Psychometric Evaluation of the Hospital Ethical Climate Survey—Brazilian Version in the Context of Primary Health Care

Abstract

Introduction: The ethical climate in primary health care (PHC) is essential to ensure a healthy work environment, respectful professional relationships, and the quality and humanization of care provided to users of the healthcare system. Objective: To evaluate the psychometric evidence of the Hospital Ethical Climate Survey—Brazilian version, for the PHC context. Materials and Methods: Methodological study that followed five stages: Adaptation of the instrument to the context; pilot testing of the adapted instrument; content validity; construct validity; and reliability. Before exploratory factor analysis, data adequacy was verified using the Kaiser-Meyer-Olkin (KMO) test, which ranges from 0 to 1, and Bartlett’s sphericity test, with a p-value ˂ 0.001. Exploratory factor analysis considered communality, specificity, and factor loadings. The confirmatory factor analysis was based on the Comparative Fit Index (CFI) and the Tucker-Lewis Index (TLI), both greater than 0.95; the Standardized Root Mean Square Residual (SRMR), with values ≤ 0.08; and the Root Mean Square Error of Approximation (RMSEA), with values ˂ 0.08. Reliability was assessed using Cronbach’s alpha, considered satisfactory when greater than 0.70, and test-retest reliability, using the weighted quadratic Kappa coefficient, whose values are considered excellent when ≥ 0.75. Descriptive statistics were based on the mean and standard deviation. The analyses were conducted using the R program. Results: In the exploratory factor analysis, all factor loadings were greater than 0.40, ranging from 0.40 to 0.82. Confirmatory factor analysis demonstrated the adequacy of the model with five factors and 26 validated items, presenting a CFI of 0.988, TLI of 0.986, RMSEA of 0.084, and SRMR of 0.084, with a 90 % confidence interval (0.084-0.988) and a significant p-value ≤ 0.05. The internal reliability of the overall instrument was 0.94. The weighted quadratic Kappa test-retest ranged from 0.18 to 0.76, and the intraclass correlation coefficient ranged from 0.26 to 0.80. Conclusion: The Brazilian version of the instrument, adapted for PHC, was considered valid and reliable in this sample. The instrument contributes to the advancement of research and practice in the field of ethics in healthcare and nursing in primary care, an area where studies on ethics remain scarce, to promote a healthier and more qualified work environment.