon removing the N95 or similar mask, it is discarded if I touch its inner surface	0.86	0.71	0.86	0.86
48. After providing care for patients with COVID-19, I remove garments in the following order upon leaving the room/box: I sanitize my hands [...]	1.00	1.00	1.00	1.00
Dimension: Psychosocial factors
3. I feel safe in the work environment in this pandemic situation	1.00	0.86	0.86	1.00
6. Stress negatively interferes with my professional performance [...]	1.00	0.86	1.00	1.00
11. I try to keep my thoughts positive during the entire shift [...]	1.00	1.00	1.00	1.00
16. Lately, I have felt fear regarding any possibility [...]	0.86	0.86	0.86	0.86
19. I am afraid to go back home and imagine that I could be transmitting [...]	1.00	1.00	1.00	1.00
22. The insecurity caused by the possibility of contamination [...]	1.00	0.86	1.00	1.00
26. I consider myself capable of getting through this pandemic [...]	1.00	1.00	1.00	1.00
33. I feel guilty when some undesired event outside of my control occurs on my shift, such as a death	0.86	0.86	0.86	0.86
39. I feel tense when providing care to patients with a suspicion [...]	1.00	0.86	1.00	1.00
42. I seek support and strength in God to continue providing [...]	0.86	0.86	0.86	0.86
Total	0.98	0.94	0.96	0.99

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Silmara Meneguin E-mail: s.meneguin@unesp.br

Initial item	1^st assessment	2^nd assessment
1. Performs hand sanitizing with bar soap and water (40-60 seconds) or 70% alcohol (20-30 seconds)	Performs hand sanitizing with liquid soap and water (40-60 seconds) or a 70% alcohol solution (20-30 seconds)	I perform hand sanitizing with liquid soap and water (40-60 seconds) or a 70% alcohol solution (20-30 seconds)
2. Before entering the isolation room, adequate conditions for hand washing or a dispenser with a 70% alcohol preparation, trashcan with a lid and opening without hand contact are always available	Before entering the room with precaution, adequate conditions for hand sanitizing and/or a dispenser with a 70% alcohol solution, trashcan with a lid and opening without hand contact are always available	Before entering the room/box with precaution, adequate conditions for hand sanitizing and/or a dispenser with a 70% alcohol solution, trashcan with a lid and opening without hand contact are always available
3.I feel safe in the work environment in this pandemic situation	I feel safe in the work environment in this pandemic situation	I feel safe in the work environment in this pandemic situation
4. All professionals receive institutional orientations on how to use, remove and discard PPE adequately	I receive orientations from the institution on how to use, remove and discard PPE adequately	I received orientations from the institution on how to use, remove and discard PPE adequately
5. PPE is NOT removed and discarded as infectious waste in an appropriate location following a procedure and before leaving the patient’s room or isolation area	I remove PPE and discard it as infectious waste in an appropriate location following a procedure and before leaving the patient’s room or isolation area	I remove PPE and discard it as infectious waste in an appropriate location following a procedure and before leaving the patient’s room/box or isolation area
6. Stress at work interferes with interpersonal relations in a negative way	Stress at work interferes with my professional performance in providing care to patients with a suspicion or confirmation of SAR-Cov2 in a negative way	Stress negatively interferes with my professional performance in providing care to patients with a suspicion or confirmation of COVID-19
7. My schedule respects the break time established between shifts so that I can get adequate rest	My work schedule respects the break time established between shifts so that I can get adequate rest	My work schedule respects the break time established between shifts so that I can have adequate rest
8. Uses some type of PPE regardless of suspicion or confirmation of patients with SARS-Cov-2	Uses some type of PPE (mask, gown, protective eyewear, etc.) regardless of suspicion or confirmation of patients with SARS-Cov-2	I use some type of PPE (mask, gown, protective eyewear, etc.) regardless of suspicion or confirmation of patients with COVID-19
9. Considers all materials that were in contact with patients contaminated even without a confirmation of the diagnosis of SARS-Cov-2	Considers all materials contaminated that were in contact with patients with or without a confirmation of the diagnosis of SARS-Cov-2	I consider all materials contaminated that were in contact with patients with or without a confirmation of the diagnosis of COVID-19
10. Stethoscopes, sphygmomanometer, thermometers, bedpans and urine pots are not the exclusive use of patients with a suspicion or confirmation of infection by SARS-Cov-2	Stethoscopes, sphygmomanometer, thermometers, bedpans and urine pots are the exclusive use of patients with a suspicion or confirmation of infection by SARS-Cov-2	Stethoscopes, sphygmomanometer, thermometers, bedpans and urine pots are the exclusive use of patients with a suspicion or confirmation of COVID-19
11. I try to keep my thoughts positive during the entire shift	I try to keep my thoughts positive during the entire shift to follow orientations with regards to the use of PPE	I try to keep my thoughts positive during the entire shift to follow orientations with regards to the correct use of PPE
12. In rooms that do not have private bathrooms, the preference is a sponge bath in bed even for patients who are conscious and can walk	In rooms that do not have private bathrooms, the preference is a sponge bath in bed or the use of a bathroom exclusively limited to patients with COVID-19	In rooms that do not have private bathrooms, the preference is a sponge bath in bed or the use of a bathroom exclusively limited to patients with COVID-19
13. The principles of standard precautions for infection control and precautions based on transmission continue being followed for the handling of the body even after death	The principles of the use of standard precautions for the control of infection and transmission for COVID-19 continue being followed for the handling of the body even after death	The principles of the use of standard precautions for the control of infection and transmission of COVID-19 continue being followed for the handling of the body even after death
14. I feel my energy drained at the end of the shift	I feel my energy drained at the end of the shift and this compromises the adequate use of PPE	I feel my energy drained at the end of the shift and this compromises the adequate use of PPE during the pandemic
15. After death, orifices (oral, nasal and rectal) are plugged/blocked still in the unit to avoid the leaking of bodily fluids when transporting the body	After death, orifices (oral, nasal and rectal) are plugged/blocked still in the unit to avoid the leaking of bodily fluids when transporting the body	After death, orifices (oral, nasal and rectal) are plugged/blocked still in the unit to avoid the leaking of bodily fluids when transporting the body to avoid the transmission of COVID-19
16. Lately, I have felt fear regarding any possibility of the risk of contagion	Lately, I have felt fear regarding any possibility of the risk of contagion by COVID-19	Lately, I have felt fear regarding any possibility of the risk of contamination by COVID-19
17. Diapers are offered to patients who are in isolation without a private bathroom even if they can walk	For patients who are in isolation for the prevention of the transmission of COVID-19 and who do not have a private bathroom, diapers are offered even to those who can walk	For patients who are in isolation for the prevention of the transmission of COVID-19 and whose room does not have a private bathroom, diapers are offered even to those who can walk
18. I change my mask whenever it is moist and dirty	I change my facial mask whenever it is moist, dirty or damaged	I change my facial mask whenever it is moist, dirty or damaged
19. I am afraid to go back home and imagine that I could be transmitting this disease to my family	I am afraid to go back home and imagine that I could be transmitting COVID-19 to my family	I am afraid to go back home and imagine that I could be transmitting the new coronavirus to my family
20. I perform the positive and negative seal test of the mask on my face and discard the mask immediately if the test is not successful	I perform the positive and negative seal test of the N95 or similar mask on my face and discard the mask immediately if the test is not successful	I perform the positive and negative seal test of the mask on my face and, when the test is not successful, I discard the mask immediately
21. The institution does not provide surgical masks for symptomatic patients (cough, sneezing, etc.) at the entrances of the healthcare services, waiting room, etc.	The institution provides surgical masks for symptomatic patients (cough, sneezing or other cold signs or symptoms) at the entrances of the healthcare services, waiting room, etc.	The institution provides surgical masks for symptomatic patients with cough, sneezing or other cold signs or symptoms at the entrances of the healthcare services, waiting room, etc.
22. My head is filled with worry about SARS-Cov-2	The insecurity caused by the possibility of contamination by COVID-19 interferes with my adherence to the use of PPE	The insecurity caused by the possibility of contamination by COVID-19 interferes with my adherence to the use of PPE
23. During invasive procedures in patients infected by SARS-Cov-2, the presence of a nursing assistant remaining outside the isolation area to fulfill the requests of the team is not necessary	During invasive procedures in patients infected by or suspected of having SARS-Cov-2, the presence of a nursing assistant remaining outside the isolation area to fulfill the requests of the team is necessary	During invasive procedures in patients infected or suspected of having COVID-19, the presence of a nursing assistant outside the isolation area to fulfill the requests of the team is necessary
24. I use an N95 or equivalent respiratory protection mask in procedures with the risk of the generation of aerosols	I use an N95/PFF2 or equivalent respiratory protection mask in procedures with the risk of the generation of aerosols	I use an N95/PFF2 or equivalent respiratory protection mask in procedures with the risk of the generation of aerosols
25. Suspected or confirmed cases of infection by SARS-Cov-2 are lodged in a private, well-ventilated (windows open) room with an exclusive bathroom and the door closed	Suspected or confirmed cases of infection by SARS-Cov-2 are lodged in a private, well-ventilated (windows open) room with an exclusive bathroom and the door closed	Suspected or confirmed cases of infection by COVID-19 are lodged in a private, well-ventilated (windows open) room with an exclusive bathroom and the door closed
26. I consider myself capable of getting through this pandemic situation without becoming contaminated in the work environment	I consider myself capable of getting through this pandemic situation without becoming contaminated in the work environment	I consider myself capable of getting through this pandemic situation without becoming contaminated in the work environment by my faith
27. All materials for invasive procedures are prepared outside of the isolation area	For patients with COVID-19, all materials for invasive procedures are organized outside of the isolation area	For patients with COVID-19, all materials for invasive procedures are organized/prepared outside of the room or isolation area
28. After leaving the room or isolation area, I remove garments in the following order: I sanitize my hands; I remove the gown; I remove the protective eyewear or facial protector; Next, I sanitize my hands again; I remove the mask and, lastly, I sanitize my hands	I remove garments in the following order when still in the room: I remove the gloves and gown and sanitize my hands	I remove garments in the following order when still in the room/box: I remove the gloves and gown and sanitize my hands
29. I do not use PPE adequately due to the excessive workload	I do not use PPE adequately due to the excessive daily workload during the pandemic	I do not use PPE adequately due to the excessive daily workload during the pandemic
30. For patients with SARS-CoV-2 on mechanical ventilation, only the closed aspiration system is performed	For patients with SARS-CoV-2 on mechanical ventilation, the closed aspiration system is preferably used	For patients with COVID-19 on mechanical ventilation, the closed aspiration system is preferably used
31.When changing the bedding, I follow the orientation to handle it as little as possible to avoid agitation	When changing the bedding, I follow the orientation to handle it as little as possible to avoid the dispersion of particles	When changing the bedding, I follow the orientation to handle it as little as possible to avoid the dispersion of particles
32. The service provides gowns of different types depending on the clinical condition of the patient. Ex: water-proof gown in cases of vomiting, diarrhea, orotracheal hypersecretion, bleeding, etc.	The institution provides gowns of different types depending on the clinical condition of the patient. Ex: water-proof gown in cases of vomiting, diarrhea, orotracheal hypersecretion, bleeding, etc.	The institution provides gowns of different types depending on the clinical condition of the patient. Ex: water-proof gown in cases of vomiting, diarrhea, orotracheal hypersecretion, bleeding, etc.
33. I feel guilty when some undesired event outside of my control occurs on my shift	I feel guilty when some undesired event outside of my control occurs on my shift, such as a death	I feel guilty when some undesired event outside of my control occurs on my shift, such as a death
34. Waste from care provided to patients with a suspicion of or confirmation of SARS-Cov-2 is placed in a red bag or, in the absence of a red bag, in milk white bags with the infectious material symbol	Waste from care provided to patients with a suspicion of or confirmation of SARS-Cov-2 is placed in a red bag or, in the absence of a red bag, in milk white bags with the infectious material symbol	Waste from care provided to patients with a suspicion of or confirmation of COVID-19 is placed in a red bag or, in the absence of a red bag, in milk white bags with the infectious material symbol
35. The institution does not provide private clothing for working in COVID areas	The institution provides private clothing for working exclusively in COVID areas	The institution provides private clothing for working exclusively in areas of patients with COVID-19
36. I do not feel influenced by the opinions of my work colleagues	I feel influenced by the opinions of my work colleagues	I feel influenced by the opinions of my work colleagues
37. A minimum of 1 meter of distance is maintained between the beds of patients with a suspicion or confirmation of SARS-Cov-2 when there is no possibility of their being isolated individually	A minimum of one meter of distance is maintained between the beds of patients with a suspicion or confirmation of SARS-Cov-2 when there is no possibility of their being isolated individually	A minimum of one meter of distance is maintained between the beds of patients with a suspicion or confirmation of COVID-19 when there is no possibility of their being isolated individually
38. During work, I do not use accessories (rings, bracelets, watch), as microorganisms accumulate under these objects, which are not removed by washing the hands	During work, I do not use adornments (rings, bracelets, watch), as microorganisms accumulate under these objects, which are not removed by sanitizing the hands	I do not use adornments (rings, bracelets, watch) when providing care for patients with a suspicion or confirmation of COVID-19
39. I feel tense in the workplace	I feel tense when providing care to patients with a suspicion or confirmation of COVID-19	I feel tense when providing care to patients with a suspicion or confirmation of COVID-19
40. The institution provides training for all professionals (in-house or outsourced) for the prevention of the transmission of SARS-CoV-2	The institution provides training at the service for all professionals (in-house or outsourced) for the prevention of the transmission of SARS-CoV-2A	The institution provides training at the service for all professionals (in-house or outsourced) for the prevention of the transmission of COVID-19
41. I place garments in the following order: washing of hands, placement of head cover, washing of hand, placement of gown, mask, protective eyewear or face shield and gloves	I place garments in the following order: I sanitize my hands; I put on a long-sleeve gown, mask, protective eyewear or face shield and gloves	When putting on garments to provide care for patients with COVID-19, I perform hand sanitizing, followed by the placement of a disposable gown, protective eyewear or face shield, N95 or similar mask, long-sleeve gown and procedure gloves
42. I seek support and strength in God	I seek support and strength in God to continue providing my care to patients with a suspicion or confirmation of COVID-19	I seek support and strength in God to continue providing my care to patients with a suspicion or confirmation of COVID-19
43. I sanitize my hands five established times: before touching the patient, before performing a procedure, after risk of exposure to fluids, after the procedure and after touching surfaces close to the patient	I sanitize my hands five established times: before touching the patient, before performing a procedure, after risk of exposure to fluids, after the procedure and after touching surfaces close to the patient	I sanitize my hands five established times: before touching the patient, before performing a procedure, after risk of exposure to fluids, after the procedure and after touching surfaces close to the patient
44. Health professionals who provide care directly to patients with a suspicion or confirmation of infection by SARS-Cov-2 are scheduled to work only in this area during their entire work shift and do not circulate in other areas that provide care	Health professionals who provide care directly to patients with a suspicion or confirmation of infection by SARS-Cov-2 are scheduled to work only in this area during their entire work shift and do not circulate in other areas that provide care	Health professionals who provide care directly to patients with a suspicion or confirmation of infection by COVID-19 are scheduled to work only in this area during their work shift and do not circulate in other areas that provide care
45. I use protective eyewear or a face shield to provide care even with no confirmation of the diagnosis	I make use of protective eyewear or a face shield to provide care for patients with a confirmation or suspicion of COVID-19	I make use of protective eyewear or a face shield to provide care for patients with a confirmation or suspicion of COVID-19
46. Uses standard precautions with all patients regardless of the confirmation of SARS-Cov-2	I use standard precautions with all patients regardless of the confirmation of SARS-Cov-2	I use standard precautions with all patients regardless of the confirmation of COVID-19
47. Upon removing the N95 or similar mask, it is discarded if I touch its inner surface	Upon removing the N95 or similar mask, it is discarded if I touch its inner surface	Upon removing the N95 or similar mask, it is discarded if I touch its inner surface
48. Item included after judges’ evaluation:	I remove garments in the following order upon leaving the room: I sanitize my hand, I remove the gown, eyewear or face shield; I sanitize my hands; I remove or maintain the N95 mask; and lastly, I sanitize my hands	After providing care for patients with COVID-19, I remove garments in the following order upon leaving the room/box: I sanitize my hand, I remove the gown, eyewear or face shield; I sanitize my hands; I remove the N95 mask; and lastly, I sanitize my hands
49. I do not believe that I may become contaminated by the new coronavirus in the workplace	I do not believe that I may become contaminated by the new coronavirus in the workplace	I do not believe that I may become contaminated by the new coronavirus in the workplace