O preparo para a alta hospitalar : adaptação transcultural e análise psicométrica do Readiness for Hospital Discharge Scale (RHDS) - adult form

Abstract

Methodological study to translate and adapt the Readiness for Hospital Discharge Scale (RHDS) Adult Form for Brazilian Portuguese and evaluate the validity and reliability of the adapted version in a sample of Brazilian patients submitted for hospital discharge. The RHDS is a questionnaire consisting of 21 items divided into four subscales: personal status, knowledge, coping ability and expected support. To date it is the only instrument available for administration during the hospitalization period in order to measure the perception of preparation for discharge from the patient's perspective. It is considered a core component for patient safety and efficacy analysis in the process of planning for discharge. The study was conducted in two sequential steps: 1. Transcultural Adaptation of the discharge preparation tool - RHDS; 2. Analysis of the psychometric aspects of the discharge preparation tool - RHDS. The process of cultural adaptation followed the following methodological stages: 1. Translation of the RHDS into Brazilian Portuguese; 2. Completion of first consensus version in Portuguese; 3. Evaluation by the Committee of Specialists; 4. Back-translation; 5. Obtaining the consensus of versions in English and comparing them to the original version; 6. Submission and evaluation of instrument reports to the author of the original version; 7. Semantic analysis of the items; 8. Pre-test. Data were collected between April and September 2015 by interviewing 121 participants hospitalized in an inpatient clinic of a university hospital in Brasilia, Brazil. The average time to apply the tool ranged from five to ten minutes. Participants were primarily females (54.5%) with mean age and education of 53.2 and 7.7 years respectively. The average hospital stay was 12,25 days (Standard deviation - SD = 8.89), with a minimum of 1 and a maximum of 47 days of hospitalization. Positive correlations were observed (r = 0,14 to 0,54) among the RHDS items, as well as between the RHDS and its subscales. Comparing the original RHDS and the initial version of the Brazilian tool found that similar values were found regarding the reliability and mean score of items, the least accurate average inter-item correlation involved the expected support subscale. Analysis of discriminant construct demonstrated the capacity of the instrument to discriminate groups with respect to age and whether escorted or not. Exploratory factor analysis resulted in a version of 12 items divided into three factors, renamed: ability to self-care, expected support, and knowledge, as a percentage of total explained variance of 51,26%. The total reliability (Cronbach's alpha) of this version was 0,72, ranging from 0,72 to 0,83 among subscales. Preliminary results met validity and reliability criteria. Further studies addressing other psychometric analyses of RHDS-Br are needed to test the structure of the shortened version with 12 items to be used in the Brazilian context