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Table 4 Evaluation of item equivalence between the Brazilian HCWM-RAT version and the original HCWM-RAT version

From: Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management • rapid assessment tool

Original Final brazilian version Comments
200 - health care facility (HCF): which category is it (are they)?
[1] ambulant service; [2] (sub-)district hospital
Estabelecimento de saúde (ES): Qual é o tipo do estabelecimento e a que nível de hierarquia pertence?
1] ES para atenção básica; [2] ES de média complexidade; [3] ES de alta complexidade
The terms “type” (tipo) and “level hierarchy” (“nível de hierarquia”) are used in the Brazilian database (CNES) to register HCF to operationalize the Informational Systems in Health. The HCF “type” is defined based on the professional activities and the services offered to a population. The “hierarchy level” indicates the degree of complexity of services provided (basic health assistance, medium and high complexity).
201 - HCF which type is it (are they)?
[1] public; [2] private
ES – De que natureza é?
[1] público; [2] privado; [3] outros (especificar)
In the Brazilian database (CNES) the term “nature” (“natureza”) defines the origin of the organization share capital and the HCF administrative link. Option 3 “others (specify)” makes possible the identification of the different administrative conditions found in Brazil.
401 - domestic waste: quantity produced/day (estimated, in kg or litres) resíduos similares aos sólidos urbanos (RSU): quantidade gerada por dia (estimativa, em kg ou litros) According to experts the term “similar to urban waste” (RSU) is the closest term applicable, for Brazilian culture. This item refers to the quantity of waste generated per day that is capable of being recycled or reused.
404 - anatomic waste: quantity produced/day (estimated, in kg or litres) peças anatômicas: quantidade gerada por dia/semana (estimativa, em kg ou litros) The term “anatomic waste” was changed to “peças anatômicas” because in the target culture the term “waste” has a negative connotation (equivalent to “garbage”), which would be considered offensive when applied to human body organs or parts. The term “produced” denotes the interest in conceiving a product. The use of the word “gerada” gives the sense of a byproduct that results from any activity or procedure and that has no use. In the target culture HCW is generated, not produced.
405 - pharmaceutical waste: quantity produced/day (estimated, in kg) Resíduo químico-farmacêutico: quantidade gerada por dia/semana (estimativa, em kg ou litros) This item uses a terminology (“químico-farmacêutico”) suggested by the target population and the experts’ committee, to accommodate the difference in waste classification. Since “pharmaceutical” is not a Brazilian waste category, classifying such waste simply as category B, “chemicals” would include more than just pharmaceutical waste. This item can apply to the amount of pharmaceutical waste generated.
501 - needle stick injuries: how many cases reported in the past 12 months ferimentos com perfurocortantes: quantos casos foram relatados nos últimos 12 meses? This item uses the terminology used in Brazilian regulations (Anvisa n° 306/04 and Conama n° 358/05) to refer to Group E – “Perfurocortantes” waste. This item asks about the number of accidents that occurred during a year.
900 - transport services: are there any control measures?
[0] none; [1] transport form; [2] other (specify)
serviços de transporte: há alguma medida de controle?
[0] nenhuma; [1] forma de transporte; [2] emissão de documento de manifesto, CADRI,…; [3] outro (especificar)
In order to identify the measures of control used by the HCW transporters, two document examples were inserted: “manifesto” (waste transportation manifesto, used in the state of Rio de Janeiro) and “CADRI” (certificate of transportation of environmental interest waste, used in São Paulo state) as an option. These documents consist of legal ways to control and monitor the waste transported to treatment and disposal sites licensed by environmental organizations.
1007 - domestic waste: how is it generally treated? resíduos similares aos RSU: geralmente, como são tratados (manejados - ogânico e recicláveis)? In this item, a term in parenthesis, suggested by the experts’ committee and the target population during the field test, was included. In Brazil, the term “treated” is not applied to the category of domestic waste, which is sent to reprocessing. In order to preserve semantic equivalence, the term “treated” was changed to the “way of handling” “similar to urban waste” (RSU) (“manejo – orgânico e recicláveis”).
1202 - national HCWM regulations: does their application cause any problems ? regulamentações nacionais para GRSS: a aplicação da regulamentação gera algum tipo de situação-problema? Suggestion of the target population (during the field test) and the experts’ committee: In the Brazilian cultural context, the word “problem” relates to a negative condition obtained by following the regulation. Hence, the term was changed to “issue” (“situação-problema”). In the re-test this item was evaluated as capable of allowing conflicts to emerge during HCWM regulations application.
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