Frequently Asked Questions

The APREMDI is a Brazilian Portuguese adaptation of the Scale of Perception of Respect for and Maintenance of the Dignity of the Inpatient, designed to measure how hospitalized patients perceive respect for their dignity during care. It assesses 6 dimensions of dignity: privacy/intimacy, integrity, identity, information, respect, and consideration, using 19 items rated on a 1 to 5 Likert scale.

Yes. The validation included 337 completed responses from adult inpatients in psychiatric, medical, and surgical units across 3 tertiary hospitals in Rio de Janeiro, recruited between September 2022 and May 2024. With 19 items on the scale, this yielded about 17.7 participants per item, which the authors reported as within the optimal range for robust exploratory and confirmatory factor analysis.

The APREMDI showed strong psychometric performance in this sample. Sampling adequacy was good, with a Bartlett test of sphericity of c72 = 3,785.8, df = 171, P < .001 and a Kaiser-Meyer-Olkin measure of 0.895. Exploratory factor analysis supported a 6-factor structure, while several indices also suggested a strong overall dignity factor.

The first factor explained 53.56% of the total variance, and parallel analysis showed F1 explaining 53.71% of the variance in the real data versus 12.36% in simulated datasets. Additional indicators supporting closeness to unidimensionality were unidimensional congruence of 0.977, explained common variance of 0.885, and mean item residual absolute loading of 0.227.

Yes. Confirmatory factor analysis supported a second-order model with 6 first-order factors corresponding to the theoretical dignity domains. Most standardized factor loadings were above 0.70, although one item, V19, loaded slightly below that threshold.

Model fit indices were strong: RMSEA = 0.000 (95% CI, 0.000b20.6865), CFI = 0.999, TLI = 1.035, GFI = 0.987, and RMSR = 0.028. The authors noted, however, that the wide RMSEA confidence interval suggests possible estimation instability and supports the need for replication in independent samples.

Yes. Higher anxiety was associated with lower perceived dignity. The APREMDI total score had a weak but statistically significant negative correlation with the HADS total score (r = b20.20, P = .019), and in multiple regression, only anxiety measured by HADS-A remained a significant predictor of lower APREMDI scores (b2 = b20.17, P = .031).

The regression model explained a modest proportion of variance (R2 = 0.062), which the authors interpreted as suggesting that other interpersonal and contextual factors may also play important roles in perceived dignity.

Most of those correlations were not statistically significant in this study. The APREMDI was not significantly correlated with Lawton-Brody instrumental activities of daily living (r = b20.06, P = .468), Pfeffer functional activities (r = b20.09, P = .293), PHQ-9 depression symptoms (r = b20.13, P = .130), or CD-RISC-Br resilience (r = 0.11, P = .195).

The authors interpreted these findings as supporting good discriminant properties for the scale, although weak concurrent correlations were observed in the expected directions for anxiety, depression, functional dependency, reduced ability, and resilience.

The APREMDI appeared feasible but moderately complex. Readability metrics included a Flesch Reading Ease of 44.9, Flesch-Kincaid Grade Level of 11.1, Gunning Fog Index of 10.5, Coleman-Liau Index of 12.0, Automated Readability Index of 9.6, and Gulpease Index of 59.6, which the authors said suggest suitability for readers with at least a high school education.

Average reading time ranged from 1.08 to 1.35 minutes. The authors concluded that the scale is suitable for educated populations but may require simplification or assisted administration in lower-literacy settings.

No statistically significant differences were found across education levels for age, length of hospitalization, or time to complete the scale. The analysis showed F2,334 = 1.27, P = .281 for age, F2,334 = 0.31, P = .731 for length of stay, and F2,334 = 0.13, P = .877 for completion time.

Post hoc tests also found no significant pairwise differences, Levene tests were nonsignificant, and effect sizes were negligible (b72 < 0.01). In this sample, education level did not explain meaningful variance in those outcomes.

Items V7 and V8 showed the strongest discrimination in item response analysis, meaning they were especially sensitive to differences in perceived dignity. Overall discrimination values ranged from 0.532 for V16 to 3.718 for V8.

The authors reported that V4 and V16 had weaker but still acceptable performance. They also noted that some negatively worded items, including V7 and V8, required higher latent trait levels for endorsement and may need wording refinement for clarity.

The authors concluded that the APREMDI is a practical tool for assessing inpatients' perceptions of dignity in both psychiatric and general hospital settings. They suggest it can be used for quality assessment, staff training, ethics review, satisfaction assessment, and monitoring of respect-related experiences during hospitalization.

Because the scale captures 6 dignity-related domains, it may help teams identify specific areas for improvement in communication, humane care, and institutional accountability. The study also suggests that attention to anxiety symptoms should be part of this work, since higher anxiety predicted lower perceived dignity.

The main limitations are that the sample was a convenience sample from 3 hospitals in southeastern Brazil, which may limit generalizability to other Brazilian regions or populations such as rural, indigenous, northern, or southern groups. The authors also noted that the wide RMSEA confidence interval may indicate possible overfitting and supports replication in larger, independent samples.

Additional limitations were potential bias from self-report data, especially because social desirability or power dynamics may influence responses in hospital settings, and the fact that readability indices do not fully capture cognitive or contextual barriers. The authors also noted that negatively worded items such as V7 and V8 showed higher variability and lower means, suggesting a need for wording refinement.