Construção e Validação de uma Calculadora Digital para Estratificação do Risco Gestacional na Atenção Primária à Saúde

Abstract

Objective: To construct and validate a gestational risk stratification instrument to support clinical decision-making in prenatal care within Primary Health Care, based on current regulations, as well as to develop and structure its operationalization in the form of a digital calculator for use in clinical practice. Methods: This methodological study was conducted between April 2025 and February 2026 and developed in two stages. The first stage consisted of content validation using the Modified Delphi Technique, conducted in two rounds. The criteria evaluated were extracted from an official guideline for gestational risk stratification previously agreed upon within the Sistema Único de Saúde (SUS). A panel of specialist gynecologist physicians and obstetric nurses assessed the items in terms of clarity, semantics, cohesion, relevance, and the scoring assigned to risk strata, using structured questionnaires on a Likert scale. Consensus was considered achieved when at least 75% of the evaluators agreed with the item, and the analysis was performed descriptively. In the second stage, the instrument was structured in a digital format, with standardization of criteria and calculation logic, resulting in a calculator that was subsequently evaluated by physicians and nurses working in Primary Health Care. A questionnaire was applied containing sociodemographic data, two clinical cases to be classified with the support of the calculator, and questions regarding perceptions and suggestions for improvement. To assess participants’ performance in relation to the clinical cases, the percentages of correct classifications were calculated for each case individually, as well as the concordance of correct responses across both cases. Results: In the first round of content validation, nine specialists participated, and 92.3% of the 68 items reached consensus, with most criteria demonstrating high agreement regarding wording and relevance. In the second round, seven judges participated, with a retention rate of 77.8%. Of the 16 questions that were re-presented in the second round, 10 (62.5%) reached consensus after textual adjustments or technical clarifications. The remaining disagreements, totaling six questions, were exclusively related to the scoring criterion, which defines the risk stratum for specific criteria. In the prototype validation stage, homogeneous performance was observed among different professional profiles: 33.1% correct responses in Clinical Case 1 and 76.4% in Clinical Case 2. Qualitative analysis of the suggestions presented by professionals revealed four main areas for improvement of the calculator, despite the high acceptance of the tool. Conclusion: The instrument demonstrated satisfactory content validity, with a high level of consensus among specialists, and its subsequent structuring in the format of a digital calculator expanded its practical applicability, proving to be a potential tool to support clinical decision-making in prenatal care within Primary Health Care. However, adjustments are still required for it to adequately contribute to strengthening regulatory frameworks with locoregional characteristics.