Construction and validation of an instrument for classifying nipple and areola complex lesions resulting from breastfeeding

Cervellini, Marina Possato; Coca, Kelly Pereira; Gamba, Mônica Antar; Marcacine, Karla Oliveira; Abrão, Ana Cristina Freitas de Vilhena

doi:10.1590/0034-7167-2021-0051

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 75 (1) • 2022 • https://doi.org/10.1590/0034-7167-2021-0051 copy

Construction and validation of an instrument for classifying nipple and areola complex lesions resulting from breastfeeding

Construcción y validación de un instrumento para la clasificación de las lesiones areolares del pezón derivadas de la lactancia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to construct and validate a classification of nipple and areola complex lesions resulting from breastfeeding, according to content and appearance.

Methods:

this is a methodological study, developed in four stages: operational definition, instrument construction, content and appearance validation. The Delphi technique and a Likert-type scale were used to validate content and appearance, through the participation of ten and sixteen judges, respectively. For analysis, Content Validity Index and Kappa Coefficient were applied.

Results:

Content Validity Index obtained an overall value of 0.93 and, for appearance, 0.94. Kappa values ranged between 0.46 and 1. The high rates of agreement among judges demonstrated the quality of the proposed content validity.

Conclusions:

the Nipple and Areola Complex Lesions Classification Instrument developed obtained acceptable values of its indexes, proving to be valid in terms of content and appearance.

Descriptors:
Breast Feeding; Wounds and Injuries; Nipples; Validation Study; Obstetric Nursing

Databases	Keywords or words
MEDLINE	1."nipples" [words] AND "sore" [words] 2."nipples" [words] AND "trauma" [words] 3."nipples" [words] AND "pain" [words]
PubMed Central	1."nipples/injuries" [mesh term] "nipples" [mesh term] AND "pain" [mesh term] 2."nipples" [mesh term] AND "sore" [words] 3."nipples/injuries" [mesh term] AND (evaluation OR classification OR signs AND symptoms [mesh term] OR treatment outcome [mesh term])
LILACS	1."mamilos" [words] AND "dor" [words] 2."mamilos" [words] AND "lesões" [words] 3."mamilos" [words] AND "trauma" [words]

Databases	Keywords or words
MEDLINE	1."estudos de validação" [type of publication] AND "lesões" [subject descriptor] AND "mamilos" [words] 2."reprodutibilidade dos testes" [subject descriptor] AND "feridas" [words] AND "mamilos" [words] "estudos de validação" [type of publication] AND "amamentação" [words] 3."estudos de validação como assunto" [subject descriptor] AND "lesões" [subject descriptor] AND "mamilos" [words]
PubMed Central	1."validation studies" [publication type] OR "validation studies as topic" [mesh term] AND "questionnaires" [words] AND "lesions" [words] AND "nipples" [words] 2."validation studies" [publication type] AND "lesions" [words] AND "nipples" [words]
LILACS	1."feridas" [words] AND "confiabilidade" [words] AND "mamilos" [words] 2."reprodutibilidade dos testes" [subject descriptor] AND "feridas" [words] AND "mamilos" [words]

First version	Content Validity Index			Kappa	Third version (after 2^nd round of answers)
First version	Clarity	Scope	Relevance	Kappa	Third version (after 2^nd round of answers)
D1. Nipple and areola complex injuries resulting from the practice of breastfeeding
1. Definition: changes in the nipple and areola complex skin, identified by (...)	0.90	0.90	0.90	1.00	1. Definition: changes in the nipple and areola complex characteristics skin during (...)
D2. Nipple and areola complex lesions without skin barrier disruption
2. Erythema: lesion with change in the natural skin color for (...)	1.00	1.00	1.00	1.00	2. Erythema: lesion characterized by the change from the natural skin color to red (...)
3. Ecchymosis or Blemish: lesion with change in the natural skin color to purplish or (...)	1.00	1.00	1.00	1.00	3. Ecchymosis: lesion characterized by the change from the natural skin color to purple (...)
4. Edema: lesion with modification of the skin's natural thickness due to fluid accumulation (...)	1.00	1.00	1.00	1.00	4. Edema: modification of the skin's natural thickness due to accumulation of fluid (plasma) in the dermis or (....)
5. Vesicle: lesion with modification of the skin's natural liquid content through the presence of a raised shape (...)	0.90	0.90	0.90	1.00	5. Vesicle: lesion with modification of the skin's natural liquid content, identified by the presence of a bulge (...)
D3. Nipple and areola complex lesions with skin barrier disruption
6. Fissure: lesion with loss of skin integrity, shape (...)	0.90	1.00	0.90	0.46	6. Fissure: linear and narrow shape continuity solution (...)
7. Erosion or Exulceration: circumscribed lesion with loss of skin integrity (...)	0.90	0.90	0.90	1.00	7. Erosion: solution of continuity of circumscribed or irregular shape, with loss of epidermis (...)
8. Crust: lesion formed in an area of tissue loss resulting from (...)	0.87	0.87	0.87	0.58	8. Crust: result of the drying of the serous, purulent exudate or (...)
Overall Content Validity Index	0.93	0.94	0.93
Global Content Validity Index	0.93

Nipple and Areola Complex Lesions Classification Instrument
Definition of nipple and areola complex lesions	Changes in the characteristics of the nipple and areola complex skin during breastfeeding, identified through changes in color, thickness, fluid content, or tissue loss.
Nipple and areola complex lesions without skin barrier disruption	Erythema	A lesion characterized by a change in the skin's natural color to red or pink in a particular nipple-areola area.
	Ecchymosis	A lesion characterized by a change in the skin's natural color to purple or brown in a particular nipple-areola area.
	Edema	Modification of the skin's natural thickness due to accumulation of fluid (plasma) in the dermis or hypodermis, with the presence of distension, shine and/or skin stiffness.
	Vesicle	A lesion with modification of the skin's natural liquid content, identified by the presence of a bulge filled with clear (serous) or white (milky) liquid, measuring up to 0.5 centimeters in diameter, located on the nipple surface.
Nipple and areola complex lesions with disruption of the skin barrier	Fissure	Linear and narrow continuity solution, which may present with bleeding or serous fluid of variable depth.
	Erosion	Continuity solution of circumscribed or irregular shape, with loss of epidermis or dermis, which may present with bleeding or serous fluid. When it occurs more superficially, it is called excoriation.
	Crust	Result of the drying of serous, purulent, or hematic exudate from a previously injured area. It can be light yellow, brown or dark red.

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[1] Corresponding author: Marina Possato Cervellini. E-mail: marina.cervellini@gmail.com