The oral ability of preterm newborns for breastfeeding: proposal for an assessment instrument.
Premature newborn; Eating behavior; Breastfeeding; Validation studies; Neonatal nursing.
The aim was to develop and psychometrically validate an instrument to assess the oral ability of preterm newborns for breastfeeding. This is a theoretical study of methodological and quantitative approaches. We used the psychometric theory of data, and the sample was obtained by criteria of convenience and intentionality, leading to 243 individuals among Nursing, Speech Therapy, and Medicine workers. The method design had three stages: 1. Operationalization of the Construct, 2. Content and Face Validity, 3. Construct Validity and Instrument Reliability. In step 1, the instrument construction was carried out based on Alaf Ibrahim Meleis, Sister Callista Roy, Arnold Sameroff, Heidelise Als, in addition to the Integrative Literature Review. An operational guide was created based on scientific articles, manuals from the Health Department, books, protocols, and technical standards. The preliminary version of the instrument had 28 items clustered in five dimensions: D1: Clinical Parameters and General Evaluation; D2: Tonic-Postural Organization and Oral Reflexes; D3: Nutritive Suction; D4: Signs of Stress in the Preterm Subsystems and D5: Physical and Human Environment of Neonatal Units. In step 2, the instrument went through content validity with the judges' evaluation - selected considering the Dreyfus and Dreyfus model for speech therapists and physicians and the Benner, Chesla, and Tanner model for nurses. Finally, ten judges were elected and performed three rounds of evaluation, which resulted in the final version of the instrument: with 27 items and five dimensions. Of these items, 26 had substantial to perfect agreement, but only one had moderate. The kappa coefficient per dimension in the three rounds (D1= 0.84/-/0.75), (D2= 0.57/0.73/0.75), (D3= 0.48/0.62/0 .81), (D4= 0.90/0.82/0.64) and (D5= 0.77/0.47/0.43) and the overall kappa (0.70/0.69/ 0.83). For the operational guide, two cycles of analysis were needed and the CVI and kappa per dimension were calculated based on these two rounds D1 (R1=0.76/0.64 and R2=086/0.76), D2 (R1=0 .98/0.95 and R2=1.00/1.00), D3 (R1=0.88/0.780 and R2=094, 0.88), D4 (R1=0.93/0.85 and R2 = 0.98 / 0.95) and D5 (R1 = 0.83 / 0.69 and R2 = 0.93 / 0.85). The CVI and the general kappa of the operational guide were 0.89 and 0.81. For face validity, the kappa per dimension was calculated for judges and students (D1= 1.00/0.90), (D2= 1.00/0.97), (D3= 0.97/0.84), (D4=1.00/0.54) and (D5=1.00/0.89). At the end, the general kappa of the instrument for judges was (0.99) and for students (0.84). The third stage revealed that the instrument had adequate factorial and convergent validity. The Classic Test Theory and the Item Response Theory found high discriminatory power, an acceptable degree of difficulty, and validation of its measurement model and its quality. This study was approved by the Research Ethics Committee under opinion Number 4,219,662. Therefore, the instrument proved to be reliable and has evidence of content, face, and construct validity to assess the oral ability of preterm infants to breastfeed.