Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton / Consequences of errors in the translation of questionnaires: spanish version of Downton index

La aplicación de escalas para detectar el riesgo de caídas en pacientes hospitalizados se ha generalizado. Durante el desarrollo de una revisión sistemática se detectó una disparidad grave en 3 ítems de la versión española del índice Downton respecto a la versión original. El objetivo de este estudio fue determinar el impacto de este error y comparar el riesgo estimado de caídas con cada versión, su validez y consistencia interna. Material y métodos. Se realizó un estudio transversal descriptivo en pacientes agudos hospitalizados durante 2011 en el Hospital Costa del Sol, Marbella. El riesgo de caídas de los pacientes se valoró mediante la versión española del índice Downton, y se recalculó conforme a los ítems de la versión original. Se calculó sensibilidad, especificidad y alfa de Cronbach. Resultados. La aplicación de la versión original de la escala redujo el número de pacientes clasificados como de «alto riesgo» de caer un 24,2%. Con la versión española de la escala, la posibilidad de ser clasificado como de «alto riesgo» de caer fue 3,3 veces mayor (OR: 3,3). Ambas versiones del índice Downton mostraron escasa precisión y validez diagnóstica. La sensibilidad de la escala original fue del 28% y la especificidad del 82%. Su consistencia interna fue baja (alfa de Cronbach: 0,51). Conclusiones. La escala Downton, dada su poca precisión y validez diagnóstica, baja consistencia interna y el error significativo observado en su traducción al español, no es el instrumento más adecuado para evaluar el riesgo de caídas en pacientes agudos hospitalizados (AU)

The application of screening tools to detect the risk of falls in hospitalized patients is in general use. During the development of a systematic review a serious disparity in three items of the Spanish version of the Downton index was detected, compared to the original version. The aim of this study was to determine the impact of this error and to compare the estimated risk of falls with each of these versions, its validity and internal consistency. Material and methods. A descriptive cross-sectional study in acute hospitalised patients was performed during 2011 in Hospital Costa del Sol, Marbella. The patients’ risk of falling was assessed by the Spanish version of the Downton index, and then it was re-calculated according to the items in the original version. Sensitivity, specificity and Cronbach's alpha were calculated. Results. Application of the original version of the index reduced the number of patients classified as “high risk” of falling by 24.2%. With the Spanish version of the tool, the possibility of being classed as “high risk” of falling was considerably 3.3 times higher (OR: 3.3). Both versions of the Downton index showed low accuracy and diagnostic validity. The sensitivity of the original scale was 28% and specificity of 82%. Its internal consistency was low (Cronbach's alpha: .51). Conclusions. The Downton index, given its poor accuracy and diagnostic validity, low internal consistency, and the significant error observed in its Spanish translation, is not the most appropriate tool to assess the risk of falls in hospitalised acute patients (AU)

[Consequences of errors in the translation of questionnaires: Spanish version of Downton index]. / Consecuencias de los errores en la traducción de cuestionarios: versión española del índice Downton.

UNLABELLED: The application of screening tools to detect the risk of falls in hospitalized patients is in general use. During the development of a systematic review a serious disparity in three items of the Spanish version of the Downton index was detected, compared to the original version. The aim of this study was to determine the impact of this error and to compare the estimated risk of falls with each of these versions, its validity and internal consistency. MATERIAL AND METHODS: A descriptive cross-sectional study in acute hospitalised patients was performed during 2011 in Hospital Costa del Sol, Marbella. The patients' risk of falling was assessed by the Spanish version of the Downton index, and then it was re-calculated according to the items in the original version. Sensitivity, specificity and Cronbach's alpha were calculated. RESULTS: Application of the original version of the index reduced the number of patients classified as "high risk" of falling by 24.2%. With the Spanish version of the tool, the possibility of being classed as "high risk" of falling was considerably 3.3 times higher (OR: 3.3). Both versions of the Downton index showed low accuracy and diagnostic validity. The sensitivity of the original scale was 28% and specificity of 82%. Its internal consistency was low (Cronbach's alpha: .51). CONCLUSIONS: The Downton index, given its poor accuracy and diagnostic validity, low internal consistency, and the significant error observed in its Spanish translation, is not the most appropriate tool to assess the risk of falls in hospitalised acute patients.

Factores predisponentes, facilitadores y reforzadores de la higiene de manos en un ámbito hospitalario / Factors predisposing, enabling and reinforcing hand hygiene in hospitals

Objetivo. El propósito fue determinar qué factores predisponentes, facilitadores o reforzadores están relacionados con la conducta de higiene de manos (HM) de los profesionales sanitarios. También quisimos investigar la prevalencia de higiene de manos. Material y métodos. A través de la metodología PRECEDE y mediante técnicas de observación no participante y cuestionarios se realizó un diagnóstico conductual sobre los factores que favorecen y dificultan la realización de higiene de manos. Además se realizó un estudio transversal de prevalencia para conocer la tasa de cumplimiento. Los sujetos de estudio fueron profesionales sanitarios y directivos. Resultados. Se detectaron variables a favor predisponentes (recibir formación, valorar la eficacia de la higiene, percepción de que es posible adquirir infecciones a través de los pacientes, etc.), facilitadoras (disponer de preparados de base alcohólica, que la higiene de manos no suponga esfuerzo, falta de presión asistencial, etc.) y reforzadores (que el superior le dé importancia a la higiene de manos, imitación de conductas positivas, etc.). El cumplimiento de HM fue de un 26,8%. Conclusiones. La accesibilidad a las herramientas para la HM, las creencias de los profesionales relacionadas con la autoprotección, el pudor, el escepticismo y los modelos o refuerzos condicionantes son los factores que determinan su conducta de HM. Los modelos cognitivos-conductuales deben ser considerados a la hora de elaborar intervenciones encaminadas a modificar e interiorizar las conductas de HM(AU)

Aims. To identify the predisposing, enabling and reinforcing factors of hand hygiene behaviour of healthcare staff, and to determine the prevalence of hand washing in hospitals. Material and methods. Using the PRECEDE methodology and techniques of non-participant observation and questionnaires, a behavioural diagnosis was made of the factors that favour and hinder the practice of hand hygiene. In addition, a cross-sectional prevalence study was performed to determine the rate of compliance. The study subjects were healthcare staff and managers. Results. Various predisposing variables were identified: instruction, valuing the effectiveness of hygiene, the perception that infections may be acquired from patients, etc. The enabling variables were the availability of alcohol-based cleansers, the understanding that hand hygiene is effortless, the absence of pressure of work, etc. The enhancing variables were the presence of hierarchical superiors stressing the importance of hand hygiene, the wish to imitate positive behaviour, etc. Compliance with hand washing recommendations was 26.8%. Conclusions. Access to instruments for hand hygiene, healthcarers’ attitudes regarding self-protection, modesty, scepticism and conditioning or reinforcing models are all factors that influence hand washing practices. Cognitive-behavioural models should be considered when policies aimed at modifying and assimilating hand washing behaviour are being developed(AU)

[Factors predisposing, enabling and reinforcing hand hygiene in hospitals]. / Factores predisponentes, facilitadores y reforzadores de la higiene de manos en un ámbito hospitalario.

AIMS: To identify the predisposing, enabling and reinforcing factors of hand hygiene behaviour of healthcare staff, and to determine the prevalence of hand washing in hospitals. MATERIAL AND METHODS: Using the PRECEDE methodology and techniques of non-participant observation and questionnaires, a behavioural diagnosis was made of the factors that favour and hinder the practice of hand hygiene. In addition, a cross-sectional prevalence study was performed to determine the rate of compliance. The study subjects were healthcare staff and managers. RESULTS: Various predisposing variables were identified: instruction, valuing the effectiveness of hygiene, the perception that infections may be acquired from patients, etc. The enabling variables were the availability of alcohol-based cleansers, the understanding that hand hygiene is effortless, the absence of pressure of work, etc. The enhancing variables were the presence of hierarchical superiors stressing the importance of hand hygiene, the wish to imitate positive behaviour, etc. Compliance with hand washing recommendations was 26.8%. CONCLUSIONS: Access to instruments for hand hygiene, healthcarers' attitudes regarding self-protection, modesty, scepticism and conditioning or reinforcing models are all factors that influence hand washing practices. Cognitive-behavioural models should be considered when policies aimed at modifying and assimilating hand washing behaviour are being developed.