Validity and reliability of the tuberculosis-related stigma scale version for Brazilian Portuguese.

BACKGROUND: Stigma associated with tuberculosis (TB) has been an object of interest in several regions of the world. The behaviour presented by patients as a result of social discrimination has contributed to delays in diagnosis and the abandonment of treatment, leading to an increase in the cases of TB and drug resistance. The identification of populations affected by stigma and its measurement can be assessed with the use of valid and reliable instruments developed or adapted to the target culture. This aim of this study was to analyse the initial psychometric properties of the Tuberculosis-Related Stigma scale in Brazil, for TB patients. METHODS: The Tuberculosis-Related Stigma scale is a specific scale for measuring stigma associated with TB, originally validated in Thailand. It presents two dimensions to be assessed, namely Community perspectives toward tuberculosis and Patient perspectives toward tuberculosis. The first has 11 items regarding the behaviour of the community in relation to TB, and the second is made up of 12 items related to feelings such as fear, guilt and sorrow in coping with the disease. A pilot test was conducted with 83 TB patients, in order to obtain the initial psychometric properties of the scale in the Brazilian Portuguese version, enabling simulation of the field study. RESULTS: As regards its psychometric properties, the scale presented acceptable internal consistency for its dimensions, with values ≥0.70, the absence of floor and ceiling effects, which is favourable for the property of scale responsiveness, satisfactory converging validity for both dimensions, with values over 0.30 for initial studies, and diverging validity, with adjustment values different from 100%. CONCLUSION: The results found show that the Tuberculosis-Related Stigma scale can be a valid and reliable instrument for the Brazilian context.

[Design and semantic validation of a new instrument to assess policy transfer of directly observed treatment for tuberculosis]. / Elaboração e validação semântica de um instrumento de avaliação da transferência do tratamento diretamente observado como política de controle da tuberculose.

OBJECTIVE: To design and semantically validate an instrument to evaluate the transfer of directly observed therapy (DOT) as a policy for tuberculosis control taking into consideration the experience of mid- and higher level health care workers. METHODS: This methodological investigation was developed in two stages: literature review to design the first draft of the instrument; and semantic validation of the first draft using questionnaires adapted from the DISABKIDS® project. The information obtained was analyzed using quantitative (descriptive statistics) or qualitative (content theme analysis) methods. RESULTS: Twenty-four mid- and higher level health care workers engaged in tuberculosis control participated in the study. The instrument was considered important for the work of study participants. The answers provided by participants led to changes in both the structure and content of the instrument. The process resulted in a final, semantically validated questionnaire. CONCLUSIONS: Semantic validation is important to ensure the applicability of assessment instruments, as shown by the contributions provided by participants. The instrument whose semantic validation was described in this study will now be assessed in terms of psychometric characteristics and usefulness to measure the transfer of DOT to health professionals as a tuberculosis control policy.

Discomfort and unease of the subject in the interpretation movement of a Tuberculosis questionnaire.

OBJECTIVE: to propose a discussion about traces of the derivation of meanings, the subjects' discomfort and resistance when they are called upon to signify a questionnaire on the transfer of the Directly Observed Treatment of Tuberculosis policy, in order to reveal the limitations of closed questionnaires in the subject's interpretation process. METHOD: health professionals from a Primary Health Care Unit in Porto Alegre/RS were interviewed and some excerpts from the interviews were investigated in the light of French Discourse Analysis. RESULTS: resistance, discomfort, slips, silencing and the derivation of meanings were observed in the subjects' interpretation. CONCLUSION: the interpretation process has multiple meanings and varies from subject to subject. The questionnaire, as a prototype of the logically stabilized universe, fails when the purpose is to control the interpretation. Its isolated use in health research can entail inexactness or incompleteness of the collected data. Therefore, its use associated with qualitative research techniques is ideal.

[Access to healthcare services for tuberculosis: analysis of patient satisfaction]. / Acesso aos serviços de atenção à tuberculose: análise da satisfação dos doentes.

Tuberculosis remains a pubic health challenge. Uncountable efforts are made to control the disease, and patient treatment and accessibility to healthcare can hinder reaching a cure. The objective of this article is to analyze the satisfaction of tuberculosis patients regarding tuberculosis control services. This is an epidemiological, prospective study, using both a quantitative and qualitative approach. Data were collected using a semi-structured questionnaire. Participants included 77 patients. The quantitative data were positively evaluated, and the qualitative data permitted an understanding of the patients' experience regarding their accessibility and treatment. Aspects such as the criteria for performing Directly Observed Treatment and the proximity of the healthcare facility to the patients' residence affected their satisfaction, which implies the need to reorganize healthcare services in order to provide more appropriate care to tuberculosis patients.

[Managing the basic health unit in tuberculosis control: a field of challenges]. / A gerência da Unidade Básica de Saúde no controle da tuberculose: um campo de desafios.

In this study we analyzed the management of Basic Health Units in terms of Tuberculosis (TB) control in a city in the interior of São Paulo state. Fourteen managers participated in the study. A closed questionnaire was administered and an open question was also applied. The interview was carried out after obtaining free and informed consent. Data analysis was performed using the Statsoft software Statistica 8.0 and thematic content analysis was used for the qualitative data. It was found there is a clear technical-bureaucratic management, deficient in the activity planning and organization dimensions at the BHU. Hence, health care managers in this study should include management aspects of planning and organization as ways to make TB control feasible.

[Pensioners with type 2 diabetes in the family health program in Ribeirão Preto, São Paulo, Brazil]. / Aposentados com diabetes tipo 2 na Saúde da Família em Ribeirão Preto, São Paulo - Brasil.

The objective of the present study was to characterize aged pensioners with type 2 diabetes, users of a primary health care service. Participants were 43 individuals selected according to the inclusion criteria. Data was obtained from primary and secondary sources, and analyzed using the SPSS (Statistical Package for the Social Sciences) software. The average age was 75.3 years. There was little participation in community groups and in physical activities. Seventeen aged individuals used the primary healthcare service. Twelve men were retired and twelve women received pension. The average arterial blood pressure was 130 x 80 mmHg and the average glucose level was 141 mg/dl. Diet orientations were given mostly by physicians. Further studies are necessary to analyze the cause of the little adherence to the groups and to physical activity. Health teams should have an effective participation in diabetes control and should encourage the family to participate in the care process, as this diseases requires long-term management.