Domestic violence on children: development and validation of an instrument to evaluate knowledge of health professionals1 1 Paper extrated from Master's Thesis "Conhecimento de profissionais de saúde sobre a violência doméstica contra a criança", presented to Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil.

Lanuza Borges Oliveira Fernanda Amaral Soares Marise Fagundes Silveira Lucinéia de Pinho Antônio Prates Caldeira Maísa Tavares de Souza Leite About the authors

ABSTRACT

Objective:

to develop and validate an instrument to evaluate the knowledge of health professionals about domestic violence on children.

Method:

this was a study conducted with 194 physicians, nurses and dentists. A literature review was performed for preparation of the items and identification of the dimensions. Apparent and content validation was performed using analysis of three experts and 27 professors of the pediatric health discipline. For construct validation, Cronbach's alpha was used, and the Kappa test was applied to verify reproducibility. The criterion validation was conducted using the Student's t-test.

Results:

the final instrument included 56 items; the Cronbach alpha was 0.734, the Kappa test showed a correlation greater than 0.6 for most items, and the Student t-test showed a statistically significant value to the level of 5% for the two selected variables: years of education and using the Family Health Strategy.

Conclusion:

the instrument is valid and can be used as a promising tool to develop or direct actions in public health and evaluate knowledge about domestic violence on children.

Descriptors:
Validation Studies; Child Health; Health Personnel; Domestic Violence; Child Abuse

RESUMO

Objetivo:

elaborar e validar um instrumento para avaliação do conhecimento dos profissionais de saúde sobre a violência doméstica contra a criança.

Método:

estudo realizado com 194 profissionais médicos, enfermeiros e cirurgiões dentistas. Para elaboração dos itens e identificação das dimensões, realizou-se a revisão da literatura. A validação aparente e de conteúdo foram realizadas por meio da análise de três especialistas e de 27 professores universitários da área de saúde da criança. Para a validação de construto, avaliou-se o coeficiente alfa de Cronbach, e o teste Kappa foi usado para verificar a reprodutibilidade. A validação de critério foi conduzida com uso do teste t-student.

Resultados:

o instrumento final apresentou 56 itens, o alfa Cronbach foi de 0,734, o teste Kappa revelou concordância superior a 0,6 para a maioria dos itens, e o teste t-student apresentou valor estatisticamente significante até o nível de 5% para as duas variáveis selecionadas, tempo de formação e tempo na Estratégia Saúde da Família.

Conclusão:

o instrumento apresentou-se válido e, deste modo , pode ser usado como ferramenta promissora para desenvolver ou direcionar as ações em saúde pública e avaliação do conhecimento sobre a violência doméstica contra a criança.

Descritores:
Estudos de Validação; Saúde da Criança; Pessoal de Saúde; Violência Doméstica; Maus-Tratos Infantis

RESUMEN

Objetivo:

elaborar y validar un instrumento para evaluación del conocimiento de los profesionales de la salud sobre la violencia doméstica ejercida contra el niño.

Método:

estudio realizado con 194 profesionales: médicos, enfermeros y cirujanos dentistas. Para elaboración de los ítems e identificación de las dimensiones, se realizó una revisión de la literatura. La validación aparente y de contenido fueron realizadas por medio del análisis de tres especialistas y de 27 profesores universitarios del área de la salud del niño. Para la validación de constructo, se evaluó el coeficiente alfa de Cronbach, y la prueba Kappa fue usada para verificar la reproductibilidad. La validación de criterio fue realizada con uso de la prueba t de Student.

Resultados:

el instrumento final presentó 56 ítems, el alfa Cronbach fue de 0,734, la prueba Kappa reveló concordancia superior a 0,6 para la mayoría de los ítems, y la prueba t de Student presentó valor estadísticamente significativo hasta el nivel de 5% para las dos variables seleccionadas: tiempo de graduación y tiempo en el programa Estrategia Salud de la Familia.

Conclusión:

el instrumento se presentó válido y, de ese modo, puede ser usado como herramienta promisora para desarrollar o dirigir acciones de salud pública y evaluar el conocimiento sobre la violencia doméstica contra el niño.

Descriptores:
Estudios de Validación; Salude del Niño; Violencia Doméstica; Personal de Salud; Maltrato a los Niños

Introduction

The concept of violence includes neglect, psychological violence and sexual abuse, in addition to physical abuse11. Magalhães MLC, Reis JTL, Furtado FM, Moreira AMP, Cardoso-Filho FNF, Carneiro PSMC, et al. O profissional de saúde e a violência na infância e adolescência. Femina. 2009;37(10):547-51.. Domestic violence is a multifactorial phenomenon, consisting of many variables that affect all societal levels and requires intervention from a multidisciplinary team to enable comprehensive care for the victim. It is also a particularly painful reality when it is perpetrated on children. In this case, domestic violence is one of life's events that can definitely change the child's behavior over the long term. The consequences for children can be immediate, medium and long term, and the feelings generated by pain resulting from such acts are most often repressed, forgotten, denied, but never disappear. Psychological trauma can develop, negatively affecting the personality over the entire life, or trigger hostile attitudes, distrust and fear22. Ramos MLC, Silva AL. Estudo sobre a violência doméstica contra a criança em unidades básicas de saúde do município de São Paulo - Brasil. Saúde Soc. 2011;20(1):136-46.-33. Marle HJCV. Violence in the family: an integrative approach to its control. Int J Offender Ther Comp Criminol. 2010;54(4):475-77..

National and international data on domestic violence on children show the relevance of the problem. Beginning in 2006, Brazil implemented the Violence and Accident Surveillance System - Vigilância de Violências e Acidentes (VIVA)44. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Viva: vigilância de violências e acidentes, 2006 e 2007. Brasília: Editora MS; 2009.460 p.. One study conducted with health professionals reported that 69.5% of them cared for cases of infant-juvenile violence: 60.0% asked for advice from another professional before notification, 54.0% talked with family members, and 42.9% reported the incident in the VIVA system55. Souza CS, Costa MCO, Carvalho RC, Araújo TM, Amaral MTR. Notificação da violência infanto-juvenil em Serviços de Emergência do Sistema Único de Saúde em Feira de Santana, Bahia, Brasil. Rev Bras Epidemiol. 2015;18(1):80-93..

The diagnosis of violence in childhood is difficult, as children tend to hide the real cause of the injuries either due to fear or love, since the aggressors are usually the parents or guardians. Thus, professionals who deal with this group, especially health care professionals, must be attentive to details that can confirm the diagnosis66. Garbin CAS, Garbin AJI, Moimaz SAS, Saliba O, Costa ACO, Guimarães APD, et al. Notificação de violência contra criança: conhecimento e comportamento dos profissionais de saúde. Rev Bras Pesqui Saúde. 2011;13(2):17-23.. Notification is not a personal act, but a legal one. Typically, health care professionals are the first to detect the violent situation and considering this fact, must immediately notify when it is observed. When the health professional does not recognize himself in this role, it becomes an impeding factor for referral and timely treatment of victims of domestic violence11. Magalhães MLC, Reis JTL, Furtado FM, Moreira AMP, Cardoso-Filho FNF, Carneiro PSMC, et al. O profissional de saúde e a violência na infância e adolescência. Femina. 2009;37(10):547-51.

2. Ramos MLC, Silva AL. Estudo sobre a violência doméstica contra a criança em unidades básicas de saúde do município de São Paulo - Brasil. Saúde Soc. 2011;20(1):136-46.

3. Marle HJCV. Violence in the family: an integrative approach to its control. Int J Offender Ther Comp Criminol. 2010;54(4):475-77.

4. Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Viva: vigilância de violências e acidentes, 2006 e 2007. Brasília: Editora MS; 2009.460 p.

5. Souza CS, Costa MCO, Carvalho RC, Araújo TM, Amaral MTR. Notificação da violência infanto-juvenil em Serviços de Emergência do Sistema Único de Saúde em Feira de Santana, Bahia, Brasil. Rev Bras Epidemiol. 2015;18(1):80-93.

6. Garbin CAS, Garbin AJI, Moimaz SAS, Saliba O, Costa ACO, Guimarães APD, et al. Notificação de violência contra criança: conhecimento e comportamento dos profissionais de saúde. Rev Bras Pesqui Saúde. 2011;13(2):17-23.
-77. Meireles AE, Nakamura E, Paula CS, Nascimento R, Bordin IA, Martin D. A visão dos profissionais de saúde em relação à violência doméstica contra crianças e adolescentes: um estudo qualitativo. Saúde Soc. 2011;20(1):147-55..

The expansion of primary care services that recently occurred in Brazil, by increasing the number of Family Health Strategy (FHS) teams, is an opportunity for greater surveillance of domestic violence. In theory, these teams should be able to deal with situations of violence, but little is known about the knowledge on this subject, or the ability of team members to approach the problem. Expanding the capacity to detect violent situations is necessary to allow the construction of social support networks and confrontation of these situations88. Tanaka OY, Ribeiro EL. Ações de saúde mental na atenção básica: caminho para ampliação da integralidade da atenção. Ciênc Saúde Coletiva. 2009;14(2):477-86..

Given the complexity of this problem, its approach cannot be competence a single area of or professional category. This complexity involves a multidisciplinary view and intersectoral action, as part of collective actions. Within the FHS framework, information can be produced and exchanged with those of other sectors. Thus, professionals must employ means such as social networking, reflecting on the vulnerable conditions of life, aiming to ensure rights, in the same way as developing potential actions against violence upon children99. Aragão AS, Ferriani MGC, Vendruscollo TS, Souza SL, Gomes R. Primary care nurses' approach to cases of violence against children. Rev. Latino-Am. Enfermagem. 2013;21(spe):172-9..

The knowledge of health professionals on this issue must be evaluated. However, effective tools to assess this knowledge are not available. Although tools for evaluation of the victims of psychological, physical and sexual violence are available, instruments aiming to evaluate health professionals were not found1010. Schraiber LB, Latorre MRDO, França JI, Segri NJ, D'Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saúde Pública. 2010;44(4):658-66.-1111. Grassi-Oliveira R, Stein LM, Pezzi JC. Tradução e validação de conteúdo da versão em português do Childhood Trauma Questionnaire. Rev Saúde Pública. 2010;44(4):249-55.. Further studies are necessary to verify the knowledge of professionals that guide public health policies, and to combat domestic violence in children. This study aimed to develop and validate an instrument that evaluates the knowledge of health professionals about domestic violence in children.

Method

The study consisted of the development and validation of an instrument for evaluating the knowledge about domestic violence in children. The process was conducted in four steps: 1) identification of the dimensions related to domestic violence in children; 2) apparent and content validation; 3) construct validation; and 4) criteria validation, as shown in Figure 1.

Figure 1
Flowchart development and validation steps of the instrument "Knowledge about domestic violence in children in the practice of healthcare professionals"

Step 1- Identification of the dimensions related to domestic violence on children

The identification of the instrument's items related to "Knowledge about domestic violence in children in the practice of healthcare professionals" was based on education materials/articles and on national and state guidelines on the theme1212. Secretaria de Estado da Saúde (MG). Atenção à Saúde da Criança. Belo Horizonte: SAS/DNAS; 2004. 224 p.-1313. Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Cadernos de Atenção Básica. Saúde da Criança: Crescimento e Desenvolvimento. Brasília: Editora MS; 2012. 273 p.. An integrative literature review was conducted using the descriptors child health, domestic violence, health personnel and family health. The search was conducted between March and May of 2013, in the Virtual Health Library; in the databases: Literatura Latino-Americana em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrieval System Online (MEDLINE) and Scientific Electronic Library Online (SciELO). The inclusion criteria for this study included articles in Spanish, English or Portuguese language, which analyzed the approach of healthcare professionals, regarding domestic violence on children, published from 2009 to 2013.

The dimensions established as important and relevant were identified, and the operational objectives were defined. The synthesis of the main contents resulted in 85 items, grouped in three dimensions: 31 items for the nature of violence dimension, 22 items for type of violence, and 32 items for professional conduct in relation to violence on children. The three dimensions considered in the study and their objectives are presented in Figure 2.

Figure 2
Objectives of the instrument dimensions, "Knowledge about domestic violence on children in the practice of healthcare professionals"

The main themes within each dimension were identified and transformed into short and objective statements, which constituted the items. Part of these was maintained as true statements, similar to the reference text; and the other part was transformed into false statements. After each statement, response options were organized in a Likert type scale of three levels: agree, disagree, and, I don't know.

Step 2- Apparent and content validation

The instrument was subjected to content and semantic structure analysis by three experts in the area: a physician with a doctorate in pediatrics and two nurses with a doctorate, experts in pediatric health, who evaluated the presence or absence of the comprehensiveness, objectivity and relevance criteria. The instrument was also administered to 27 professors of undergraduate and graduate programs in the health area that taught disciplines related to child health. After the analysis of experts and professors, the instrument was redesigned, according to directions and suggestions, and six items were excluded. Next, a pilot study was performed with six health professionals from a private health system the municipality, in order to verify the adequacy and clarity regarding the interpretation of the instrument.

Step 3- Construct validation

The preliminary version of the instrument, "Knowledge about domestic violence on children in the practice of health professionals" with 79 items, was administered to 194 professionals (physicians, nurses and dentists) registered at the FHS of Montes Claros, MG.

Those items correctly answered by more than 90% (very easy) and less than 10% (considered too difficult level) of the FHS professionals were excluded1414. Whati LH, Senejkal M, Steyn NP, Nel JH, Lombard C, Norris S. Development of a reliable and valid nutritional knowledge questionnaire for urban South African adolescents. Nutrition. 2005;21:76-85.. The correlation of each item with the mean score of the full questionnaire was performed, using the minimum cutoff point of 0.2 for the correlation coefficient between the total mean score and each item of the instrument, excluding those items with lower values1515. Steyn NP, Labaradios D, Nel JH, Heidi-Lee R. Development and validation of a questionnaire to test knowledge and practices of dietitians regarding dietary supplements. Nutrition. 2005;21:51-8.. After expert and researcher analysis, seven items considered important with respect to content were maintained. As the internal coherence decreased when dimensions classified the instrument, it was considered as a single scale; thus, the Chronbach α value was calculated for the full instrument with 56 items, reflecting a satisfactory level of internal consistency1616. Bland JM, Altman DG. Statistics notes: Cronbach's alpha. BMJ 1997;314:572.. After this analysis, the reproducibility of the questionnaire was evaluated by administering the redesigned version to 30 professionals among the 194, with an interval of two weeks. The Kappa test was applied to verify the correlation between the mean scores of the test-retest of the instrument items, and for the Kappa agreement test, the following parameters were used: small agreement <0.40; moderate agreement: 0.41-0.60; good agreement: 0.61-0.80; excellent agreement > 0.801717. Motta VT, Oliveira PF Filho. SPSS Análise de dados biomédicos. Rio de Janeiro: Medbook; 2009..

Step 4- Criteria validation

Initially, the scores were calculated using the sum of the values assigned in the Likert scale of the items included in the instrument by assigning the following values for statistical purposes: zero to answer "I don't know", +1 for a correct answer and -1 for a wrong answer. Using the formula of total amplitude, which is the difference between the highest and the lowest value from a data set (W = Xn-X 1), the transformation of the scores on a scale of 0 to 100 was performed. In this case, the highest value is represented by Xn, and X1 for the smallest value. For this instrument, the total amplitude would be equal to 112, because W=56-(-56). Thus, with the use of the formula Y=(X+56) x 100/112, the transformation of each score in centesimal scale was obtained, where X is the final score of each questionnaire, which can range from -56 to + 56; and Y is the final value of the scale from 0 to 1001818. Bussab WO, Moretin PA. Estatística Básica. 8 ed. São Paulo: Ed. Saraiva; 2013..

For classification of the level of knowledge, the scale of 0 to 100 was used, and the score of 70 or more points would be considered satisfactory, and scores of less than 70 points would be considered unsatisfactory.

The comparison of scores of items was performed among the subgroups that hypothetically should present different levels of knowledge, using the student t-test, with a significance level of 5%. These groups were defined based on " time since graduation" and "time working in the FHS". These variables were dichotomized considering the overall mean time at the FHS and time working, in order to verify the degree of effectiveness of the instrument in predicting specific performance of the subject1919. Pasquali L. Psicometria. Rev Esc Enferm USP. 2009;43(spe):992-9..

The data was analyzed using the SPSS IBM statistical software program, version 19. The study was conducted, conforming to the ethical principles for research involving human beings. The participation was voluntary, the informed consent form was signed, and the Research Ethics Committee of the Universidade Estadual de Montes Claros, protocol No. 401,241/2014, approved the design of the study.

Results

Among the professionals who participated in the validation process, a predominance of women (74.7%) was verified; nurses (42.8%), with less than five years since graduation (55.6%). The title that was most often identified was that of family health resident (37.6%). Most of them had one to five years working in the FHS (44.3%), and almost half (45.4%) had attended cases of domestic violence on children.

While developing the instrument, the summary of the issues identified in the literature resulted in 85 items. After analysis of the experts and professors, six items were excluded, and the remaining 79 were arranged at random, according to the numeric Likert scale of three levels, with the following options: agree, disagree, I don't know. For construct validation, after analyses by 194 professionals, 11 more items were excluded that were considered too easy or too hard, that is, as the agreement and errors by more than 90% of the professionals. Among that, 56 items remained, whose Cronbach's α analysis was 0.734, reflecting a satisfactory level of internal consistency.

Table 1 presents the result of the Kappa statistic in the reproducibility of the instrument. More than 80% of the items showed a moderate to very good agreement1212. Secretaria de Estado da Saúde (MG). Atenção à Saúde da Criança. Belo Horizonte: SAS/DNAS; 2004. 224 p..

Table 1
Kappa statistic for the reproducibility of the instrument. Montes Claros, MG, Brazil, 2014

The results of criteria validation, based on the time working in FHS and time since completing education are shown in Table 2. Both the criteria used showed a statistically significant association.

Table 2
Mean score of time in the FHS and time after educational degree of professionals. Montes Claros, MG, Brazil, 2014

Discussion

The development of a reliable and valid instrument occurred according to elements considered important. The instrument evaluates the knowledge about domestic violence on children in the practice of health professionals, considered important for implementation of actions that improve the care of the child victim of domestic violence, a reality in several family nuclei.

The first bibliographic survey showed the absence of an instrument that evaluates the knowledge about domestic violence of the health professionals. Schraiber et al., conducted a study with the objective of validating the instrument, World Health Organization Violence against Women (WHO VAW) on psychological, physical and sexual violence by intimate partners against women1010. Schraiber LB, Latorre MRDO, França JI, Segri NJ, D&apos;Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saúde Pública. 2010;44(4):658-66.. Authors translated, adapted and validated the content of the Childhood Trauma Questionnaire, which is administered to adolescents and adults, with the aim to investigate the history of abuse and neglect during childhood1111. Grassi-Oliveira R, Stein LM, Pezzi JC. Tradução e validação de conteúdo da versão em português do Childhood Trauma Questionnaire. Rev Saúde Pública. 2010;44(4):249-55..

The process of preparation followed the recommended methodological and statistical aspects2020. Schmidt DRC, Dantas RAS. Analysis of validity and reliability of the adapted portuguese version of Antonovsky's Sense of Coherence Questionnaire among nursing professionals. Rev. Latino-Am. Enfermagem. 2011;19(1):42-9.

21. Guedes ES, Sousa RMC, Turrini RNT, Baltar VT, Cruz DALM. Adaptation and validation of the instrument positions on the nursing process. Rev. Latino-Am. Enfermagem . 2013;21(1):404-11.
-2222. Gomes-Villas Boas LC, Lima MLSAP, Pace AE. Adherence to treatment for diabetes mellitus: validation of instruments for oral antidiabetics and insulin. Rev. Latino-Am. Enfermagem.2014;21(1):11-8., with satisfactory internal consistency and reliability in the final version. According the recommended aspects in the development of items, as performed in the study of Paschoal and Tamayo, the items were prepared based on the literature2323. Paschoal T, Tamayo A. Construção e validação da Escala de bem-estar no trabalho. Aval Psicol. 2008;7(1):11-22., to validate the content.

Semantic analysis was performed with a more sophisticated sample (higher skill) of the studied population, ensuring that the items in the instrument were intelligible to the lower stratum. Thus, the instrument was referred for an analysis of experts on the subject, suggesting addition or modification of items. This same process was conducted in the study of Stelkoo-Pereira and colleagues, whose goal was the validity and internal consistency of the School Violence Prevalence Investigation Questionnaire - student version, a situation similar to that which was found in the study of Hermida and Araújo that aimed for the development and validation of the nursing instrument2424. Stelko-Pereira AC, Williams LCA, Freitas LC. Validade e consistência interna do Questionário de Investigação de Prevalência de Violência Escolar: versão estudantes. Aval Psicol. 2010;9(3):403-11.-2525. Hermida PMV, Araujo IEMA. Elaboração e validação do instrumento de entrevista de enfermagem. Rev Bras Enferm. 2006;59:314-20..

In construct validation, the dimensions of the items of the instrument of this study, must be simultaneously evaluated, as the internal coherence decreases when they are individually analyzed, and the value of Cronbach's α indicates a positive association when a larger number of issues is associated. Similar results were obtained in the survey conducted by Pinho and collaborators2626. Pinho L, Moura PHT, Silveira MF, Botelho ACC, Caldeira AP. Development and validity of a questionnaire to test the knowledge of primary care personnel regarding nutrition in obese adolescents. BMC Fam Pract. 2013;14:102.. The criteria validity showed significance when the time since completion of education and the time working in the FHS, according to the knowledge, were analyzed, as the performance of the research subject and actual behavior are related.

In the studied context, the instrument developed has been shown to be important, since it can be used for verification of the knowledge of working professionals, and can be used by professors in undergraduate health courses, whose theme is present, as a learning tool.

Investment in education, providing the professional with tools for early identification of cases of violence on children is necessary2727. Gabatz RIB, Padoin SMM, Neves ET, Schwartz E, Lima JFL. A violência intrafamiliar contra a criança e o mito do amor materno: contribuições da enfermagem. Rev Enferm UFSM. 2013;3(esp):563-72.. The importance of the health care professional and members of the FHS teams being attentive for the detection of children who are victims of violent acts, showing discernment and responsibility for notification regarding cases, even if they are only suspicions, is also stressed2828. Zanelatto PF, Medeiros M, Santos WS, Munari DB. Violência contra crianças e adolescentes: significados e atitudes por equipes da estratégia saúde da família. Cienc Enferm. 2012;18(2):41-9..

Conclusion

The final version of the questionnaire showed a satisfactory internal consistency and good reliability and reproducibility, as shown in the Cronbach's alpha, Kappa test and student's t-test statistics.

The instrument on the evaluation of knowledge about domestic violence on children, in the practice of health professionals, was valid and still awakens the interest of the health care professional on the subject, which can be regarded as positive and encourages an approximation with the subject. Furthermore the instrument is simple, objective, relatively short and easy to understand and can be considered as a promising tool to develop or direct actions in public health and public policy of intervention with respect to domestic violence on children, and can be used by teachers as a learning tool. The instrument is available for use in further studies.

References

  • 1
    Magalhães MLC, Reis JTL, Furtado FM, Moreira AMP, Cardoso-Filho FNF, Carneiro PSMC, et al. O profissional de saúde e a violência na infância e adolescência. Femina. 2009;37(10):547-51.
  • 2
    Ramos MLC, Silva AL. Estudo sobre a violência doméstica contra a criança em unidades básicas de saúde do município de São Paulo - Brasil. Saúde Soc. 2011;20(1):136-46.
  • 3
    Marle HJCV. Violence in the family: an integrative approach to its control. Int J Offender Ther Comp Criminol. 2010;54(4):475-77.
  • 4
    Ministério da Saúde (BR). Secretaria de Vigilância em Saúde. Departamento de Análise de Situação de Saúde. Viva: vigilância de violências e acidentes, 2006 e 2007. Brasília: Editora MS; 2009.460 p.
  • 5
    Souza CS, Costa MCO, Carvalho RC, Araújo TM, Amaral MTR. Notificação da violência infanto-juvenil em Serviços de Emergência do Sistema Único de Saúde em Feira de Santana, Bahia, Brasil. Rev Bras Epidemiol. 2015;18(1):80-93.
  • 6
    Garbin CAS, Garbin AJI, Moimaz SAS, Saliba O, Costa ACO, Guimarães APD, et al. Notificação de violência contra criança: conhecimento e comportamento dos profissionais de saúde. Rev Bras Pesqui Saúde. 2011;13(2):17-23.
  • 7
    Meireles AE, Nakamura E, Paula CS, Nascimento R, Bordin IA, Martin D. A visão dos profissionais de saúde em relação à violência doméstica contra crianças e adolescentes: um estudo qualitativo. Saúde Soc. 2011;20(1):147-55.
  • 8
    Tanaka OY, Ribeiro EL. Ações de saúde mental na atenção básica: caminho para ampliação da integralidade da atenção. Ciênc Saúde Coletiva. 2009;14(2):477-86.
  • 9
    Aragão AS, Ferriani MGC, Vendruscollo TS, Souza SL, Gomes R. Primary care nurses&apos; approach to cases of violence against children. Rev. Latino-Am. Enfermagem. 2013;21(spe):172-9.
  • 10
    Schraiber LB, Latorre MRDO, França JI, Segri NJ, D&apos;Oliveira AFPL. Validade do instrumento WHO VAW STUDY para estimar violência de gênero contra a mulher. Rev Saúde Pública. 2010;44(4):658-66.
  • 11
    Grassi-Oliveira R, Stein LM, Pezzi JC. Tradução e validação de conteúdo da versão em português do Childhood Trauma Questionnaire. Rev Saúde Pública. 2010;44(4):249-55.
  • 12
    Secretaria de Estado da Saúde (MG). Atenção à Saúde da Criança. Belo Horizonte: SAS/DNAS; 2004. 224 p.
  • 13
    Ministério da Saúde (BR). Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Cadernos de Atenção Básica. Saúde da Criança: Crescimento e Desenvolvimento. Brasília: Editora MS; 2012. 273 p.
  • 14
    Whati LH, Senejkal M, Steyn NP, Nel JH, Lombard C, Norris S. Development of a reliable and valid nutritional knowledge questionnaire for urban South African adolescents. Nutrition. 2005;21:76-85.
  • 15
    Steyn NP, Labaradios D, Nel JH, Heidi-Lee R. Development and validation of a questionnaire to test knowledge and practices of dietitians regarding dietary supplements. Nutrition. 2005;21:51-8.
  • 16
    Bland JM, Altman DG. Statistics notes: Cronbach's alpha. BMJ 1997;314:572.
  • 17
    Motta VT, Oliveira PF Filho. SPSS Análise de dados biomédicos. Rio de Janeiro: Medbook; 2009.
  • 18
    Bussab WO, Moretin PA. Estatística Básica. 8 ed. São Paulo: Ed. Saraiva; 2013.
  • 19
    Pasquali L. Psicometria. Rev Esc Enferm USP. 2009;43(spe):992-9.
  • 20
    Schmidt DRC, Dantas RAS. Analysis of validity and reliability of the adapted portuguese version of Antonovsky's Sense of Coherence Questionnaire among nursing professionals. Rev. Latino-Am. Enfermagem. 2011;19(1):42-9.
  • 21
    Guedes ES, Sousa RMC, Turrini RNT, Baltar VT, Cruz DALM. Adaptation and validation of the instrument positions on the nursing process. Rev. Latino-Am. Enfermagem . 2013;21(1):404-11.
  • 22
    Gomes-Villas Boas LC, Lima MLSAP, Pace AE. Adherence to treatment for diabetes mellitus: validation of instruments for oral antidiabetics and insulin. Rev. Latino-Am. Enfermagem.2014;21(1):11-8.
  • 23
    Paschoal T, Tamayo A. Construção e validação da Escala de bem-estar no trabalho. Aval Psicol. 2008;7(1):11-22.
  • 24
    Stelko-Pereira AC, Williams LCA, Freitas LC. Validade e consistência interna do Questionário de Investigação de Prevalência de Violência Escolar: versão estudantes. Aval Psicol. 2010;9(3):403-11.
  • 25
    Hermida PMV, Araujo IEMA. Elaboração e validação do instrumento de entrevista de enfermagem. Rev Bras Enferm. 2006;59:314-20.
  • 26
    Pinho L, Moura PHT, Silveira MF, Botelho ACC, Caldeira AP. Development and validity of a questionnaire to test the knowledge of primary care personnel regarding nutrition in obese adolescents. BMC Fam Pract. 2013;14:102.
  • 27
    Gabatz RIB, Padoin SMM, Neves ET, Schwartz E, Lima JFL. A violência intrafamiliar contra a criança e o mito do amor materno: contribuições da enfermagem. Rev Enferm UFSM. 2013;3(esp):563-72.
  • 28
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  • 1
    Paper extrated from Master's Thesis "Conhecimento de profissionais de saúde sobre a violência doméstica contra a criança", presented to Universidade Estadual de Montes Claros, Montes Claros, MG, Brazil.

Publication Dates

  • Publication in this collection
    2016

History

  • Received
    20 Feb 2015
  • Accepted
    15 Mar 2016
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