STRENGTHENING ADHERENCE TO TUBERCULOSIS TREATMENT: CONSTRUCTION AND VALIDATION OF A HANDBOOK

Cabral, Juliana da Rocha; Cabral, Luciana da Rocha; Pinho, Clarissa Mourão; Andrade, Maria Sandra; Pinto, Erika Simone Galvão; Oliveira, Regina Celia de

doi:10.1590/1980-265X-TCE-2025-0028en

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Original Article • Texto contexto - enferm. 35 • 2026 • https://doi.org/10.1590/1980-265X-TCE-2025-0028en linkcopy

STRENGTHENING ADHERENCE TO TUBERCULOSIS TREATMENT: CONSTRUCTION AND VALIDATION OF A HANDBOOK

FORTALECIMIENTO DE LA ADHERENCIA AL TRATAMIENTO DE LA TUBERCULOSIS: CONSTRUCCIÓN Y VALIDACIÓN DE UNA CARTILLA

Authorship SCIMAGO INSTITUTIONS RANKINGS

Objective: to present the development and validation stages of an educational handbook to support and strengthen medication adherence among patients undergoing tuberculosis treatment.

Method: this is a methodological study which involved developing and validating a handbook based on Pasqual’s psychometric precepts and Echer’s framework, developed in Recife, Pernambuco, Brazil. A literature review was conducted to develop the educational technology. The project was developed between April 2023 and March 2024. Content validation used the Content Validity Coefficient, with judges being selected by the snowball technique. Semantic validation with the target population used the Suitability Assessment of Materials.

Results: the “Em busca da cura da tuberculose” (“In search of a cure for tuberculosis”) handbook was organized into eight sections subdivided into 25 essential topics. The Content Validity Coefficient achieved was considered adequate. High agreement was observed among participants in the semantic validation, with a Suitability Assessment of Materials score between 0.90 and 1.0 for each item.

Conclusion: the handbook was considered valid by experts and the target audience, and suitable for use in strengthening adherence to tuberculosis treatment.

DESCRIPTORS:
Tuberculosis; Health education; Validation studies; Educational technology; Medication adherence

Section	Essential content
Presentation	Catalog Card.
	Information from the Handbook.
	Patient Data.
General information about tuberculosis	After all, what is tuberculosis?
	Types of tuberculosis.
	Who are the most vulnerable people?
Symptoms	When to suspect tuberculosis?
Symptoms	Record of symptoms presented by the patient.
Transmission and Prevention	Transmission Modes.
	Prevention.
	Myths and truths.
Diagnosis	Guidelines on diagnostic tests.
Diagnosis	Record of test results.
Household contacts	Record of household contacts.
	Record of contacts eligible for tuberculin skin testing.
	Record of contacts eligible for Latent Tuberculosis Infection Testing.
	Record of symptomatic household contacts.
Treatment	Information on medication treatment.
	Record of follow-up tests.
	Medication reactions.
	Healthy habits during treatment.
	Myths about treatment.
	Consultation records.
Post-discharge follow-up	Follow-up appointments.
Post-discharge follow-up	Record of new symptoms.

Item	Mean	*CVC	†SD		‡D		§A		\|\|SA		¶A+SA%
Item	Mean	*CVC	N	%	n	%	n	%	n	%	¶A+SA%
Appearance
Does the handbook look good?	3.83	0.96	0	0.0	0	0.0	2	16.7	10	83.3	100.0
Does the cover attract attention and convey the purpose of the material?	3.42	0.85	0	0.0	1	8.3	5	41.7	6	50.0	91.7
Is the layout satisfactory?	3.58	0.90	0	0.0	0	0.0	5	41.7	7	58.3	100.0
Are the topics covered in the handbook appropriate?	3.83	0.96	0	0.0	0	0.0	2	16.7	10	83.3	100.0
Do the colors used interfere with reading?	3.92	0.98	0	0.0	0	0.0	1	8.3	11	91.7	100.0
Do the handbook’s layouts facilitate understanding?	3.83	0.96	0	0.0	0	0.0	2	16.7	10	83.3	100.0
Do the illustrations present key visual messages so the reader can grasp the main points on their own, without distractions?	3.67	0.92	0	0.0	0	0.0	4	33.3	8	66.7	100.0
Content
Is the objective clear, facilitating quick comprehension of the material?	4.00	1.00	0	0.0	0	0.0	0	0.0	12	100.0	100.0
Does the handbook facilitate understanding of the topic?	3.75	0.94	0	0.0	1	8.3	1	8.3	10	83.3	91.6
Does the handbook offer content consistent with current knowledge?	3.33	0.83	0	0.0	2	16.7	4	33.3	6	50.0	83.3
Is the information contained in the handbook adequate for guidance and follow-up for users undergoing tuberculosis treatment?	3.58	0.90	0	0.0	1	8.3	3	25.0	8	66.7	91.7
Is the information contained in the handbook appropriate for the target audience (users undergoing tuberculosis treatment)?	3.33	0.83	1	8.3	0	0.0	5	41.7	6	50.0	91.7
Is the guidance presented necessary and addressed correctly?	3.33	0.83	0	0.0	0	0.0	8	66.7	4	33.3	100.0
Is there unnecessary information in the handbook?	2.25	0.69	3	25.0	4	33.3	4	33.3	1	8.3	58.3
Relevance
Do the images represent important aspects for users undergoing tuberculosis treatment to understand the pathology and follow-up?	3.58	0.90	1	8.3	0	0.0	2	16.7	9	75.0	91.7
Do the images enable transferring content to the target audience?	3.58	0.90	0	0.0	1	8.3	3	25.0	8	66.7	91.7
Are the visual compositions attractive and well-organized?	3.58	0.90	0	0.0	1	8.3	3	25.0	8	66.7	91.7
Is the number of images adequate?	3.75	0.94	0	0.0	0	0.0	3	25.0	9	75.0	100.0
Are the images integrated into the text content of the response letters?	3.67	0.92	0	0.0	0	0.0	4	33.3	8	66.7	100.0
Can the handbook serve as a document with the patient’s treatment history?	3.42	0.85	1	8.3	0	0.0	4	33.3	7	58.3	91.6
Verbal language
Is the reading level appropriate for the patient’s understanding?	3.00	0.75	1	8.3	1	8.3	7	58.3	3	25.0	83.3
Does the conversational style facilitate understanding of the text?	3.17	0.79	1	8.3	1	8.3	5	41.7	5	41.7	83.4
Does the vocabulary use common words?	3.08	0.77	1	8.3	3	25.0	2	16.7	6	50.0	66.7
Are the concepts covered clearly and objectively presented?	3.67	0.92	0	0.0	0	0.0	4	33.3	8	66.7	100.0
Is the verbal language easy to understand?	3.42	0.85	0	0.0	2	16.7	3	25.0	7	58.3	83.3
Does the handbook contain any errors or misleading information?	2.08	0.73	3	25.0	5	41.7	4	33.3	0	0.0	66.7
Cultural adequacy
Is the material culturally appropriate to the logic, language, and experience of the target audience?	3.50	0.88	0	0.0	1	8.3	4	33.3	7	58.3	91.6
Does it present culturally appropriate images and examples?	3.75	0.94	0	0.0	0	0.0	3	25.0	9	75.0	100.0

Item to be classified	*E	†A	‡NA	Score
1 - Content				99 %
1.1 Is the purpose clear?	35	-	-	100 %
1.2 Does the content address behaviors?	35			100 %
1.3 Is the content focused on purpose?	35	-	-	100 %
1.4 Does the content highlight key points?	34	1	-	98 %
2 - Literacy requirement				98 %
2.1 Reading level	32	2	1	94 %
2.2 Uses active voice writing	35	-	-	100 %
2.3 Uses vocabulary with common words in the text	34	1	-	98 %
2.4 Context comes before new information	35	-	-	100 %
2.5 Learning is facilitated by topics	35	-	-	100 %
3 - Ilustrations				98 %
3.1 The purpose of the illustration in relation to the text is clear	35	-	-	100 %
3.2 Types of illustrations	35	-	-	100 %
3.3 The figures/illustrations are relevant	33	2	-	97 %
3.4 Lists, tables, figures, etc. have explanations	35	-	-	100 %
3.5 The illustrations have captions	33	2	-	97 %
4 - Layout and presentation				99 %
4.1 Layout Features	35	-	-	100 %
4.2 Font size and typeface	34	1	-	98 %
4.3 Subtitles are used	35	-	-	100 %
5 - Learning motivation				97 %
5.1 Uses interaction	32	2	1	94 %
5.2 Guidelines are specific and provide examples	33	1	1	95 %
5.3 Motivation and self-efficacy	35	-	-	100 %
6 - Cultural adequacy				100 %
6.1 It is similar to the logic, language, and experience	35	-	-	100 %
6.2 Cultural image and examples	35	-	-	100 %
General				98 %

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Universidade Federal de Santa Catarina, Programa de Pós Graduação em Enfermagem Campus Universitário Trindade, 88040-970 Florianópolis - Santa Catarina - Brasil, Tel.: (55 48) 3721-4915 / (55 48) 3721-9043 - Florianópolis - SC - Brazil
E-mail: textoecontexto@contato.ufsc.br

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[TFN1] * CVC - Item Content Validity Coefficient; † SD - Strongly Disagree; ‡ D - Disagree; § A - Agree; || SA - Strongly Agree; ¶ C+CF - sum of agreement.