Scale for evaluating food and nutrition education practices in Primary Health Care

ABSTRACT Objective To develop, validate and analyse intra- and inter-raters’ agreement and reliability of a scale for the evaluation of food and nutrition education practices in primary health care. Methods Three theoretical references were used for the development of items with answers on a 4-point scale (not observed, partially/satisfactorily/fully observed): the Brazilian Dietary Guidelines, the Interprofessional Collaborative Practice and the Family Health Strategy as models for organizing primary health care. The scale was submitted for content and face panel validation and it was further reevaluated online. Thirty specialists used the scale for the rating of 4 videos produced for the study showing food and nutrition education practices in primary health care settings. Intra- and inter-raters agreement and reliability were analyzed by test at one time point and retest 30 days later. Results The scale initially included 72 items but was reduced to 17 items after content and face validation, together with a fill-out manual that was reviewed by experts. In the re-evaluation, all 17 items were maintained, and content adjustments were made in the manual. Thirty raters applied the scale to the videos in the test, and 28 in the retest. All videos obtained combined kappa values of >0.4. In the test-retest, 19 raters showed >80% agreement; in the inter-rater evaluation, 14 raters generated kappa values >0.75. Conclusion The scale underwent content and face validation and showed to be useful to diagnose the absence and the full addressing of the Brazilian Dietary Guidelines content with good intra- and inter-rater agreement and reliability in different settings of Primary Health Care.摘要 研究目的：开发、验证并分析用于评估基层医疗卫生服务（Primary Health Care）中食品与营养教育实践的量表的评定者内部及评定者间一致性与信度。 研究方法：本研究依托3项理论参考框架开发量表条目，并采用4级评分量表（未观察到、部分/基本/完全观察到）进行作答，参考依据分别为《巴西膳食指南》、跨专业协作实践模式以及家庭健康战略，以此作为基层医疗卫生服务的组织范本。随后该量表接受专家小组的内容效度与表面效度验证，并通过线上方式开展复评。共有30名专家使用该量表对本研究制作的4段展示基层医疗卫生服务场景中食品与营养教育实践的视频进行评定。通过单次测评与30天后的复测，分析评定者内部及评定者间的一致性与信度。 研究结果：该量表初始包含72个条目，经内容与表面效度验证后精简至17个条目，并配套编制了经专家审核的填写手册。复评阶段保留了全部17个条目，并对填写手册进行了内容调整。测评阶段共有30名评定者使用该量表对视频进行评定，复测阶段则为28名。所有视频的综合Kappa值均大于0.4。复测一致性分析中，19名评定者的一致性达80%以上；评定者间一致性分析中，14名评定者的Kappa值大于0.75。 研究结论：该量表通过了内容与表面效度验证，可用于诊断《巴西膳食指南》相关内容的缺失与完整落实情况，且在不同基层医疗卫生服务场景中展现出良好的评定者内部及评定者间一致性与信度，具备良好的应用价值。