Clinical Summary
Clinical Summary: Validation of the Adapted Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient for Brazilian Portuguese: A Multicenter Cross-Sectional Study
Hospitalized patients, especially those in psychiatric and other high-dependency settings, can experience subtle losses of privacy, autonomy, and respect that routine quality metrics miss. This study validates a Brazilian Portuguese instrument that gives clinicians and institutions a way to measure patients’ perceived dignity directly and identify where care experiences are falling short.
Design
This multicenter cross-sectional study was conducted to culturally adapt and validate the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient for use in Brazil.
N
337 completed responses
Population
337 inpatients were recruited through convenience sampling from psychiatric, medical, and surgical units across 3 tertiary hospitals in Rio de Janeiro
Duration
between September 2022 and May 2024
Key Findings
- The APREMDI showed strong internal structure for inpatient dignity assessment: Bartlett test of sphericity was highly significant (χ2 =3,785.8, df=171, P <.001), the Kaiser-Meyer-Olkin measure was 0.895, and parallel analysis supported a 6-factor solution with F1 explaining 53.71% of the variance in real data versus 12.36% in randomly simulated datasets.
- Exploratory factor analysis suggested a strong general dignity factor despite 6 conceptual domains: the first factor accounted for 53.56% of the total variance (eigenvalue = 10.19), and the cumulative variance explained by the first 4 factors was 72.45%.
- Confirmatory factor analysis supported the second-order model, with fit indices of RMSEA=0.000 (95% CI, 0.000–0.6865), CFI=0.999, TLI =1.035, GFI =0.987, and RMSR=0.028.
- Higher anxiety was associated with lower perceived dignity: the APREMDI had a weak but statistically significant negative correlation with the HADS total score (r=−0.20, P=.019), and in multiple regression only anxiety (HADS-A) remained significant (β=−0.17, P=.031; R2 = 0.062).
- Readability testing showed the scale is feasible but moderately complex, with Flesch Reading Ease (44.9), Gunning Fog Index (10.5), Flesch-Kincaid Grade Level (11.1), Coleman-Liau Index (12.0), Automated Readability Index (9.6), Gulpease Index (59.6), and average reading time ranging from 1.08 to 1.35 minutes.
Clinical Bottom Line
APREMDI provides a psychometrically strong, practical way to measure hospitalized patients’ perceptions of dignity in Brazilian Portuguese across psychiatric, medical, and surgical settings. Inpatient anxiety tracks with lower dignity perception, so dignity assessment and distress assessment belong together in routine care quality review.
Practice Implications
- Use APREMDI as a patient-reported quality tool across inpatient units to detect dignity problems that standard satisfaction measures may miss, especially given the supported 6-factor structure and strong general factor.
- Pay closer attention to anxiety symptoms during hospitalization, because higher anxiety was linked to lower APREMDI scores (β=−0.17, P=.031), making psychological distress an important target when addressing perceived disrespect or loss of autonomy.
- Plan administration thoughtfully in lower-literacy settings, since readability indices placed the scale around high school level and average reading time was 1.08 to 1.35 minutes; assisted administration or simplified versions may be needed.
- Use item-level results to focus staff training on the most sensitive markers of dignity violations, as discrimination values ranged from 0.532 (V16) to 3.718 (V8), with V7 and V8 showing particularly strong discrimination.
