Evidence of content and response processes validity instruments to assess structure, processes, and outcomes in surgical centers
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Bruna Pires Madrid1, João Lucas Campos1, Cristiane Gallasch2
1- Universidade Federal do Rio Grande do Sul Porto Alegre - Rio Grande do Sul, Brasil.
Introduction:
The Operating Room (OR) is a complex hospital setting characterized by a high concentration of technology and the integrated work of a multidisciplinary team. Quality indicators are important tools for monitoring service performance, supporting decision-making, and guiding interventions aimed at continuous improvement. This study aimed to analyze content validity and response process validity evidence for the Escala sobre Indicadores de Estrutura no Bloco Operatório (IEBO) [Operating Room Structure Indicators Scale (ORSIS)], Escala de Processos de Qualidade Assistencial no Bloco Operatório (PQABO) [Operating Room Quality of Care Processes Scale (ORQCP)], and Escala sobre Resultados de Qualidade no Bloco Operatório (RQBO) [Operating Room Quality Outcomes Scale (ORQOS)], adapted into Brazilian Portuguese.
Method:
This psychometric study was conducted from April 2024 to June 2025 and followed the methodological procedures recommended by the Patient-Reported Outcomes Measurement Information System (PROMIS®). Descriptive statistics were used to characterize participants. The Content Validity Ratio (CVR) was calculated to assess semantic, idiomatic, experiential, and conceptual equivalence and content validity evidence. Qualitative analysis was also conducted to investigate evidence of preliminary response process validity.
Results:
The ORSIS and ORQCP required the greatest number of revisions based on expert recommendations (CVR = 0.39-0.44). Following the cross-cultural adaptation and validation procedures, the Brazilian Portuguese versions were entitled "Escala sobre Indicadores de Estrutura no Centro Cirúrgico (IECC)", with 28 items across seven theoretical dimensions; "Escala de Processos de Qualidade Assistencial no Centro Cirúrgico (PAQCC)", with 19 items across four dimensions; and "Escala sobre Resultados de Qualidade no Centro Cirúrgico (RQCC)", with 13 items across three dimensions.
Conclusion:
The Brazilian Portuguese versions of the instruments demonstrated robust evidence of semantic, idiomatic, experiential, and conceptual equivalence, as well as content validity, supporting their use for quality assessment in Brazilian Operating Room settings.
