Revista Adolescência e Saúde

Revista Oficial do Núcleo de Estudos da Saúde do Adolescente / UERJ

NESA Publicação oficial
ISSN: 2177-5281 (Online)

Vol. 15 nº 2 - Apr/Jun - 2018

Original Article Imprimir 

Páginas 92 a 101

Construction and validation of instrument to subsidize the primary health care of adolescent

Construcción y validación de instrumentos para subsidiar el cuidado al adolescente en la Atención Primaria de Salud

Construção e validação de instrumento para subsidiar o cuidado ao adolescente na Atenção Primária à Saúde

Autores: José Jeová Mourão Netto1; Maria Socorro de Araújo Dias2; Maria de Fátima Antero Sousa Machado3; Fabiane do Amaral Gubert4; Maristela Inês Osawa Vasconcelos5; Mariza Silva de Oliveira6; Natália Frota Goyanna7

1. Doctoral fellow in Clinical Care of Nursing and Health by the Ceará State University (UECE). Nurse at the North Regional Hospital. Sobral, CE, Brazil
2. Post-Doutorate in Clinical Care in Nursing and Health by the Ceará State University (UECE). Doctor in Nursing by the Ceará Federal University (UFC). Teacher of Professional Master's in Family Health and Associated Professor of the Nursing Course at Vale do Acaraú State University (UVA). Sobral, CE, Brazil
3. Post-Doctoral fellow in Education at Ceará State University (UECE). Doctor in Nursing by the Ceará Federal University (UFC). Assistant Professor of the Cariri Regional University (URCA). Juazeiro do Norte, CE, Brazil
4. Doctorado in Nursing by the Ceará Federal University (UFC). Assistant Professor of the Nursing Course at Ceará Federal University. Fortaleza, CE, Brazil
5. Post-Doctorate in Clinical Care in Nursing and Health by the Ceará Federal University (UECE). Master and Doctorate in Nursing by the Ceará Federal University (UFC), Coordinator of the Professional Master's Degree in Family Health at Vale do Acaraú State University (UVA). Sobral, CE, Brazil
6. Doctor in Nursing by the Ceará Federal University (UFC). Municipal Server – Basic Attention - Municipal Health Department of Fortaleza. Fortaleza, CE, Brazil
7. Master in Family Health by the Ceará Federal University (UFC). Coordenator of the Four Leaf Clover Strategy - Municipal Health Secretary of Sobral. Sobral, CE, Brazil

José Jeová Mourão Netto
Av. Margarida Moura, n° 1.114, casa, Bairro Jerônimo de Medeiros Prado
Sobral, CE, Brasil. CEP: 62044-240

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How to cite this article

Keywords: Adolescent, comprehensive health care, primary health care, Family Health Strategy, protocols.
Palabra Clave: Adolescente, asistencia integral a la salud, atención primaria a la salud, Estrategia Salud de la Familia, protocolos.
Descritores: Adolescente, assistência integral à saúde, atenção primária à saúde, Estratégia Saúde da Família, protocolos.

OBJECTIVE: Construct and validate an instrument to subsidize Primary Health Care of adolescents.
METHODS: Methodological study involving 47 participants among adolescents, parents of adolescents, teachers and health professionals. The validation process involved 10 judges and the calculation of the Content Validation Index.
RESULTS: The judges evaluated the instrument in its totality, analyzing its comprehensiveness, pertinence, presentation, clarity, readability and interpretation, objectivity, simplicity and items organization. The final instrument had 61 items.
CONCLUSION: The document obtained satisfactory validation and resulted in an instrument that can subsidize a better attention to the adolescent in the context of Primary Health Care.

OBJETIVO: Construir y validar un instrumento para subsidiar el cuidado al adolescente en la Atención Primaria de la Salud.
MÉTODOS: Estudio metodológico que involucra a 47 participantes entre adolescentes, padres de adolescentes, profesores y profesionales de la salud. El proceso de validación involucró a 10 jueces y el cálculo del índice de validación de contenido.
RESULTADOS: Los jueces evaluaron el instrumento en su totalidad, analizando su alcance, pertinencia, presentación, claridad, facilidad en la lectura e interpretación, objetividad, simplicidad y organización de los ítems. El instrumento final contó con 61 ítems.
CONCLUSIÓN: El documento obtuvo validación satisfactoria y resultó en un instrumento que puede subsidiar una mejor atención al adolescente en el contexto de la Atención Primaria a la Salud.

OBJETIVO: Construir e validar um instrumento para subsidiar o cuidado ao adolescente na Atenção Primária à Saúde.
MÉTODOS: Estudo metodológico envolvendo 47 participantes entre adolescentes, pais de adolescentes, professores e profissionais de saúde. O processo de validação envolveu 10 juízes e o cálculo do Índice de Validação de Conteúdo.
RESULTADOS: Os juízes avaliaram o instrumento em sua totalidade, analisando sua abrangência, pertinência, apresentação, clareza, facilidade na leitura e interpretação, objetividade, simplicidade e organização dos itens. O instrumento final contou com 61 itens.
CONCLUSÃO: O documento obteve validação satisfatória e resultou em um instrumento que pode subsidiar uma melhor atenção ao adolescente no contexto da Atenção Primária à Saúde.


Adolescence corresponds to the second decade of life, between 10 and 19 years, and comprises an important stage in human development. It is characterized by the normal adolescence syndrome, evidenced by the search for identity, group tendency, development of conceptual thinking, singular temporal experience and evolution of sexuality1.

Statistics show the significant representation of young people in the world population, between 10 and 24 years, making a total of 1.8 billion people2. In Brazil, there are 34 million adolescents, representing 18% of the population3. In view of the contingent of adolescents, especially in developing countries such as Brazil, it is fundamental to invest in this population, being a predictive factor to break the cycle of poverty and inequity that harms communities and countries, endangering the development and rights of countless of adolescents1. Thus, health policies and actions that improve the care provided to the adolescent should be prioritized, and should understand the adolescent beyond vulnerability, but as a potential holder, and be responsible for changes and improvements that impact on their quality of life.

Attention to Adolescent Health in Brazil has been oriented for more than two decades by specific projects in order to guarantee a singular service that contemplates the peculiarities of this phase of the life cycle. However, despite the efforts, the care given to this group remains fragmented, presenting strong evidence of practices aimed at welfare, which oppose health promotion concepts4.

The approach to the adolescent should be differentiated and use creative strategies of education and health promotion, so the use of technologies, as validated instruments, can contribute to this approach with Primary Health Care (PHC) teams. However, the literature has presented incipience as to the scientific production about the development and use of validated instruments aimed at professionals who work with the adolescent and who guide care processes5.

Referring to nurses' work in the context of PHC, there is a gap in what concerns the actions directed at the adolescent in the current care practice, indicating the need for changes in the work of this professional6.

In view of the above, this study aimed to build and validate an instrument to subsidize adolescent care in PHC, constituting a tool that can contribute to the conduction of new practices, since it can help nurses and other health professionals to the care of this population segment.


This methodological study occurred between August 2012 and March 2014, in Sobral / CE / BR, involving the areas included in two Basic Health Units (UBS). These were chosen because they contain a large number of adolescents, have the largest number of health professionals among the BHU of the municipality and because they cover middle and elementary schools.

The establishment of the items that make up the instrument was based on literature searches, the authors' experience and listening to 18 adolescents, 6 parents of adolescents, six teachers and 17 PHC professionals (doctors, nutritionists, physiotherapists, nurses, community agents health educators, dentists, physical educators, social workers, pharmacists and psychologists). The information was collected through a semi-structured interview and the sample was established for convenience. The adolescents included the age group between 10 and 19 years and the three stages of adolescence (initial, intermediate and final) were contemplated7. In all, 66 items comprised the initial instrument to be submitted to the judges.

Ten judges participated, which were identified using the snowball technique8, and included from the following criteria: being a professional of a higher level and having recognized experience in management, assistance, research or teaching in the area of Adolescent Health and / or experience in construction of instruments. This group was composed of nurses, doctors, social workers and a pedagogue, with the following training: 3 doctors (pediatrics, nutrition and nursing), 1 master (adolescent health) and 6 specialists (comprehensive care for adolescent health).

The judges received the material via e-mail or face-to-face and had: a letter of presentation, an Informed Consent Form, a judge's characterization form, and an item evaluation tool. In the latter, in addition to the request for evaluation of each item, space was also made available for recommendations and opinions on the instrument under development.

In the validation of content, the judges evaluated the instrument as a whole, analyzing its comprehensiveness, that is, if each domain or concept was adequately covered by the set of items and if all dimensions were included, and their pertinence, being able to suggest inclusion or deletion of items. In the validation of appearance, the presentation, clarity, ease in reading and interpretation, objectivity, simplicity and organization of items were verified9.

For the content validation, the judges evaluated the items regarding the extent, relevance of the item to the health of the adolescent and pertinence. We also used the Content Validity Index (IVC), considering acceptable values of agreement values above 80%.

The study was approved by the Research Ethics Committee of the State University of Vale do Acaraú, under the opinion n ° 470.653, of November 6, 2013. It was used the Term of Informed Consent form for adults, and assent for adolescents.


The items included in the instrument deal with sexuality, pregnancy, drug use, family relationship, work, insertion in higher education, functioning of health services, criminality, groups, physiological and pathological aspects of adolescent growth and development.

In the content validation process, mean IVC corresponded to 92%, ranging from 82% to 100%. In the validation of appearance, the recommended changes discussed: items that should be directed from one age group to another; organization in a way that showed an interrelation between the items; and reduce the number of items, from eliminating redundancies. The summary of recommendations is given in Table 1.

The writing of the items gained more objectivity, distancing itself from the broad and subjective character identified by the judges. Some items were considered repetitive by the judges and these were then arranged and grouped in a new order considering the proximity of the themes, so that of the 66 initial items, 61 remained.

After all the stages of the study, the final version was constituted in a checklist, titled "Instrument to Subsidize Adolescent Health Care". This format was chosen because it is easy to understand and handle, allowing a control of the items worked, avoiding redundancies during the approaches to the adolescent.


The proposed instrument is in line with the National Guidelines for Comprehensive Health Care for Adolescents and Young People, which are structured in two main axes: a) strengthening health promotion in actions for comprehensive health care for adolescents and young people and (b) reorientation of health services to promote responsiveness to comprehensive health care for adolescents and young people10.

Thus, the proposal to develop an instrument aimed at the adolescent, in the context of PHC, can contribute to the development of integral care, in the sense that the latter presupposes the organization of services and the execution of health practices that integrate a set of strategies for the prevention of diseases, health promotion and for curative and rehabilitation actions11.

It is worth noting that the search for theoretical and methodological references that support nursing care with adolescents is still recent and, although important knowledge and practices are already available, it is necessary to deepen, discuss and expand the workers, in different care contexts or fields of work12.

In a review of the literature, it is pointed out the incipience in the production of instruments without psychometric end, in the context of adolescent health5. Thus, it is pointed out that intentionality in the elaboration of an instrument should be understood as a guiding resource for adolescent health care, and therefore not constituting a mechanism for controlling or engaging the possibilities of care innovation.

Instruments used in health can make an important contribution to the provision of care, since they contribute to the standardization of procedures. However, this standardization can contribute to a little singular attention, so that health professionals must be sensitive to this peculiarity.

In the context of PHC, the relatively large number of instruments used in order to systematize attention and print agility to the work process is noteworthy, however, few instruments have been produced under valid methodological paths based on the scientific method13. Thus, the production of instruments that subsidize better health care must follow well defined methodological path, breaking with the empiricism that seems to mark this production.

In the judgment of the validation process, it is common to use qualitative approaches14,15, especially for the development of instruments with no psychometric purpose, which may contribute to the fact that there are no well-designed methodologies for the construction of this type of material, such as serials, explanatory leaflets, educational materials and booklets, compared to existing methodological frameworks for the construction of scales, for example, representing a knowledge gap.

Actions directed at adolescent health can benefit from the development of adequate standardized instruments16. Thus, the use of the proposed instrument presents a potential to contribute with the attention directed to this public. However, it is recognized that the incorporation of a new technology requires a reorganization of services, as well as awareness and qualification of professionals, in order to create a favorable context not only for its application, but also for the implementation of other technologies aimed at adolescents.

In this sense, the structuring of an instrument aimed at guiding and systematizing a process of caring for adolescents with a view to their integral care in the context of PHC has a character of novelty and reveals a potential for practice, since the interventions of promotion have been shown to be effective in modifying the health behavior of adolescents17.

Participation in interventions adapted for adolescents can be positive experiences, providing them with knowledge, skills and emotional support18. Thus, the instrument developed emerges from this need to adapt health services to consonant practices with integral attention to adolescent health.

The instrument in question holds a multi-professional perspective and should be handled by all the professionals who make up the PHC team in order to have all items addressed during the care of these adolescents. The developed instrument is in line with the current discussions on the promotion of adolescent health, since these include the theme of improving biopsychosocial well-being, for example through regular reinforcement of exercises, nutrition, spiritual dimension and interpersonal relationship19,20.

For its operation, this must be attached to the medical record, so that all professionals have access. The instrument should be used when there is an opportunity to contact the adolescent, either in scheduled consultation or spontaneous demand, or regardless of the complaint, so that opportunities for intervention aren´t lost. The choice of which item to approach will be carried out by each professional, according to their professional training and experience, so that the entries in the service will allow, besides the resolution of the main complaint, also a follow-up of their development.

It is ratified that, although the instrument can be used by taking advantage of services for different reasons, it is also significant that, depending on the need, specific consultations are scheduled for the evaluation of the health of these adolescents.


The results obtained in this study, through the apparent validation and content of the instrument by the group of judges, showed satisfactory level of validation. The checklist was built taking into consideration scientific material, the experience of the authors and perceptions of adolescents, parents, teachers and professionals of the FHT, imparting an integral character to the construct.

The online version of the instrument is available in the Northeast Network of Training in Family Health (RENASF). It is also worth noting the efforts made for the instrument to be used in adolescent care services, such as Family Health Centers, outpatient services or even during home visits.

As a limitation, it is significant to note that no participants linked to private schools were heard. It is believed that such discourses can bring contributions to the construct.


This study is a product of the Master's Dissertation "Attention to Adolescent Health in the Family Health Strategy: development of an instrument to subsidize a practice" - of the Professional Master's Degree in Family Health of the Vale do Acaraú State University (UVA), in association with the Northeast Network of Training in Family Health (RENASF) and Fundação Oswaldo Cruz (FIOCRUZ).


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