Desenvolvimento e validação de um instrumento para avaliação da adesão de cirurgiões-dentistas aos protocolos de controle de infecção e aspectos psicológicos na prática odontológica frente a doenças infectocontagiosas

Abstract

Infection control practices in dentistry are important for protecting both patients and professionals and ensuring a safe working environment. Therefore, they should be implemented and followed for all patients treated, regardless of their infection status. Another important point to highlight is the psychological well-being of dentists and oral health care team, as infectious diseases appear to interfere with the practice of care, potentially generating fear and anxiety. In Brazil, most research evaluates the adherence of dental professionals to infection control protocols using instruments that have not had their psychometric properties evaluated. Furthermore, there is no instrument that seeks to associate psychological aspects in dental practice with infectious diseases. This study aimed to develop and validate an instrument in the Portuguese language called “Escala multidimensional relacionada às doenças infectocontagiosas em Odontologia (EMRDIO)” to assess the dentists’ adherence to infection control protocols and explore psychological aspects in dental practice concerning infectious diseases. The initial version of the instrument comprised 49 items and 81 subitems. The first phase involved a content validity index and face validity analyses by ten judges with expertise in this field, reviewing each item`s content, scope, and relevance. The second phase included a verbal comprehension analysis with a representative subsample of dentists. After these phases, some questions were removed and modified to enhance the clarity for the dentists. The factor structure of EMRDIO was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Reliability was evaluated using internal consistency by McDonald's Omega coefficient (ω) and Cronbach's Alpha (α). A total of 405 individuals had access to the instrument. Findings from EFA (n = 135) revealed a four-factor structure (Proteção Ambiental no Trabalho, Desinfecção, Treinamento da Equipe e Medo e Ansiedade) with 23 items with a factor loading above 0.60. The KMO value of 0.803 and Bartlett's test of sphericity yielded χ²: 2501.136, df: 253.000, with a significant value of P < 0.001 was observed. CFA (n = 270) showed an good fit of the model: χ²/df = 1.75; CFI: 0.997; TLI: 0.996; SRMR: 0.079; RMSEA: 0.053 (90% CI:0.044 to 0.061), supporting the 4-factor structure derived from the EFA. Reliability analysis showed adequate internal consistency for all factors (ω and α ≥ 0.70). The development of the EMRDIO instrument followed all the appropriate steps for validation, demonstrating adequate validity and internal consistency. Thus, this instrument can be considered suitable for assessing infection control aspects and identifying psychological factors in the dental practice of dentists facing infectious diseases.