Synthesis of final model.

Background
In primary healthcare (PHC) settings, initiatives to identify mental health care needs (MHCN) are needed to ensure integral and quality care. However, there are few valid tools supporting health professionals in decision-making. This study aimed to obtain evidence of validity of the Brazilian Scale for Evaluation of Mental Health Care Needs (CuidaSM) in PHC.
Methods
A group of health professional experts developed 130 dichotomous items, which were assessed by a heterogeneous group of panelists from different regions of Brazil (n = 73). Content validity ratio (CVR) was calculated, resulting in a second version of the scale with 43 items, which was administered to 879 healthcare users to provide evidence of internal-structure validity using exploratory factor analysis (EFA). Dimensionality was assessed through robust parallel analysis and the model was then cross-validated to create the final CuidaSM version. The CuidaSM score was subjected to normalization.
Results
The final version of CuidaSM comprised 31 items, which were divided into two blocks: a “self-referred” block with 17 items distributed into five dimensions (Social Relationships, Functioning, Autonomy, Impulsiveness and Aggressiveness, and Spirituality) and a “health professional evaluation” block with 14 items and three dimensions (Violence, Self-aggression and Suicidal Behavior, and Caregiving Plan). The final model’s explained variance was 62.7%. Dimensionality values pointed to a multidimensional model (UNICO = 0.79; ECV = 0.69; and MIREAL = 0.22). All indicators were within adequate and satisfactory limits. CuidaSM score normalization stratified MHCN into four strata.
Conclusions
The CuidaSM scale is a concise instrument combining healthcare user self-assessment and health professional clinical assessment. CuidaSM show satisfactory evidence of validity and was found to be a consistent, reliable, and robust instrument capable of accurately measuring MHCN in the PHC setting in Brazil.