Construção e validação de um instrumento para detecção dos fatores associados ao desmame precoce no aleitamento materno: fase 1 do DesmaP

Abstract

Exclusive breastfeeding should be maintained in infants until they are six months old; however, certain factors are associated with early weaning. These factors are multifactorial in nature, and it is understood that knowledge of their prevalence enables the targeting of specific interventions aimed at reducing them. There are instruments designed to assess the prevalence of breastfeeding; however, there is a scarcity of instruments to identify the factors associated with early weaning. Thus, the objective of this study is to develop and validate the content of an instrument to identify the factors associated with early weaning in breastfeeding up to the child’s sixth month of life. This is a methodological study focused on developing and validating the content of a measurement instrument designed to detect factors associated with early weaning in infants up to six months of age, based on the framework for developing measurement instruments proposed by Pasquali. It was developed between August 2025 and July 2026, following these steps: 1) defining the construct’s dimensionality; 2) reviewing the literature on factors associated with early weaning; 3) drafting the initial version of the instrument; 4) refining the instrument through a focus group; 5) content validation by experts using the Delphi method; 6) qualitative analysis of suggestions in a new focus group; 7) semantic validation of the instrument with the target audience; 8) pretesting of the instrument; and 9) finalization of the instrument. The panel of experts participating in the Delphi phase followed the criteria adapted by Guimarães. Fifteen experts participated in the first round (which produced Version 2 of the instrument) and 13 in the second (which produced Version 3) of the Delphi technique. The Delphi experts assessed the relevance, clarity, representativeness, and essentiality of each item, as well as the representativeness and appropriateness of the items within the domain. During the content validation stage, the Content Validity Coefficient (CVC) was used, with items having a CVC ≥ 0.80 considered acceptable, as well as the Content Validity Ratio (CVR) to assess the essentiality of the items, using the following cutoff points: in the first round, CVR > 0.425 and, in the second round, CVR > 0.456 (considering a significance level of p < 0.05). Data analysis was performed using Microsoft Excel®. Version 1 of the instrument consisted of 49 items. After analyzing the qualitative and quantitative data, the instrument was expanded to 65 items in Version 2. Items 2, 27, and 65 had CVR values below the reference

threshold. Items 2 and 65 were excluded; however, item 27 was retained due to its contribution to the scientific literature on the association between obstetric violence and early weaning. The instrument’s total CVC was 0.99. Version 3 consisted of 61 items and 7 domains; it was administered to 10 participants from the target population during the semantic validation phase and to 16 participants during the pretest. Item 14, related to breast changes, was excluded. Finally, Version 4 of DesmaP was finalized with 60 items and 7 blocks. The instrument is valid in terms of content and semantics, proving to be relevant, clear, and representative for detecting factors associated with early weaning, thereby filling the gap in validated national tools. Future studies involving empirical testing and reliability testing are recommended to expand its applicability in different contexts of maternal and child care.