Abstract
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.
Highlights
Strategies to promote adequate and healthy eating make up a set of interventions considered by the World Health Organization (WHO) to be cost-effective [1]
As food has become an important determinant of chronic non-communicable diseases, Food and Nutrition Education (FNE) started to be valued in the Sistema Único de Saúde (SUS, the Brazilian National Health System) policies and dietary guidelines have been published to be meant as technologies to promote adequate and healthy eating [4]
The scale was developed for the evaluator, a nutritionist with expertise in the Brazilian Dietary Guidelines, to observe the health professionals or team performing FNE actions in order to diagnose the appropriateness of that publication approach
Summary
Strategies to promote adequate and healthy eating make up a set of interventions considered by the World Health Organization (WHO) to be cost-effective [1]. Brazil is considered a reference country with a food and nutrition agenda that incorporates FNE in Primary Health Care (PHC) [2,3]. As food has become an important determinant of chronic non-communicable diseases, FNE started to be valued in the Sistema Único de Saúde (SUS, the Brazilian National Health System) policies and dietary guidelines have been published to be meant as technologies to promote adequate and healthy eating [4]. Dietary guidelines are defined by the Food and Agriculture Organization of the United Nations (FAO) as the expression of the FNE principles used as a guidance for the population and the national. The Dietary Guidelines for the Brazilian Population (Brazilian Dietary Guidelines) announced an innovative paradigm of healthy eating and adopted an expanded vision of sustainability [6,7,8]
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