Validation of logical models for the management of tuberculosis treatment

to describe the steps of validation of the logical models of the Directly Observed Treatment and the Information System of the Directly Observed Treatment Short-Course Strategy.

Methods:

methodological study carried out from February to June 2018, in two stages. The content of the items that make up the models was based on scientific evidence and submitted to the experts for content validation. The Content Validity Index was applied, accepting the value ≥ 0.80.

Results:

the agreement, regarding its validity, was satisfactory in the 79 items analyzed. The logical models were considered valid with a Global Validity Index of 0.91 for the Directly Observed Treatment and 0.87 for the Information System.

Conclusions:

the logical models were considered valid in terms of content, being a useful and timely instrument to support managers in decision-making.

Descriptors:
Validation Study; Tuberculosis; Health Management; Health Evaluation; Health Services

Structural component	Items analyzed Directly Observed Treatment	IVC
Input	Human Resources	1
	Standardization of conduct	0.87
	Physical structure	0.87
	Tuberculostatic drugs	1
	Information system*	1
	Computer	0.87
	Internet	1
	Printer	0.62
	Refrigerator	1
	Sputum pot	1
	Rapid HIV** test	1
	Electronic medical record	0.87
	Green Book	1
	Training of professionals in DOT***	0.87
Activities	Contacts evaluation	1
	Direct observation of medication taking	0.87
	Monthly consultations	1
	Conducting home visits	0.75
	Case notification at SINAN-RIO****	1
	Registration in the Green Book	0.87
	Proper record in the electronic medical record	0.87
	Follow-up bulletin update	0.75
	Conducting active search for missing persons	0.87
	Rapid HIV testing	1
	Rapid Test Request, BAAR *****, Culture,	1
	TS *****, chest X-ray and PPD ******	0.87
Product	No. of observations made during the attack and maintenance phase	1
	No. of consultations carried out	1
	% of home visits made per patient	0.75
	No. of cases notified at SINAN-RIO	1
	No. of cases recorded in the Green Book	0.87
	% of medical records with proper record	0.87
	% of notifications updated in the Green Book	0.75
	Number of absentees in the semester	0.62
	% of contacts evaluated	0.87
	% of patients being treated with result of HIV-RT	1
	% Rapid Test, BAAR, Culture, TS, chest radiography and PPD requested	0.75
	Improvement in the technical capacity of professionals for TB********* service	1
Immediate result	Improvement in the quality of information	1
	Reduced underreporting of TB cases	1
	Practices for diagnosis and treatment of the appropriate disease	0.87
	Reduction of treatment abandonment	1
Intermediate result	Increased adherence to treatment	1
	Increased cure rate	1
	Reduced incidence of tuberculosis	1
	Reduction of TB morbidity and mortality	1

Structural component	Items analyzed Information System	CVI
Input	Human resources	1
	Protocols	0.87
	Physical structure	0.87
	Greenbook	1
	Notification Sheets	0.87
	Computer	0.87
	Internet	1
	Printer	0.87
	TB cases follow-up bulletin	0.87
	Electronic medical record	0.87
Activities	Training of professionals in IS *	1
	Protocol for recording information	0.87
	Cleaning the SINAN database	0.62
	Registration of information in ISs *	1
	Updating and sending the follow-up bulletin	0.75
	Timely closure of the case in the Information Systems	0.87
	Monthly monitoring of records in ISs	0.87
	Periodic verification of data completeness at SINAN	0.87
	Analysis of variables 1 and 3 * of the electronic medical record	0.75
Product	No. of training courses	0.87
	Protocol for recording the information prepared	0.87
	% of qualified records	0.87
	% TB cases registered in ISs	0.87
	% notifications with updated information	0.87
	No. of cases closed timely	0.87
	Regularly monitored IS	0.87
	% of notification forms with records in all fields	0.87
	No. of new cases closed as a cure	0.62
	No. of patients computed in variable 3	0.75
Immediate result	Professionals aware of the importance of notification and proper registration of cases
Immediate result	Up-to-date and reliable information on the treatment and status of the disease	1
Intermediat eresult	Reduction of underreporting	1
Intermediat eresult	Improving the quality of filling out the notification form	1
Impact	Strengthening the actions of the Tuberculosis Control Program	1
Impact	Improvement in the analysis of the population's health situation and in the evaluation of the work developed in the PA*	1

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: Shirley Ribeiro dos Santos Linhares. E-mail: shirleyrslinhares@gmail.