Cultural Adaptation and Validation of the WHO QualityRights Training to Brazilian Portuguese

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The WHO QualityRights training is an important educational tool for empowering health professionals and driving institutional change. Recognizing the need for culturally relevant mental health training materials in Brazil, this study aimed to adapt and validate the WHO QualityRights training modules into Brazilian Portuguese. Methods : Seven modules were translated and validated through four stages (translation, synthesis, expert committee review, and pretesting), following models by Beaton et al. (2000) and Pasquali (1998). A total of 42 experts evaluated semantic, idiomatic, and conceptual equivalence using the Content Validation Index (CVI). The pretest involved 21 primary health care professionals, who assessed the training's relevance through closed and open-ended questions. Quantitative analyses were performed using IBM® SPSS Statistics version 25, while qualitative data were analyzed using Braun & Clarke’s Thematic Analysis. Results : The CVI ranged from 93% to 99% across modules, confirming content validity. During pretesting, 82.6% of participants found the training relevant and applicable to their practice. Responses to open-ended questions revealed three themes, highlighting increased empathy, understanding of human rights-based approaches, and the effectiveness of the training methodology used by facilitators. Conclusions : The training modules were well-received and understood, demonstrating potential to promote human rights-oriented mental health care tailored to Brazil’s cultural and contextual needs. This approach could also serve as a replicable model for other low- and middle-income countries aiming to integrate human rights into health services. Human Rights Mental Health People with disability CRPD Training QualityRights Rights-based care World Health Organization Validation Study Figures Figure 1 Figure 2 Introduction Mental health has gained increasing prominence on global health agendas and is recognized as a priority by international organizations(1). Various global recommendations point to the need to expand mental health services in primary care and community contexts, emphasizing promotion, prevention, and the integration of human rights as a central theme(2). The relationship between mental health and human rights is complex and bidirectional: on the one hand, the violation of human rights can worsen mental health conditions; on the other hand, the protection and promotion of these rights can contribute to better health outcomes(3,4). The concept of recovery-oriented care advocates that the integration of human rights principles into mental health policies and practices can promote autonomy, dignity, and personal safety—elements that are fundamental for the recovery process(5). In this sense, the shift from an institutional model to a community care model has been a crucial strategy to reduce human rights violations, especially in institutional environments where abuses are more frequent(4). Consequently, the inclusion of human rights has been a central consideration in revisions of mental health policies worldwide(4). The 2030 Sustainable Development Goals (SDGs) also recognize the importance of promoting mental health and emphasize the need for greater investment in mental health services, with discussions about a possible paradigm shift to face existing challenges(6)(7). In this context, mental health services must consider equitable, evidence-based, and recovery-oriented access, ensuring that human rights are respected at all stages of care(8). Furthermore, the Convention on the Rights of Persons with Disabilities (CRPD), adopted by the United Nations in 2006, reaffirms the need for countries to protect the rights of persons with disabilities, including those with mental and psychosocial disorders(9). The CRPD establishes clear guidelines for national legislation to promote social changes that ensure respect for the rights of these populations, protecting them against abuse, discrimination, and inhumane treatment. However, despite these legal and normative advances, many regions still face significant challenges in implementing these rights, as demonstrated in studies addressing human rights violations in mental health institutions(10,11). In light of this situation, the World Health Organization (WHO) launched the QualityRights Initiative in 2012(12), which offers practical solutions to mitigate such abuses(13). This initiative aims to improve living conditions and promote human rights in mental health and social care units, both for hospitalized and outpatient patients. Additionally, it aims to empower organizations in advocating for the rights of individuals with mental and psychosocial disabilities, ensuring the quality of mental health services. The project encompasses proposals, actions, tools, and comprehensive programs aimed at safeguarding the rights of users of these services(12,14). The QualityRights Initiative includes various tools, including training tools consisting of five core modules addressing human rights, mental health, disability, the right to health and recovery, legal capacity, and the right to freedom from coercion, violence, and abuse. Additionally, it includes three specialized trainings focused on recovery practices, strategies to combat isolation and restraint, and support for decision-making and advance planning(9). Several studies have demonstrated the effectiveness of QualityRights training tools in training health professionals(9,15,16). In Brazil, despite advances in mental health legislation, there are still significant gaps regarding training tools specifically adapted to address this theme in the national context. Most Brazilian health professionals do not have access to structured training that integrates human rights principles, such as those outlined in the CRPD, into their daily practices(17,18). This highlights the need to adapt tools such as the QualityRights training tool to Brazilian reality, considering the cultural specificities and particularities of the local health system. The cultural adaptation of these tools not only makes the content more accessible and relevant but also ensures that mental health and human rights issues are addressed in a manner sensitive to the country’s socioeconomic and cultural context. The lack of adequate training aimed at promoting human rights in mental health can hinder the fight against violations that still occur in institutions and outpatient care(19). Additionally, health professionals trained with culturally adapted tools have greater potential to offer more humanized care aligned with human rights, which is essential for promoting recovery and the dignity of service users. Thus, the adaptation and validation of the WHO QualityRights Initiative modules in Brazil represent a fundamental step to fill this gap, contributing to the strengthening of mental health care in the country and promoting an environment of respect and protection for human rights. WHO QualityRights Training Tools The QualityRights training and guidance modules were developed to enhance knowledge, skills, and understanding among mental health practitioners; individuals with psychosocial, intellectual, and cognitive disabilities; mental health service users; families; care partners; other supporters; nongovernmental organizations; organizations of persons with disabilities; and others. These modules focus on promoting the rights of individuals with psychosocial, intellectual, or cognitive disabilities and improving the quality of mental health and related services and support. They align with international human rights standards, particularly the CRPD, and emphasize a recovery-oriented approach(14). The ultimate goal of the WHO’s QualityRights initiative is to bring about sustainable changes in mindsets and practices, empowering all stakeholders to advocate for rights and recovery. This, in turn, aims to improve the lives of people with psychosocial, intellectual, or cognitive disabilities worldwide. The QualityRights training modules cover crucial topics, including human rights, mental health and disability, legal capacity, recovery, and strategies to prevent coercion, violence, and abuse in mental health services. Through these modules, participants gain a comprehensive understanding of the rights of individuals with disabilities, learning to identify and address human rights violations while promoting supportive and inclusive mental health services(14). Each module includes practical, scenario-based exercises designed to deepen participants' understanding of human rights principles and legal frameworks, such as the CRPD. This training initiative ultimately aims to reshape mindsets and practices in mental health services to ensure that they respect, protect, and fulfill the rights of individuals with disabilities. By doing so, it fosters an inclusive, supportive, and rights-based approach to care. Aims and objectives The current study aims to describe the cultural adaptation and validation of the WHO QualityRights training tools in Brazilian Portuguese. Method This study conducted the cultural adaptation and validation of seven of the eight training modules of the QualityRights Initiative. The included modules were Human Rights, Mental Health, Disability and Human Rights, Recovery and the Right to Health, Legal Capacity and the Right to Decide, Protection from Coercion, Violence, and Abuse, Supported Decision-Making and Advance Planning, and Recovery Practices for Mental Health and Well-Being. The remaining module, "Strategies to End Isolation and Restraint," had already been adapted and validated in a previous pilot study(20). The primary objective of the methodological approach was to evaluate and validate the QualityRights Initiative modules, initially developed in English, in the Brazilian context, ensuring their reliability for use in educational contexts(21,22). This methodological proposal was adapted from the model of Beaton et al.(23) and Pasquali(24). Thus, the steps followed in this study are are detailed below: Stage I: Translation The translation of the modules involved translation from the original language (English) to the target language (Brazilian Portuguese). The translation was performed by a contracted company and reviewed by two different and independent researchers who are native to the target language (Portuguese) and have different professions, as this allows for the detection of errors and divergent interpretations(23). Stage II: Synthesis After the review, the two researchers met to synthesize their assessments regarding the translations of the materials. The versions from the first and second reviewers resulted in a common version. The entire synthesis process was documented in writing, carefully detailing each issue discussed and the solutions adopted. Notably, decisions were made by consensus, preventing anyone from relinquishing their opinions on critical translation aspects. In this way, all suggestions and disagreements were duly considered, resulting in a version that accurately represented the original content while maintaining its cultural and semantic relevance in the Brazilian context. This synthesis process was essential to ensure that the final translation was clear, understandable, and adaptable to the target audience's particularities, ensuring that the nuances of the original language were preserved. Stage III: Expert Committee The methodology for validating the instrument, adapted from the model proposed by Pasquali(24), prioritized theoretical procedures because of the nature of the educational manual(25). For this purpose, a committee of judges was tasked with evaluating the semantic, idiomatic, cultural, and conceptual equivalences of the material, following the recommendations of Pasquali(26) and Polit & Beck(27). For such validation, the participation of six to ten specialists is needed(27). An agreement of at least 80% among the judges serves as a decision criterion regarding the relevance and/or acceptance of the item to which it theoretically refers(26). The search for these specialists was actively conducted via the snowball technique(28,29). The experts were selected through the Lattes Curriculum on the website of the National Council for Scientific and Technological Development (CNPq) in Brazil, using specific keywords related to the area of training and action (law, psychology, and nursing) and the line of research of interest (human rights and mental health). A total of 83 specialists were invited via email, which averages ten invitations per module. Of these, 48 agreed and participated in the evaluation, with six specialists for each of the training modules, who also received the research material via email. To assess the experts' agreement regarding the material, we used an adaptation of the suitability assessment of materials (SAM), which was culturally validated by Sousa, Turrini, and Poveda(30), and a Likert scale to facilitate participant understanding(31,32). The SAM consists of a list with six categories that evaluate the appropriateness of the material for patients. After the evaluation, the experts' suggestions were analyzed and incorporated. Stage IV: Pretesting After the experts' evaluation, a pretest was conducted. The pretest aimed to verify whether the training was comprehensible to all the members of the target population it was intended for. Thus, the modules were offered through a training course for health professionals at a primary health care service. This service provides essential services to the community: medical clinics, pediatrics, gynecology and obstetrics, vaccinations, dentistry, nursing, pharmaceutical assistance, and home visits. Educational activities are also promoted for pregnant women, hypertensive individuals, and diabetic individuals, in addition to physical exercise sessions and mental health care within the community. The modules were offered as a training course for healthcare professionals, with each module conducted on a specific prescheduled date coordinated with the health unit manager. A multidisciplinary team with expertise in relevant topics and prior experience with the QualityRights Initiative designed and delivered the training. Throughout the course, a support team consisting of nurses, psychologists, lawyers, and nursing students assisted with preparation and provided onsite support during each module. Since the training materials are comprehensive and time and resources may be limited, the QualityRights Initiative team recommends adapting the training to the group's existing knowledge, background, and desired outcomes. Consequently, each training session was tailored to the local context, respecting the availability of the health unit professionals and aiming to last no more than 1.5--2 hours per day. This adaptation was carried out by the principal researchers, who carefully reviewed the content of each module to eliminate unnecessary repetitions. Table 1 below provides a summary of the topics covered in each training module offered at the health unit. Table 1. Summary of the QualityRights training module content Learning objectives Topics Human Rights • understand what human rights are, as well as the links between the different rights; • understand the origins and content of the Universal Declaration of Human Rights and how the rights it contains are still relevant today; • recognize human rights violations in specific situations; • understand what makes groups of people at higher risk of human rights violations; • identify who defends human rights; • identify specific ways in which mental health workers and other professionals, people with psychosocial disabilities or intellectual or cognitive disabilities, families, care partners and other supporters can be agents of change and defenders of human rights. 1: Human rights and living a good life 2: What are human rights? 3: The relationship between different rights 4: Examples of human rights violations 5: Groups/segments of the population at risk of human rights violations 6: Consequences of human rights violations 7: Respecting, protecting and fulfilling human rights 8: Empowering people to defend human rights 9: Human rights advocacy Mental Health, Disability and human rights • understand the concepts of discrimination and denial of rights; • understand the concept of disability; • acquire an understanding of the Convention on the Rights of Persons with Disabilities (CRPD) and how this instrument is central to respecting, protecting and fulfilling the human rights of persons with disabilities; • be able to apply knowledge of the CRPD to real-life scenarios and identify violation of the rights of persons with disabilities; • be able to identify concrete ways to respect and uphold the rights of people with psychosocial, intellectual or cognitive disabilities. 1: Understanding discrimination and denial of rights 2: Understanding disability from a human rights’ perspective 3: The Convention on the Rights of Persons with Disabilities 4: Applying the CRPD to real-life scenarios 5: Zooming in on article 12 – Equal recognition before the law 6: Zooming in on article 16 – Freedom from exploitation, violence and abuse 7: Zooming in on article 19 – Living independently and being included in the community 8: Empowering people to defend CRPD rights Recovery and right to health • understand the concepts of mental health and well-being; • explore what mental health and related services can do to promote people’s health and well-being; • understand the key components of, and barriers to, recovery; • develop an understanding of the role of mental health and related services in promoting and supporting health and recovery; • explore how individuals and services can respect, protect and fulfill people’s right to health and recovery. 1: What is mental health? 2: Promoting the right to health in mental health and social services 3: What is recovery? 4: Promoting recovery 5: The role of practitioners and mental health and social services in promoting recovery Legal capacity and the right to decide • learn to challenge the misconceptions around the decision-making skills of people with psychosocial, intellectual and cognitive disabilities; • understand article 12 of the CRPD and the right to legal capacity; • learn how to respect the right to legal capacity in specific scenarios; • gain applied knowledge of supported decision-making and advance planning; • explore how to ensure that people are not detained and/or treated against their wishes. 1: Understanding the right to legal capacity 2: Supported decision-making and advance planning 3: Informed consent and person-led treatment and recovery plans 4: Avoiding involuntary detention and treatment in mental health and social services Freedom from coercion, violence and abuse • understand how and why violence, coercion and abuse occur in mental health and social care settings; • understand the impact of violence, coercion and abuse; • apply knowledge of the CRPD to understand how it protects people with disabilities from violence, coercion and abuse; • understand and address attitudes, power relations and dynamics in mental health and social care settings; • understand and apply different approaches and strategies for diffusing conflictual and tense situations. 1: What are violence, coercion and abuse? 2: What does the CRPD say about violence, coercion and abuse? 3: What are the impacts of violence, coercion and abuse? 4: Why are these practices happening? 5: Understanding attitudes and power relations 6: Key strategies to avoid and defuse conflictual situations 7: Communication techniques 9: Creating a “saying yes” and “can do” culture 10: Individualized plans to explore and respond to sensitivities and signs of distress 12: Complaints and reporting procedures 13: Stopping violence, coercion and abuse in my mental health or social service Supported decision-making and advance planning • be able to appreciate how negative assumptions about people with psychosocial, intellectual or cognitive disabilities impact on their right to make decisions; • understand the importance of supporting people in exercising their fundamental human rights to make their own choices and have control over their lives; • understand the difference between substitute decision-making and supported decision making; • gain an understanding of the human rights principles underlying the concept of supported decision-making; • be able to take personal actions to adopt a supported decision-making approach; • be able to use advance planning as a tool to ensure that people’s will and preferences are respected. 1: Challenging denial of legal capacity in mental health 2: Substitute versus supported decision-making 3: Supported decision-making in practice 4: Nominating a person to communicate best interpretation of will and preferences 5: Positive steps to adopt a supported decision-making approach 6: What is advance planning? 7: Making advance planning documents Recovery practices for mental health and well-being • gain an in-depth knowledge of the recovery approach to mental health care and its key principles and components; • understand and discuss the role of people with psychosocial disabilities, mental health and other practitioners, family, care partners and other supporters in promoting recovery; • develop recovery communication skills; • learn how to apply the principles of recovery-oriented care; • learn how to create a recovery plan. 1: What is recovery? 2: Recovery-oriented services and practices 6: Working alongside people 7: Boundaries within the context of recovery practices After all the training modules were offered to the target population (pretest), the participants evaluated the training via the QualityRights Initiative evaluation instrument (training evaluation tool) regarding the level of content provided (measured on a 5-point Likert scale: Very Basic, Basic, Reasonable, Advanced, or Very Advanced), the facilitators, and the learning needs, expectations, and utility of the training (Strongly Disagree, Disagree, Neutral, Agree, or Strongly Agree). The training evaluation tool also included open-ended questions, in which healthcare professionals could express their opinions (see Additional file 1). Data analysis Stage III Expert Committee The information from the professionals and their sociodemographic data were coded and entered into Excel spreadsheets, which assigned codes to the characteristics and profiles. A descriptive analysis was subsequently conducted, and frequencies and percentages were calculated via IBM SPSS Statistics v.25 software. To analyze the data from the SAM assessment instrument, the average agreement among participants was calculated(25). The method used to quantify the degree of agreement among specialists during the content validity assessment was the content validity index (CVI), which is calculated on the basis of the representativeness of positive responses from specialists. The content validity index (CVI) is a measure that assesses agreement among judges regarding the aspects of the instrument and its items, with those marked as "agree" or "strongly agree" being considered representative, achieving a score of 1.00—indicating 100% agreement(33). To calculate the CVI, the item responses were regrouped and assigned scores from -1 to +1. The average agreement of the judges' committee was calculated from these responses(25). For item approval, at least 80% agreement among professionals is needed(26). The evaluation of the instrument as a whole can be conducted in three ways, with a recommended rating of no less than 0.78 when the number of items is six or more specialists(27). In this study, the evaluation was performed by dividing the total number of items considered relevant by the total number of items answered in the instrument. Data Analysis Stage IV Pretesting Each participant (health professional) received a unique identification code that was followed throughout the study (Examples: ACS1 - Community Health Agent; ENF2 - Nurse; MED3 - Doctor). Data obtained after the training were analyzed via simple descriptive statistical methods for both absolute and relative numbers on the Likert scales. This analysis was conducted with the help of the Statistical Package for the Social Sciences (SPSS), version 25. The open responses from the posttraining questionnaire were analyzed via the content analysis technique of Braun and Clarke(34), which allows for a deeper understanding of the content and facilitates the synthesis of the main elements present in communication(34). Figure 1 summarizes the stages of the translation, cultural adaptation, and validation process. Ethical Approval The research was approved by the Ethics Committee of the School of Nursing of Ribeirão Preto at the University of São Paulo (Number: 6.257.303/2021). The free and informed consent term was read and signed by the participants (experts and healthcare professionals) in two copies, with one kept by them and the other by the research team. To preserve the anonymity of the responses from the open-ended questions, codes were assigned to the healthcare professional participants (ACS, ENF, TEC-ENF). The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings(35). Notably, the QualityRights training materials are publicly available and hosted on the WHO website, and the research project was authorized by WHO to translate and apply them in the Brazilian context. Results Demographics The sociodemographic characteristics of the experts who contributed to this study revealed a variety of profiles. Each module included six participants, with ages ranging from 24--59 years, distributed across specific sexes (predominantly females in five of the seven modules). The professions represented included nurses, university professors, researchers, lawyers, psychologists, and public defenders. The predominant educational level was a master's degree, followed by a doctoral degree and specialization in some modules. Table 2 presents the sociodemographic characteristics of the judges/experts in the different modules. Table 2. Sociodemographic Characteristics Experts Committee Module Participants Age Range Gender (Majority) Professions Education Level Human Rights 6 27-59 years Male (66.67%) Nurses (50.00%), University Professors (16.67%), Lawyers (33.33%) Master's (100%) Mental Health, Disability, and Human Rights 6 26-45 years Female (66.7%) Nurses (16.67%), University Professors (50.00%), Researchers (33.33%) Master's (66.70%), Doctorate (33.30%) Recovery and the Right to Health 6 24-45 years Female (66.7%) Nurses (16.67%), University Professors (50.00%), Researchers (33.33%) Master's (66.70%), Doctorate (33.30%) Legal Capacity and the Right to Decide 6 27-55 years Female (66.7%) Nurses (50.00%), University Professors (16.67%), Supplementary Health Auditors (16.67%), Lawyers (16.67%) Doctorate (50.00%), Master's (16.70%), Specialization/Residency (33.30%) Freedom from Coercion, Violence, and Abuse 6 24-42 years Male (50%), Female (50%) Nurses (16.67%), University Professors (16.67%), Police Officers (16.67%), Psychologists (16.67%), Researchers (33.33%) Master's (66.70%), Doctorate (33.30%) Supported Decision-Making and Advance Planning 6 27-50 years Female (83.3%) Nurses (33.33%), University Professors (16.67%), Public Defenders (16.67%), Researchers (16.67%) Master's (66.70%), Doctorate (33.30%) Recovery Practices for Mental Health and Well-Being 6 24-50 years Female (66.7%) Nurses (50.00%), Psychologists (16.67%), Researchers (33.33%) Master's (66.70%), Doctorate (16.70%), Specialization/Residency (16.70%) With respect to the sociodemographic characteristics of the target population (pretesting stage), which included 21 study participants, the age range varied from 29--70 years, with the majority (76.19%) being female. At the time, the majority (38.10%) did not respond to the topic of whether they had participated in a course or previous training on human rights and/or mental health, 33.33% reported not having participated, and 28.57% reported having participated. Among the professionals, the majority (57.14%) were Community Health Agents (ACS); however, the group also included nurses (19.05%), nursing technicians (14.29%), and doctors (09.52%), with work time in the current service ranging from 4 months to 31 years. With respect to professional training, they have technical high school courses and undergraduate degrees in administration, public management, nursing, and medicine, with training times ranging from 2--35 years. Among the participating professionals, 8 held postgraduate degrees, with the majority (75.00%) holding specialization/residency, (12.50%) holding a master's degree, and (12.50%) holding a doctorate, with the areas of qualification encompassing public management, collective health, family health, and worker health (Table 3). Table 3. Sociodemographic characteristics of the target population (pretesting stage) Module Participants Age Range Gender (Majority) Professions Education Level Core training (All modules) 21 29-70 years Female (76.19%) Community Health Agents (ACS) (57.14%), Nurses (19.05%), Nursing technicians (14.29%), Doctors (09.52%) Specialization/Residency (75.00%) Master's (12.50%) Doctorate (12.50%) Specialized training (Supported Decision-Making and Advance Planning; Recovery Practices for Mental Health and Well-Being) Equivalences In the evaluation carried out by the experts in the different modules, variations in item approval rates were observed. In the Human Rights Module, most items received 100% approval, with the exception of one item that recorded 83% approval, resulting in an overall approval rate of 99%. In the Mental Health, Disability and Human Rights Module, most items achieved 100% approval, with some specific items recording 83% approval, culminating in a total rate of 96%. In the Recovery and the Right to Health Module, most items were fully approved, with only one item recording 83% approval, totaling 99% overall approval. In the Legal Capacity and the Right to Decide Module, although most items reached 100% approval, some recorded rates between 50% and 83%, resulting in variable total approval. In the Freedom from Coercion, Violence and Abuse Module, the vast majority of items were approved, except for a single item that recorded 83% approval, culminating in a total rate of 99%. In the Supported Decision-Making and Advance Planning Module, most items were approved, but some recorded approval rates of 83% and 67%, resulting in variable overall approval rates. Finally, in the Recovery Practices for Mental Health and Well-Being Module, although most items achieved 100% approval, some recorded 83% approval, resulting in a total rate of 96%. The details are summarized in Table 4. Table 4. Validation Results of Each Module According to Expert Opinion Module Total Approval of Each Module Content Validity Index (CVI) Approval Percentage Human rights 0,99 99% Mental health, disability and human rights 0,96 96% Recovery and the right to health 0,99 99% Legal capacity and the right to decide 0,93 93% Freedom from coercion, violence and abuse 0,99 99% Supported decision-making and advance planning 0,96 96% Recovery practices for mental health and well-being 0,96 96% In addition to the evaluation via the Likert scale, the experts could provide suggestions for each item. To improve any item that did not achieve maximum approval (100%), all the suggestions were accepted, and modifications were made to the module before the pretesting stage. The suggestions focused on enhancing the clarity and detail of the texts, with topics that facilitate reading and comprehension. Adjustments were recommended for the language, particularly replacing foreign and academic terms with simpler equivalents, as well as defining technical terms. The inclusion of more illustrations was also suggested to enhance visual communication, and there was a reinforced need to create an interactive environment to encourage participation from those involved. Target population evaluation According to the skill and knowledge level of the participants, 68% considered the content level advanced, 12% basic, 8% very basic, and 12% reasonable. The majority of the content agreed that it was relevant (82.6%), as was its flow and corresponding activities (82.6%), with clarity in communication (73.9%), participant engagement (69.6%), useful scenarios (69.6%) and discussions (73.9%), and sufficient information (82.6%). Concerning the individuals who facilitated the training, a large majority agreed or strongly agreed that the communication was clear (52%; 32%), with participant engagement (56%; 32%), useful questions answered (52%; 36%), creating a participatory environment (56%; 32%), and respecting participants' viewpoints (52%; 40%). The participants agreed that, overall, the training met their learning needs (72%) and expectations (69.6%) and was useful in their work/life (60.9%). Furthermore, they agreed that the training changed attitudes toward individuals with psychosocial, intellectual, and cognitive disabilities (78.3%) or would alter personal practices/aspects (78.3%). All these data are detailed in Table 5. Table 5. Distribution of Responses Obtained from the QualityRights Training Evaluation Tool Applied to the Target Population in the Pretest Stage. Evaluation Tool Items Without Response (%) Strongly Disagree (%) Disagree (%) Neutral (%) Agree (%) Strongly Agree (%) About the Training Content The content presented was relevant. 4,3 - - - 82,6 13,0 The flow of the content and activities worked well. - - - 4,3 82,6 13,0 The content was clearly communicated. 4,3 - - - 73,9 21,7 The training engaged participants. 4,3 - - - 69,6 26,1 The case scenarios were helpful. 4,3 - - - 69,6 26,1 The discussions during the training were useful. - - - - 73,9 26,1 The amount of information was sufficient. - - - 4,3 82,6 13,0 About people delivering the training Clearly, communicated the content 4,0 8,0 - 4,0 52,0 32,0 Engaged the participants - 4,0 - 8,0 56,0 32,0 Responded to questions in a helpful way - 4,0 - 8,0 52,0 36,0 Created a participatory environment - 4,0 8,0 56,0 32,0 Respected the participants’ point of view - 4,0 - 4,0 52,0 40,0 Regarding Learning, Expectations, and Utility of the Training Overall, this training met my learning needs. 4,0 4,0 - 8,0 72,0 12,0 The training met my expectations. 4,3 - - 8,7 69,6 17,4 The training experience will be useful in my work/life. 4,3 - - 4,3 60,9 30,4 This course changed my attitude toward people with psychosocial, intellectual and cognitive disabilities. - - - 4,3 78,3 17,4 This course will alter my practice/aspects of my life. 4,3 - - - 78,3 17,4 The responses to the open-ended questions from the training evaluation tool revealed three themes: more empathetic and humanized attitudes and practices; additional benefits and impacts on professional careers; positive impacts on the Facilitators; and teaching methodology . In the first theme, the comments from healthcare professionals reflect an acknowledgment of the need to enhance their practices with greater sensitivity and empathy in care. There is a self-critique and a commitment to humanizing care, as they emphasize the adoption of an attentive and empathetic perspective toward others. The training ignited in them a desire to transform their professional approaches, leading them to value understanding and closeness to individuals with disabilities more. “(...) I tested a much more humane perspective than I previously had.” (ACS9) “I will look at others with more love.” (ACS24) “I will strive to be more empathetic.” (ACS26) “I believe this will change my practices toward a more empathetic view of people with psychosocial disabilities.” (ENF16) In the second theme, the accounts indicate an enhancement in the analysis of situations and a more conscious and critical approach to patient care. Additionally, the training was perceived as highly relevant to daily practice, especially in the context of home visits, reinforcing the direct application of the knowledge acquired. “(...) we began to analyze each situation better.” ACS7 “I learned a lot in practice and in how to care for individuals with mental health issues.” ACS25 “My attitude changed for the better, I mean, after the course.” ENF16 “This training has been and will be of great value for my home visits.” ACS1 In the third theme, the comments highlight the quality and effectiveness of the training, with particular emphasis on the performance of the team responsible for the training. There is an appreciation for the engagement and clarity of the explanations. The interaction between the facilitators and the professionals was a central point, creating a welcoming and conducive environment for the sharing of experiences and opinions, which contributed to making the training dynamics more interesting and participatory. This involvement facilitated learning, promoted an atmosphere of trust and open dialog among all participants. “The professionals who delivered the course deserve congratulations.” ACS1 “The team engaged the participants, making the dynamics more interesting.” ACS7 “I liked the explanations; they were very clear regarding how to interact with people with disabilities.” ACS6 “I was struck by the interaction of the facilitators with the team, making us feel comfortable sharing our experiences and opinions.” TECENF13 These testimonies reflect the transformation in the professionals' approach, the enrichment of their practices, and the quality of the training provided. Figure 2 illustrates the interconnected elements that contribute to fostering empathy, commitment, and professional transformation in healthcare practices. Discussion The methodological rigor of our study follows standards similar to those of other methodological studies, such as Santos et al.(36). The experts conducted a critical reading of the material and filled out an adapted assessment instrument, the suitability assessment of materials (SAM)(36). We ensured that the validation was accessible and appropriate for the target audience by organizing the information in a simple and objective manner(37). As in other studies in the literature, the majority of the experts were women and held a master's degree(38). Like other studies in the literature, each training module was validated by six judges(39). The evaluation of the educational material by the judges, using the SAM, was validated as superior, reflecting similar findings in the literature. For example, a study validated a series album, achieving 92.7% agreement among content judges. Items assessed across the six domains achieved over 70% agreement, being considered superior, although some technical items had lower evaluations, and one item was classified as inadequate in the layout and typography domain. After suggestions for modifications, the album was deemed adequate(40). Like in the aforementioned study, we made modifications on the basis of the specialists' suggestions, ensuring that the modules were appropriate and effective for the target audience. The results of our study align with the literature, demonstrating the validity and suitability of the modules adapted for the Brazilian context. A relevant study for comparison with our results is the one conducted by Santos et al.(36). In this validation process, 12 judges/experts participated, obtaining the following content validity index (CVI) results for the categories: content (0.91), writing (0.84), illustrations (0.87), presentation (0.62), motivation (0.93), and cultural appropriateness (0.91). Subitem 4.2, regarding the size and type of font in the presentation category, received a score of 0.6, necessitating the required alteration. The educational material achieved an overall CVI of 0.85, which was considered validated(36). Similar results were found in our study. In Module 1, the majority of items received 100% approval, with the exception of one item that recorded 83%, resulting in a total approval rate of 99%. In the Mental Health, Disability and Human Rights Module, most items achieved 100% approval, with some specific items recording 83%, culminating in a total rate of 96%. In the Recovery and the Right to Health Module, the majority of items were fully approved, with only one item recording 83%, totaling 99% overall approval. In the Legal Capacity and the Right-to-Decide Module, although most items achieved 100% approval, some recorded rates between 50% and 83%, resulting in variable total approval. In the Freedom from Coercion, Violence and Abuse Module, the vast majority of the items were approved, except for a single item that recorded 83%, culminating in a total rate of 99%. In the Supported Decision-Making and Advance Planning Module, most items were approved, but some recorded approval rates of 83% and 67%, resulting in variable overall approval rates. Finally, in the Recovery Practices for Mental Health and Well-Being Module, although most items achieved 100% approval, some recorded 83%, resulting in a total rate of 96%. In the study by Costa et al.(37), the average CVI across the three analyzed dimensions was above 0.8, validating the contents of the educational booklet. With a global CVI of 0.96, the result was quite satisfactory, validating the content of the booklet. Additionally, the judges suggested replacing technical terms, reformulating and adding illustrations, simplifying sentences for greater clarity, defining necessary acronyms and technical terms, and including additional information. These results are comparable to those of our study, where the average CVI per item was above 0.8 and the minimum overall CVI was 0.93. In the study by Santos et al.(38), the agreement among the judges regarding the educational material resulted in a global CVI of 0.92 in the first evaluation, validating the content(38). Another study, which developed an educational booklet and used SAM analysis, reported that all the items were individually rated as superior. The overall evaluation of the booklet, which was based on the average scores among the items, revealed that the material was considered superior, with a percentage of 85.2%(41). In addition to the evaluation percentages, it is important to highlight the relevance of the comments and suggestions from the experts, which enriched the educational material, enhancing its ability to achieve the outlined objectives(36), as well as the suggestions made in our study, which were fundamental for improving each evaluated category. The formative process in health, especially in the area of mental health and the construction and validation of educational technologies, aims to enhance practices and care, strengthening the National Mental Health Policy(42). The use of evidence-based educational materials subjected to content and semantic validation processes is crucial for mediating health education practices and raising awareness among university students, promoting effective dialog with the target audience(43). Educational activities that employ technologies and aim for behavioral changes are an integral part of the health education process(41). The use of these technologies in health education is significantly growing, as they have the potential to empower individuals both individually and collectively, providing pertinent information and knowledge on the subject(36). The results of this research, in line with the findings of Morrissey(9), reinforce the positive impact of training on changing the attitudes and practices of healthcare professionals. In the pretest of this research, 82.6% of the participants considered the training content relevant, and 82.6% also believed that the information provided was sufficient to promote a mindset change regarding care. This is complemented by the responses to the open-ended questions explored in the first and second themes, where participants highlighted the practical relevance of the content addressed, reinforcing the finding that the training not only enhanced technical knowledge but also positively influenced personal attitudes, promoting greater empathy and sensitivity in their daily practices. This recognition of relevance is similar to that observed in the study by Morrissey(9), in which 92% of the participants believed that the training would be useful in their professional and personal lives. Additionally, the engagement of participants and the clarity in the application of content (73.9%) were also highlighted in this research, reflecting the effectiveness of active methodologies, such as scenarios and discussions, which were used to make learning more practical and applicable. The study by Morrissey(9) also emphasized the personal impact of the training, highlighting how it sensitized participants to the importance of human rights and the realities experienced by individuals with disabilities, resulting in 89% of participants stating that their practices would change directly through learning. The results indicate that the majority of participants positively evaluated the clarity in communication and the engagement of the facilitators, with 84% of the respondents agreeing or strongly agreeing about the clarity of the information conveyed and 88% recognizing a high level of engagement from the facilitators. Additionally, the participants highlighted that their questions were adequately answered (88%) and that the environment promoted during the training was participatory and respectful, with 84% stating that different viewpoints were considered. The expertise of the facilitating team was widely explored in the comments that constitute the third theme of the qualitative analysis, recognized as an important factor for the validation of the training. The literature reinforces that the technical and interpersonal competence of course facilitators generates trust among participants and facilitates the assimilation of content and involvement in proposed activities(44). The study by Morrissey(9) also pointed to a positive perception regarding the facilitators of the QualityRights training, with participants emphasizing that their expertise and knowledge were crucial for understanding the concepts presented, particularly regarding human rights and mental health practices. The quality of facilitation was identified as a key factor for the success of the training, promoting not only the absorption of theoretical content but also the practical application of the discussed principles. Regarding the expectations and utility of the training, the majority of participants (60.9%) highlighted the practical applicability of the content, whereas 78.3% reported expected changes in their attitudes and practices toward individuals with psychosocial disabilities. These results align with studies conducted in India and Tunisia, where health professionals also rated the training as useful or extremely useful, with emphasis on the content and feedback mechanisms. They also showed a significant improvement in knowledge and attitudes after the training, indicating that the training applied by the facilitators and with active participation from professionals enhanced the understanding and approach to mental health care on the basis of human rights(45,46). The participatory approach to learning, which uses personal stories and group discussions, is highlighted in the literature as a powerful tool to promote empowerment and critical reflection on human rights in the context of mental health across different countries(9,45,46. Therefore, these findings align with the global objectives of implementing QualityRights training(47), which are based on the principles of the CRPD(48). However, it is worth noting that the Czech Republic demonstrated difficulties in the translation and cultural adaptation of training, such as the course's length and the consequent loss of participants, with the COVID-19 pandemic being the main reason(49). These challenges highlight the importance of ensuring that the training content is relevant and accessible to the local context to maximize its utility, as well as specific transformation plans to implement ongoing training and promote effective changes in practice(45). Therefore, the validation of the QualityRights training modules significantly influences the practices of mental health professionals in Brazil, as well as the routines of other professionals who may encounter demands related to mental health, as it enables more humanized care that provides autonomy and a safe environment for individuals with mental disorders, thereby increasing access to health services, guaranteeing the human rights of these users, and fulfilling the principles outlined in the Convention on the Rights of Persons with Disabilities (CRPD)(9,48). The open-ended questions provided a deeper understanding of the content by the target audience and the manner in which the training was delivered. This was also significant in a study with healthcare professionals from China, Ethiopia, India, Nepal, and Tunisia, who participated in training on experienced and anticipated discrimination related to mental health. They considered the content highly relevant and useful for their professional practices, emphasizing the direct applicability of the topics addressed in their daily work. They also praised the competence and accessibility of the team that delivered the course, appreciating the instructors' experience, knowledge, and willingness to clarify doubts and offer additional support, recognized as important facilitators(50). Moreover, it is important to emphasize that, in light of the professional attitude changes following training, there is a goal to eliminate barriers such as discrimination, rights violations, and other disparities, not only through the recognition of the aforementioned factors but also through the joint advocacy of user autonomy. Through respect, dignified treatment, and the importance given to the issues reported by these individuals, holistic care and recognition of the subject beyond the biomedical approach are achieved, thereby ensuring continuity of care by promoting an equitable and comprehensible environment(9). The aforementioned individual changes favor the implementation of a system that guarantees individuals with mental disorders not only access to health services, which will have trained teams but also professionals who are willing to intervene in specific needs and the community at large. Given that mental health is interconnected with social and economic factors and represents a collective responsibility involving health institutions, families, communities, governments, and other civil society organizations, trained professionals will have mediation tools between different institutions and the means to act comprehensively in the treatment and recovery of users, ensuring the success of assistance(9). In summary, the validation of educational technologies and the use of evidence-based materials are fundamental to improving practices in mental health and health education. Our results indicate significant progress in the cultural adaptation of the modules, which will contribute to the effective implementation and strengthening of mental health policies in Brazil. Conclusion The cultural adaptation and validation of the WHO QualityRights training modules to Brazilian Portuguese represent important steps forward in enhancing mental health practices in Brazil. By aligning the training content with the specific cultural and contextual needs of Brazilian healthcare professionals, this initiative facilitates the integration of human rights principles into mental health care, promoting more humane, dignified, and person-centered approaches. The results of this study reinforce the importance of rigorous validation of educational technologies in the mental health field aimed at improving the practices and care provided to patients. By adopting a consistent methodological approach aligned with established standards in the literature, we demonstrated the effectiveness of educational materials adapted for the Brazilian context. The active participation of experts provided valuable insights that enriched the validation process, confirming not only the relevance of the adopted approach but also offering robust support for the effective implementation of mental health policies. This, in turn, promotes the well-being of the Brazilian population and facilitates the continuous improvement of health services. The participants expressed a strong commitment to applying the knowledge gained in their professional practice, anticipating improvements in their attitudes toward individuals with psychosocial disabilities. The study demonstrated that the training modules were well received by participants, as evidenced by high approval rates and positive feedback on the clarity, relevance, and applicability of the content. Furthermore, the engagement of facilitators and the interactive nature of the training contributed to a supportive learning environment, fostering trust and open dialog. This aligns with global efforts to improve mental health services and highlights the importance of training that empowers professionals to challenge existing biases and adopt a more empathetic approach to care. In summary, the successful adaptation and validation of these training modules not only enhance the capacity of healthcare professionals in Brazil but also contribute to the broader objective of promoting human rights and improving mental health outcomes for individuals with mental disorders. This initiative underscores the need for ongoing training and support to ensure that mental health practices remain aligned with international human rights standards. Declarations Ethics approval and consent to participate The research was approved by the Ethics Committee of the School of Nursing of Ribeirão Preto at the University of São Paulo (Opinion Number: 6.257.303/2021). The free and informed consent term was read and signed by the participants (experts and healthcare professionals) in two copies, with one kept by them and the other by the research team. To preserve the anonymity of the responses from the open-ended questions, codes were assigned to the healthcare professional participants (ACS, ENF, TEC-ENF). The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings (Brazil, 2012). Consent for publication Not applicable. Availability of data and materials Not applicable. Clinical trial number Not applicable. Competing interests The authors declare that they have no competing interests. Funding This study was funded by the National Council for Scientific and Technological Development (CNPq)-Brazil (process n° 408399/2021-0). Authors' contributions ESB and ABZM wrote the main manuscript, with input from IOR and CAAV. IOR and AMS prepared the tables and figures. ESB and ABZM coordinated the expert committee stage, with contributions from AMS. ESB, ABZM, and IOR conducted the pretesting stage. ABZM conducted the analysis. ESB obtained ethical consent for the study. IOR, ABZM and CAAV contributed to data interpretation. ESB, IOR and CAAV revised the manuscript. All the authors read and approved the final manuscript. Acknowledgments Not applicable. References Mahdanian AA, Laporta M, Drew Bold N, Funk M, Puras D. Human rights in mental healthcare; A review of current global situation. International Review of Psychiatry [Internet]. 2023 [cited 2024 Nov 26];35(2):150–62. Available from: https://www.tandfonline.com/doi/abs/10.1080/09540261.2022.2027348 Puras D, Gooding P. Mental health and human rights in the 21st century. World Psychiatry [Internet]. 2019 Feb 1 [cited 2024 Nov 26];18(1):42–3. Available from: https://pubmed.ncbi.nlm.nih.gov/30600633/ Hughes K, Bellis MA, Jones L, Wood S, Bates G, Eckley L, et al. Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. The Lancet. 2012 Apr;379(9826):1621–9. Mann SP, Bradley VJ, Sahakian BJ. Human Rights-Based Approaches to Mental Health: A Review of Programs – Health and Human Rights Journal. Health Numan Rights [Internet]. 2016 Jun [cited 2024 Oct 2];1(18):263–76. Available from: https://www.hhrjournal.org/2016/05/human-rights-based-approaches-to-mental-health-a-review-of-programs/ Jacob K. Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care. Indian J Psychol Med [Internet]. 2015 Apr 1 [cited 2024 Oct 2];37(2):117. Available from:/pmc/articles/PMC4418239/ Patel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet [Internet]. 2018 Oct 27 [cited 2024 Nov 26];392(10157):1553–98. Available from: https://pubmed.ncbi.nlm.nih.gov/30314863/ United Nations. Convention on the Rights of Persons with Disabilities. New York; Dec 13, 2006. Bhugra D, Tribe R, Poulter D. Social justice, health equity, and mental health. https://doi.org/101177/00812463211070921 [Internet]. 2022 Jan 8 [cited 2024 Nov 26];52(1):3–10. Available from: https://journals.sagepub.com/doi/full/10.1177/00812463211070921 Morrissey FE. An evaluation of attitudinal change toward CRPD rights following delivery of the WHO QualityRights training programme. Ethics Med Public Health. 2020 Apr 1;13:100410. Muhia J, Jaguga F, Wamukhoma V, Aloo J, Njuguna S. A human rights assessment of a large mental hospital in Kenya. Pan Afr Med J [Internet]. 2021 [cited 2024 Nov 26];40. Available from: https://pubmed.ncbi.nlm.nih.gov/35096226/ Moro MF, Kola L, Fadahunsi O, Jah EM, Kofie H, Samba D, et al. Quality of care and respect of human rights in mental health services in four West African countries: collaboration between the mental health leadership and advocacy programme and the World Health Organization QualityRights initiative. BJPsych Open [Internet]. 2022 Jan [cited 2024 Nov 26];8(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35076357/ Pitta AMF, Coutinho DM, Rocha CCM. Direitos humanos nos Centros de Atenção Psicossocial do Nordeste do Brasil: um estudo avaliativo, tendo como referência o QualityRights - WHO. Saúde em Debate [Internet]. 2015 Sep [cited 2024 Oct 2];39(106):760–71. Available from: https://www.scielo.br/j/sdeb/a/zqy4dxc8v5Qm8T5SvTk9PrP/ Osei AO, Amissah C, Hanu SC, Tawiah PE, Brobbey KA, Arthur YA, et al. Implementation of the World Health Organization’s QualityRights initiative in Ghana: an overview. BJPsych Open [Internet]. 2024 May;10(3):e111. Available from: https://www.cambridge.org/core/product/identifier/S2056472424000115/type/journal_article WHO WHO. QualityRights materials for training, guidance and transformation [Internet]. World Health Organization. 2019. Available from: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools Carta MG, Ghacem R, Milka M, Moula O, Staali N, Uali U, et al. Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital. Clin Pract Epidemiol Ment Health [Internet]. 2020 Aug 2 [cited 2022 Sep 15];16(Suppl-1):125. Available from:/pmc/articles/PMC7431701/ Pathare S, Funk M, Drew Bold N, Chauhan A, Kalha J, Krishnamoorthy S, et al. Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India. The British Journal of Psychiatry [Internet]. 2021 Apr 1 [cited 2024 Nov 26];218(4):196–203. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/systematic-evaluation-of-the-qualityrights-programme-in-public-mental-health-facilities-in-gujarat-india/0D467F4768D9D08725AE9F0056A3B929 Melo RMDSB de, Morais GB, Morais JB, Leite SN. Conception of the Right to Health of Mid-Level Technical Professionals of Unified Health System In Brazil. Journal of Human Growth and Development. 2018 Mar 12;28(1):95. Ortega F, Müller MR. Rethinking structural competency: Continuing education in mental health and practices of territorialization in Brazil. Glob Public Health [Internet]. 2023 Jan 2 [cited 2024 Nov 26];18(1). Available from: https://www.tandfonline.com/doi/abs/10.1080/17441692.2022.2157034 Newham R, Hewison A, Graves J, Boyal A. Human rights education in patient care: A literature review and critical discussion. Nurs Ethics [Internet]. 2021 Mar 1 [cited 2024 Nov 26];28(2):190–209. Available from: https://journals.sagepub.com/doi/10.1177/0969733020921512 Zanardo ABR, Ventura CAA. Cultural adaptation and validation of the Strategies to end seclusion restraint module of the QualityRights ToolKit*. Rev Lat Am Enfermagem. 2022;30. Lobiondo-Wood G, Haber J. Desenhos não experimentais. In: Pesquisa em enfermagem: métodos, avaliação crítica e utilização. 4th ed. Guanabara-Koogan; 2001. Polit DF, Beck CT. Fundamentos da pesquisa em enfermagem: avaliação de evidências para a prática de enfermagem. . 7th ed. Artmed; 2011. Beaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine (Phila Pa 1976). 2000 Dec;25(24):3186–91. Pasquali L. Princípios de elaboração de escalas psicológicas. Rev Psiquiatr Clín. 1998;25(5):206–13. Oliveira MS de, Fernandes AFC, Sawada NO. Manual educativo para o autocuidado da mulher mastectomizada: um estudo de validação. Texto & Contexto - Enfermagem. 2008 Mar;17(1):115–23. Pasquali L. Princípios de elaboração de escalas psicológicas. Rev Psiquiatr Clín. 1998;25(5):206–13. Polit DF, Beck CT. The content validity index: Are you sure you know what’s being reported? critique and recommendations. Res Nurs Health. 2006 Oct;29(5):489–97. Lobiondo-Wood G, Haber J. Desenhos não experimentais. In: Pesquisa em enfermagem: métodos, avaliação crítica e utilização. 4th ed. Guanabara-Koogan; 2001. Polit DF, Beck CT. Fundamentos da pesquisa em enfermagem: avaliação de evidências para a prática de enfermagem. . 7th ed. Artmed; 2011. Sousa CS, Turrini RNT, Poveda VB. Tradução e adaptação do instrumento “suitability assessment of materials” (sam) para o português. Revista de Enfermagem UFPE on line [Internet]. 2015 Apr 12 [cited 2024 Nov 26];9(5):7854–61. Available from: https://periodicos.ufpe.br/revistas/index.php/revistaenfermagem/article/view/10534 Aguiar B, Correia W, Campos F. Uso da Escala Likert na Análise de Jogos. In: Proceedings of SBGames. 2011. Paro BA. Escala Likert: coisas que todo pesquisador deveria saber. NetQuest; 2012. Aragão J da S, de França ISX, Coura AS, de Sousa FS, Batista JDL, Magalhães IM de O. A content validity study of signs, symptoms and diseases/health problems expressed in LIBRAS. Rev Lat Am Enfermagem [Internet]. 2015 Nov 1 [cited 2024 Nov 27];23(6):1014–23. Available from: https://www.scielo.br/j/rlae/a/q4fPCn9RTfczrvYDQCgWcct/?lang=en Braun V, Clarke V. Conceptual and Design Thinking for Thematic Analysis. Qualitative Psychology. 2021 May 13;9(1):3–26. Brasil. Resolução n o 466. Ministério da Saúde; Dec 12, 2012. Santos IL, Nascimento L de CN, Coelho MP, Freitas P de SS, Moraes-Partelli AN. Produção e validação de material educativo: instrumento educativo para o cuidado domiciliar ao recém-nascido prematuro. Rev Bras Enferm. 2023;76(1). Costa CC da, Gomes LF de S, Teles LMR, Mendes IC, Oriá MOB, Damascen AK de C. Construção e validação de uma tecnologia educacional para prevenção da sífilis congênita. Acta Paulista de Enfermagem. 2020 Oct 20;33. Santos A da S, Rodrigues L do N, Andrade KC, Santos MSN dos, Viana MCA, Chaves EMC. Construction and validation of an educational technology for mother-child bond in the neonatal intensive care unit. Rev Bras Enferm. 2020;73(4). Lins MLR, Evangelista CB, Gomes GLL, Macedo JQ de. Autocuidado domiciliar após cirurgias ginecológicas: elaboração e validação de material educativo. Acta Paulista de Enfermagem. 2021 Nov 5;34. Vasconcelos FX, Barbosa LP, Lima FET, Sabino LMM de, Lima KF, Mendes ER da R. Álbum seriado para promoção da autoeficácia na asma infantil: construção e validação. Revista da Escola de Enfermagem da USP. 2023;57. Balsells MMD, Silveira GEL, Aquino P de S, Barbosa LP, Damasceno AK de C, Lima TM. Desenvolvimento de cartilha como tecnologia educacional para alívio da dor do parto. Acta Paulista de Enfermagem. 2023 Jan 20;36. Silva FP da, Alves BMM, Silva DMR da, Frazão I da S, Brandão Neto W, Pinto ID da S, et al. VALIDAÇÃO DE TECNOLOGIA EDUCACIONAL COMO RECURSO DIDÁTICO NO ENSINO DE ENFERMAGEM EM SAÚDE MENTAL. Texto & Contexto - Enfermagem. 2024;33. Gigante VCG, Oliveira RC de, Ferreira DS, Teixeira E, Monteiro WF, Martins AL de O, et al. CONSTRUÇÃO E VALIDAÇÃO DE TECNOLOGIA EDUCACIONAL SOBRE CONSUMO DE ÁLCOOL ENTRE UNIVERSITÁRIOS. Cogitare Enfermagem. 2021 Feb 22;26. Kuske S, Icks A, Zaletel J, Rothe U, Lindstrom J, Sorensen M, et al. Education and health professionals training programs for people with type 2 diabetes: a review of quality criteria. Ann Ist Super Sanità. 2015;51(3):199–205. Carta MG, Ghacem R, Milka M, Moula O, Staali N, Uali U, et al. Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital. Clin Pract Epidemiol Ment Health [Internet]. 2020 Aug 2 [cited 2022 Sep 15];16(Suppl-1):125. Available from:/pmc/articles/PMC7431701/ Pathare S, Funk M, Drew Bold N, Chauhan A, Kalha J, Krishnamoorthy S, et al. Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India. The British Journal of Psychiatry [Internet]. 2021 Apr 1 [cited 2024 Nov 26];218(4):196–203. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/systematic-evaluation-of-the-qualityrights-programme-in-public-mental-health-facilities-in-gujarat-india/0D467F4768D9D08725AE9F0056A3B929 WHO WHO. QualityRights materials for training, guidance and transformation [Internet]. World Health Organization. 2019. Available from: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools United Nations. Convention on the Rights of Persons with Disabilities. New York; Dec 13, 2006. Mion ABZ, Ventura CAA. The WHO QualityRights Initiative and its use worldwide: A literature review. International Journal of Social Psychiatry [Internet]. 2023 Dec; Available from: http://journals.sagepub.com/doi/10.1177/00207640231207580 Henderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, et al. Training for mental health professionals in responding to experienced and anticipated mental health related discrimination (READ-MH): protocol for an international multisite feasibility study. 2022. Additional Declarations No competing interests reported. Supplementary Files POSTtrainingquestionnaireEN.docx.pdf Additional file 1 Title: Evaluation of the effects of QualityRights training on mental health, human rights and recovery: Posttraining questionnaire Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5753746","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":405853386,"identity":"f1453330-3ef6-49b3-b784-c79ca54a7073","order_by":0,"name":"Emanuele Seicenti de 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19:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5753746/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5753746/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":78338257,"identity":"0b80a8ea-2853-41bb-90d5-f33d39ec291a","added_by":"auto","created_at":"2025-03-12 08:21:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":186684,"visible":true,"origin":"","legend":"\u003cp\u003eStages of the translation, cultural adaptation, and validation process\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5753746/v1/a83d8675a420479b167d6cab.png"},{"id":78337911,"identity":"2b39a03d-6e98-4ee9-b685-502319e5f651","added_by":"auto","created_at":"2025-03-12 08:13:09","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":103109,"visible":true,"origin":"","legend":"\u003cp\u003eThemes Emerging from the Training Evaluation: Empathy, Professional Growth, and Methodological Impact\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-5753746/v1/dc714ecb4ca989213b912117.png"},{"id":78339985,"identity":"282c6e03-e645-49ba-af8d-83620155e776","added_by":"auto","created_at":"2025-03-12 08:37:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1441218,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5753746/v1/f4d0ee8e-3fd6-477b-9960-0156a11c9a0a.pdf"},{"id":78338259,"identity":"d09d8f97-c5bc-4a51-9b65-ffc4ff70899d","added_by":"auto","created_at":"2025-03-12 08:21:09","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":302393,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eAdditional file 1\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTitle: Evaluation of the effects of QualityRights training on mental health, human rights and recovery: Posttraining questionnaire\u003c/p\u003e","description":"","filename":"POSTtrainingquestionnaireEN.docx.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5753746/v1/6fc7392d22abfc5de22a0b40.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eCultural Adaptation and Validation of the WHO QualityRights Training to Brazilian Portuguese\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMental health has gained increasing prominence on global health agendas and is recognized as a priority by international organizations(1). Various global recommendations point to the need to expand mental health services in primary care and community contexts, emphasizing promotion, prevention, and the integration of human rights as a central theme(2). The relationship between mental health and human rights is complex and bidirectional: on the one hand, the violation of human rights can worsen mental health conditions; on the other hand, the protection and promotion of these rights can contribute to better health outcomes(3,4).\u003c/p\u003e\n\u003cp\u003eThe concept of recovery-oriented care advocates that the integration of human rights principles into mental health policies and practices can promote autonomy, dignity, and personal safety\u0026mdash;elements that are fundamental for the recovery process(5). In this sense, the shift from an institutional model to a community care model has been a crucial strategy to reduce human rights violations, especially in institutional environments where abuses are more frequent(4). Consequently, the inclusion of human rights has been a central consideration in revisions of mental health policies worldwide(4).\u003c/p\u003e\n\u003cp\u003eThe 2030 Sustainable Development Goals (SDGs) also recognize the importance of promoting mental health and emphasize the need for greater investment in mental health services, with discussions about a possible paradigm shift to face existing challenges(6)(7). In this context, mental health services must consider equitable, evidence-based, and recovery-oriented access, ensuring that human rights are respected at all stages of care(8).\u003c/p\u003e\n\u003cp\u003eFurthermore, the Convention on the Rights of Persons with Disabilities (CRPD), adopted by the United Nations in 2006, reaffirms the need for countries to protect the rights of persons with disabilities, including those with mental and psychosocial disorders(9). The CRPD establishes clear guidelines for national legislation to promote social changes that ensure respect for the rights of these populations, protecting them against abuse, discrimination, and inhumane treatment. However, despite these legal and normative advances, many regions still face significant challenges in implementing these rights, as demonstrated in studies addressing human rights violations in mental health institutions(10,11).\u003c/p\u003e\n\u003cp\u003eIn light of this situation, the World Health Organization (WHO) launched the QualityRights Initiative in 2012(12), which offers practical solutions to mitigate such abuses(13). This initiative aims to improve living conditions and promote human rights in mental health and social care units, both for hospitalized and outpatient patients. Additionally, it aims to empower organizations in advocating for the rights of individuals with mental and psychosocial disabilities, ensuring the quality of mental health services. The project encompasses proposals, actions, tools, and comprehensive programs aimed at safeguarding the rights of users of these services(12,14).\u003c/p\u003e\n\u003cp\u003eThe QualityRights Initiative includes various tools, including training tools consisting of five core modules addressing human rights, mental health, disability, the right to health and recovery, legal capacity, and the right to freedom from coercion, violence, and abuse. Additionally, it includes three specialized trainings focused on recovery practices, strategies to combat isolation and restraint, and support for decision-making and advance planning(9). Several studies have demonstrated the effectiveness of QualityRights training tools in training health professionals(9,15,16).\u003c/p\u003e\n\u003cp\u003eIn Brazil, despite advances in mental health legislation, there are still significant gaps regarding training tools specifically adapted to address this theme in the national context. Most Brazilian health professionals do not have access to structured training that integrates human rights principles, such as those outlined in the CRPD, into their daily practices(17,18). This highlights the need to adapt tools such as the QualityRights training tool to Brazilian reality, considering the cultural specificities and particularities of the local health system. The cultural adaptation of these tools not only makes the content more accessible and relevant but also ensures that mental health and human rights issues are addressed in a manner sensitive to the country\u0026rsquo;s socioeconomic and cultural context.\u003c/p\u003e\n\u003cp\u003eThe lack of adequate training aimed at promoting human rights in mental health can hinder the fight against violations that still occur in institutions and outpatient care(19). Additionally, health professionals trained with culturally adapted tools have greater potential to offer more humanized care aligned with human rights, which is essential for promoting recovery and the dignity of service users. Thus, the adaptation and validation of the WHO QualityRights Initiative modules in Brazil represent a fundamental step to fill this gap, contributing to the strengthening of mental health care in the country and promoting an environment of respect and protection for human rights.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eWHO QualityRights Training Tools\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe QualityRights training and guidance modules were developed to enhance knowledge, skills, and understanding among mental health practitioners; individuals with psychosocial, intellectual, and cognitive disabilities; mental health service users; families; care partners; other supporters; nongovernmental organizations; organizations of persons with disabilities; and others. These modules focus on promoting the rights of individuals with psychosocial, intellectual, or cognitive disabilities and improving the quality of mental health and related services and support. They align with international human rights standards, particularly the CRPD, and emphasize a recovery-oriented approach(14).\u003c/p\u003e\n\u003cp\u003eThe ultimate goal of the WHO\u0026rsquo;s QualityRights initiative is to bring about sustainable changes in mindsets and practices, empowering all stakeholders to advocate for rights and recovery. This, in turn, aims to improve the lives of people with psychosocial, intellectual, or cognitive disabilities worldwide. The QualityRights training modules cover crucial topics, including human rights, mental health and disability, legal capacity, recovery, and strategies to prevent coercion, violence, and abuse in mental health services. Through these modules, participants gain a comprehensive understanding of the rights of individuals with disabilities, learning to identify and address human rights violations while promoting supportive and inclusive mental health services(14).\u003c/p\u003e\n\u003cp\u003eEach module includes practical, scenario-based exercises designed to deepen participants\u0026apos; understanding of human rights principles and legal frameworks, such as the CRPD. This training initiative ultimately aims to reshape mindsets and practices in mental health services to ensure that they respect, protect, and fulfill the rights of individuals with disabilities. By doing so, it fosters an inclusive, supportive, and rights-based approach to care.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAims and objectives\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe current study aims to describe the cultural adaptation and validation of the WHO QualityRights training tools in Brazilian Portuguese.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003eThis study conducted the cultural adaptation and validation of seven of the eight training modules of the QualityRights Initiative. The included modules were Human Rights, Mental Health, Disability and Human Rights, Recovery and the Right to Health, Legal Capacity and the Right to Decide, Protection from Coercion, Violence, and Abuse, Supported Decision-Making and Advance Planning, and Recovery Practices for Mental Health and Well-Being. The remaining module, \u0026quot;Strategies to End Isolation and Restraint,\u0026quot; had already been adapted and validated in a previous pilot study(20).\u003c/p\u003e\n\u003cp\u003eThe primary objective of the methodological approach was to evaluate and validate the QualityRights Initiative modules, initially developed in English, in the Brazilian context, ensuring their reliability for use in educational contexts(21,22). This methodological proposal was adapted from the model of\u0026nbsp;Beaton et al.(23) and Pasquali(24). Thus, the steps followed in this study are are detailed below:\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage I: Translation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe translation of the modules involved translation from the original language (English) to the target language (Brazilian Portuguese). The translation was performed by a contracted company and reviewed by two different and independent researchers who are native to the target language (Portuguese) and have different professions, as this allows for the detection of errors and divergent interpretations(23).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage II: Synthesis\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the review, the two researchers met to synthesize their assessments regarding the translations of the materials. The versions from the first and second reviewers resulted in a common version. The entire synthesis process was documented in writing, carefully detailing each issue discussed and the solutions adopted. Notably, decisions were made by consensus, preventing anyone from relinquishing their opinions on critical translation aspects. In this way, all suggestions and disagreements were duly considered, resulting in a version that accurately represented the original content while maintaining its cultural and semantic relevance in the Brazilian context. This synthesis process was essential to ensure that the final translation was clear, understandable, and adaptable to the target audience\u0026apos;s particularities, ensuring that the nuances of the original language were preserved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage III: Expert Committee\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe methodology for validating the instrument, adapted from the model proposed by Pasquali(24), prioritized theoretical procedures because of the nature of the educational manual(25). For this purpose, a committee of judges was tasked with evaluating the semantic, idiomatic, cultural, and conceptual equivalences of the material, following the recommendations of Pasquali(26) and Polit \u0026amp; Beck(27). For such validation, the participation of six to ten specialists is needed(27). An agreement of at least 80% among the judges serves as a decision criterion regarding the relevance and/or acceptance of the item to which it theoretically refers(26). The search for these specialists was actively conducted via the snowball technique(28,29).\u003c/p\u003e\n\u003cp\u003eThe experts were selected through the Lattes Curriculum on the website of the National Council for Scientific and Technological Development (CNPq) in Brazil, using specific keywords related to the area of training and action (law, psychology, and nursing) and the line of research of interest (human rights and mental health). A total of 83 specialists were invited via email, which averages ten invitations per module. Of these, 48 agreed and participated in the evaluation, with six specialists for each of the training modules, who also received the research material via email.\u003c/p\u003e\n\u003cp\u003eTo assess the experts\u0026apos; agreement regarding the material, we used an adaptation of the suitability assessment of materials (SAM), which was culturally validated by Sousa, Turrini, and Poveda(30), and a Likert scale to facilitate participant understanding(31,32). The SAM consists of a list with six categories that evaluate the appropriateness of the material for patients. After the evaluation, the experts\u0026apos; suggestions were analyzed and incorporated.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage IV: Pretesting\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter the experts\u0026apos; evaluation, a pretest was conducted. The pretest aimed to verify whether the training was comprehensible to all the members of the target population it was intended for. Thus, the modules were offered through a training course for health professionals at a primary health care service. This service provides essential services to the community: medical clinics, pediatrics, gynecology and obstetrics, vaccinations, dentistry, nursing, pharmaceutical assistance, and home visits. Educational activities are also promoted for pregnant women, hypertensive individuals, and diabetic individuals, in addition to physical exercise sessions and mental health care within the community.\u003c/p\u003e\n\u003cp\u003eThe modules were offered as a training course for healthcare professionals, with each module conducted on a specific prescheduled date coordinated with the health unit manager. A multidisciplinary team with expertise in relevant topics and prior experience with the QualityRights Initiative designed and delivered the training. Throughout the course, a support team consisting of nurses, psychologists, lawyers, and nursing students assisted with preparation and provided onsite support during each module.\u003c/p\u003e\n\u003cp\u003eSince the training materials are comprehensive and time and resources may be limited, the QualityRights Initiative team recommends adapting the training to the group\u0026apos;s existing knowledge, background, and desired outcomes. Consequently, each training session was tailored to the local context, respecting the availability of the health unit professionals and aiming to last no more than 1.5--2 hours per day. This adaptation was carried out by the principal researchers, who carefully reviewed the content of each module to eliminate unnecessary repetitions.\u003c/p\u003e\n\u003cp\u003eTable 1 below provides a summary of the topics covered in each training module offered at the health unit.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003eSummary of the QualityRights training module content\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"580\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLearning objectives\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTopics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eHuman Rights\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u0026bull; understand what human rights are, as well as the links between the different rights;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand the origins and content of the Universal Declaration of Human Rights and how the rights it contains are still relevant today;\u003c/p\u003e\n \u003cp\u003e\u0026bull; recognize human rights violations in specific situations;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand what makes groups of people at higher risk of human rights violations;\u003c/p\u003e\n \u003cp\u003e\u0026bull; identify who defends human rights;\u003c/p\u003e\n \u003cp\u003e\u0026bull; identify specific ways in which mental health workers and other professionals, people with psychosocial disabilities or intellectual or cognitive disabilities, families, care partners and other supporters can be agents of change and defenders of human rights.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e1: Human rights and living a good life\u003c/p\u003e\n \u003cp\u003e2: What are human rights?\u003c/p\u003e\n \u003cp\u003e3: The relationship between different rights\u003c/p\u003e\n \u003cp\u003e4: Examples of human rights violations\u003c/p\u003e\n \u003cp\u003e5: Groups/segments of the population at risk of human rights violations\u003c/p\u003e\n \u003cp\u003e6: Consequences of human rights violations 7: Respecting, protecting and fulfilling human rights\u003c/p\u003e\n \u003cp\u003e8: Empowering people to defend human rights\u003c/p\u003e\n \u003cp\u003e9: Human rights advocacy\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMental Health, Disability and human rights\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u0026bull; understand the concepts of discrimination and denial of rights;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand the concept of disability;\u003c/p\u003e\n \u003cp\u003e\u0026bull; acquire an understanding of the Convention on the Rights of Persons with Disabilities (CRPD) and how this instrument is central to respecting, protecting and fulfilling the human rights of persons with disabilities;\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u0026bull; be able to apply knowledge of the CRPD to real-life scenarios and identify violation of the rights of persons with disabilities;\u003c/p\u003e\n \u003cp\u003e\u0026bull; be able to identify concrete ways to respect and uphold the rights of people with psychosocial, intellectual or cognitive disabilities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e1: Understanding discrimination and denial of rights\u003c/p\u003e\n \u003cp\u003e2: Understanding disability from a human rights\u0026rsquo; perspective\u003c/p\u003e\n \u003cp\u003e3: The Convention on the Rights of Persons with Disabilities\u003c/p\u003e\n \u003cp\u003e4: Applying the CRPD to real-life scenarios 5: Zooming in on article 12 \u0026ndash; Equal recognition before the law\u003c/p\u003e\n \u003cp\u003e6: Zooming in on article 16 \u0026ndash; Freedom from exploitation, violence and abuse\u003c/p\u003e\n \u003cp\u003e7: Zooming in on article 19 \u0026ndash; Living independently and being included in the community\u003c/p\u003e\n \u003cp\u003e8: Empowering people to defend CRPD rights\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecovery and right to health\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u0026bull; understand the concepts of mental health and well-being;\u003c/p\u003e\n \u003cp\u003e\u0026bull; explore what mental health and related services can do to promote people\u0026rsquo;s health and well-being;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand the key components of, and barriers to, recovery;\u003c/p\u003e\n \u003cp\u003e\u0026bull; develop an understanding of the role of mental health and related services in promoting and supporting health and recovery;\u003c/p\u003e\n \u003cp\u003e\u0026bull; explore how individuals and services can respect, protect and fulfill people\u0026rsquo;s right to health and recovery.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e1: What is mental health?\u003c/p\u003e\n \u003cp\u003e2: Promoting the right to health in mental health and social services 3: What is recovery?\u003c/p\u003e\n \u003cp\u003e4: Promoting recovery\u003c/p\u003e\n \u003cp\u003e5: The role of practitioners and mental health and social services in promoting recovery\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLegal capacity and the right to decide\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u0026bull; learn to challenge the misconceptions around the decision-making skills of people with psychosocial, intellectual and cognitive disabilities;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand article 12 of the CRPD and the right to legal capacity;\u003c/p\u003e\n \u003cp\u003e\u0026bull; learn how to respect the right to legal capacity in specific scenarios;\u003c/p\u003e\n \u003cp\u003e\u0026bull; gain applied knowledge of supported decision-making and advance planning;\u003c/p\u003e\n \u003cp\u003e\u0026bull; explore how to ensure that people are not detained and/or treated against their wishes.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e1: Understanding the right to legal capacity\u003c/p\u003e\n \u003cp\u003e2: Supported decision-making and advance planning\u003c/p\u003e\n \u003cp\u003e3: Informed consent and person-led treatment and recovery plans\u003c/p\u003e\n \u003cp\u003e4: Avoiding involuntary detention and treatment in mental health and social services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFreedom from coercion, violence and abuse\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u0026bull; understand how and why violence, coercion and abuse occur in mental health and social care settings;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand the impact of violence, coercion and abuse;\u003c/p\u003e\n \u003cp\u003e\u0026bull; apply knowledge of the CRPD to understand how it protects people with disabilities from violence, coercion and abuse;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand and address attitudes, power relations and dynamics in mental health and social care settings;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand and apply different approaches and strategies for diffusing conflictual and tense situations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e1: What are violence, coercion and abuse?\u003c/p\u003e\n \u003cp\u003e2: What does the CRPD say about violence, coercion and abuse?\u003c/p\u003e\n \u003cp\u003e3: What are the impacts of violence, coercion and abuse?\u003c/p\u003e\n \u003cp\u003e4: Why are these practices happening?\u003c/p\u003e\n \u003cp\u003e5: Understanding attitudes and power relations\u003c/p\u003e\n \u003cp\u003e6: Key strategies to avoid and defuse conflictual situations\u003c/p\u003e\n \u003cp\u003e7: Communication techniques\u003c/p\u003e\n \u003cp\u003e9: Creating a \u0026ldquo;saying yes\u0026rdquo; and \u0026ldquo;can do\u0026rdquo; culture\u003c/p\u003e\n \u003cp\u003e10: Individualized plans to explore and respond to sensitivities and signs of distress\u003c/p\u003e\n \u003cp\u003e12: Complaints and reporting procedures\u003c/p\u003e\n \u003cp\u003e13: Stopping violence, coercion and abuse in my mental health or social service\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSupported decision-making and advance planning\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u0026bull; be able to appreciate how negative assumptions about people with psychosocial, intellectual\u003c/p\u003e\n \u003cp\u003eor cognitive disabilities impact on their right to make decisions;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand the importance of supporting people in exercising their fundamental human\u003c/p\u003e\n \u003cp\u003erights to make their own choices and have control over their lives;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand the difference between substitute decision-making and supported decision making;\u003c/p\u003e\n \u003cp\u003e\u0026bull; gain an understanding of the human rights principles underlying the concept of supported\u003c/p\u003e\n \u003cp\u003edecision-making;\u003c/p\u003e\n \u003cp\u003e\u0026bull; be able to take personal actions to adopt a supported decision-making approach;\u003c/p\u003e\n \u003cp\u003e\u0026bull; be able to use advance planning as a tool to ensure that people\u0026rsquo;s will and preferences are\u003c/p\u003e\n \u003cp\u003erespected.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e1: Challenging denial of legal capacity in mental health\u003c/p\u003e\n \u003cp\u003e2: Substitute versus supported decision-making\u003c/p\u003e\n \u003cp\u003e3: Supported decision-making in practice\u003c/p\u003e\n \u003cp\u003e4: Nominating a person to communicate best interpretation of will and preferences\u003c/p\u003e\n \u003cp\u003e5: Positive steps to adopt a supported decision-making approach\u003c/p\u003e\n \u003cp\u003e6: What is advance planning?\u003c/p\u003e\n \u003cp\u003e7: Making advance planning documents\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 21.2069%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRecovery practices for mental health and well-being\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.4828%;\"\u003e\n \u003cp\u003e\u0026bull; gain an in-depth knowledge of the recovery approach to mental health care and its key\u003c/p\u003e\n \u003cp\u003eprinciples and components;\u003c/p\u003e\n \u003cp\u003e\u0026bull; understand and discuss the role of people with psychosocial disabilities, mental health and\u003c/p\u003e\n \u003cp\u003eother practitioners, family, care partners and other supporters in promoting recovery;\u003c/p\u003e\n \u003cp\u003e\u0026bull; develop recovery communication skills;\u003c/p\u003e\n \u003cp\u003e\u0026bull; learn how to apply the principles of recovery-oriented care;\u003c/p\u003e\n \u003cp\u003e\u0026bull; learn how to create a recovery plan.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39.3103%;\"\u003e\n \u003cp\u003e1: What is recovery?\u003c/p\u003e\n \u003cp\u003e2: Recovery-oriented services and practices\u003c/p\u003e\n \u003cp\u003e6: Working alongside people\u003c/p\u003e\n \u003cp\u003e7: Boundaries within the context of recovery practices\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAfter all the training modules were offered to the target population\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e(pretest), the participants evaluated the training via the QualityRights Initiative evaluation instrument (training evaluation tool) regarding the level of content provided (measured on a 5-point Likert scale: Very Basic, Basic, Reasonable, Advanced, or Very Advanced), the facilitators, and the learning needs, expectations, and utility of the training (Strongly Disagree, Disagree, Neutral, Agree, or Strongly Agree). The training evaluation tool also included open-ended questions, in which healthcare professionals could express their opinions (see Additional file 1).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eStage III Expert Committee\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe information from the professionals and their sociodemographic data were coded and entered into Excel spreadsheets, which assigned codes to the characteristics and profiles. A descriptive analysis was subsequently conducted, and frequencies and percentages were calculated via IBM SPSS Statistics v.25 software. To analyze the data from the SAM assessment instrument, the average agreement among participants was calculated(25). The method used to quantify the degree of agreement among specialists during the content validity assessment was the content validity index (CVI), which is calculated on the basis of the representativeness of positive responses from specialists. The content validity index (CVI) is a measure that assesses agreement among judges regarding the aspects of the instrument and its items, with those marked as \u0026quot;agree\u0026quot; or \u0026quot;strongly agree\u0026quot; being considered representative, achieving a score of 1.00\u0026mdash;indicating 100% agreement(33). To calculate the CVI, the item responses were regrouped and assigned scores from -1 to +1. The average agreement of the judges\u0026apos; committee was calculated from these responses(25). For item approval, at least 80% agreement among professionals is needed(26). The evaluation of the instrument as a whole can be conducted in three ways, with a recommended rating of no less than 0.78 when the number of items is six or more specialists(27). In this study, the evaluation was performed by dividing the total number of items considered relevant by the total number of items answered in the instrument.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eData Analysis Stage IV Pretesting\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach participant (health professional) received a unique identification code that was followed throughout the study (Examples: ACS1 - Community Health Agent; ENF2 - Nurse; MED3 - Doctor). Data obtained after the training were analyzed via simple descriptive statistical methods for both absolute and relative numbers on the Likert scales. This analysis was conducted with the help of the Statistical Package for the Social Sciences (SPSS), version 25.\u003c/p\u003e\n\u003cp\u003eThe open responses from the posttraining questionnaire were analyzed via the content analysis technique of Braun and Clarke(34), which allows for a deeper understanding of the content and facilitates the synthesis of the main elements present in communication(34).\u003c/p\u003e\n\u003cp\u003eFigure 1 summarizes the stages of the translation, cultural adaptation, and validation process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthical Approval\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the Ethics Committee of the School of Nursing of Ribeir\u0026atilde;o Preto at the University of S\u0026atilde;o Paulo (Number: 6.257.303/2021). The free and informed consent term was read and signed by the participants (experts and healthcare professionals) in two copies, with one kept by them and the other by the research team. To preserve the anonymity of the responses from the open-ended questions, codes were assigned to the healthcare professional participants (ACS, ENF, TEC-ENF). The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings(35).\u003c/p\u003e\n\u003cp\u003eNotably, the QualityRights training materials are publicly available and hosted on the WHO website, and the research project was authorized by WHO to translate and apply them in the Brazilian context.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eDemographics\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sociodemographic characteristics of the experts who contributed to this study revealed a variety of profiles. Each module included six participants, with ages ranging from 24--59 years, distributed across specific sexes (predominantly females in five of the seven modules). The professions represented included nurses, university professors, researchers, lawyers, psychologists, and public defenders. The predominant educational level was a master\u0026apos;s degree, followed by a doctoral degree and specialization in some modules. Table 2 presents the sociodemographic characteristics of the judges/experts in the different modules.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eSociodemographic Characteristics Experts Committee\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"604\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModule\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (Majority)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003eHuman Rights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e27-59 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003eMale (66.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003eNurses (50.00%), University Professors (16.67%), Lawyers (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003eMaster\u0026apos;s (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003eMental Health, Disability, and Human Rights\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e26-45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003eFemale (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003eNurses (16.67%), University Professors (50.00%), Researchers (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003eMaster\u0026apos;s (66.70%), Doctorate (33.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003eRecovery and the Right to Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e24-45 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003eFemale (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003eNurses (16.67%), University Professors (50.00%), Researchers (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003eMaster\u0026apos;s (66.70%), Doctorate (33.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003eLegal Capacity and the Right to Decide\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e27-55 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003eFemale (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003eNurses (50.00%), University Professors (16.67%), Supplementary Health Auditors (16.67%), Lawyers (16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003eDoctorate (50.00%), Master\u0026apos;s (16.70%), Specialization/Residency (33.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003eFreedom from Coercion, Violence, and Abuse\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e24-42 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003eMale (50%), Female (50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003eNurses (16.67%), University Professors (16.67%), Police Officers (16.67%), Psychologists (16.67%), Researchers (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003eMaster\u0026apos;s (66.70%), Doctorate (33.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003eSupported Decision-Making and Advance Planning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e27-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003eFemale (83.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003eNurses (33.33%), University Professors (16.67%), Public Defenders (16.67%), Researchers (16.67%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003eMaster\u0026apos;s (66.70%), Doctorate (33.30%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 14.2384%;\"\u003e\n \u003cp\u003eRecovery Practices for Mental Health and Well-Being\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 13.9073%;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 8.44371%;\"\u003e\n \u003cp\u003e24-50 years\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 17.053%;\"\u003e\n \u003cp\u003eFemale (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 21.6887%;\"\u003e\n \u003cp\u003eNurses (50.00%), Psychologists (16.67%), Researchers (33.33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 24.6689%;\"\u003e\n \u003cp\u003eMaster\u0026apos;s (66.70%), Doctorate (16.70%), Specialization/Residency (16.70%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWith respect to the sociodemographic characteristics of the target population (pretesting stage), which included 21 study participants, the age range varied from 29--70 years, with the majority (76.19%) being female. At the time, the majority (38.10%) did not respond to the topic of whether they had participated in a course or previous training on human rights and/or mental health, 33.33% reported not having participated, and 28.57% reported having participated. Among the professionals, the majority (57.14%) were Community Health Agents (ACS); however, the group also included nurses (19.05%), nursing technicians (14.29%), and doctors (09.52%), with work time in the current service ranging from 4 months to 31 years. With respect to professional training, they have technical high school courses and undergraduate degrees in administration, public management, nursing, and medicine, with training times ranging from 2--35 years. Among the participating professionals, 8 held postgraduate degrees, with the majority (75.00%) holding specialization/residency, (12.50%) holding a master\u0026apos;s degree, and (12.50%) holding a doctorate, with the areas of qualification encompassing public management, collective health, family health, and worker health (Table 3).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u0026nbsp;\u003c/strong\u003eSociodemographic characteristics of the target population (pretesting stage)\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"621\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModule\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParticipants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge Range\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender (Majority)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProfessions\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eCore training (All modules)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 87px;\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e29-70 years\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 78px;\"\u003e\n \u003cp\u003eFemale (76.19%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 126px;\"\u003e\n \u003cp\u003eCommunity Health Agents (ACS) (57.14%), Nurses (19.05%), Nursing technicians (14.29%), Doctors (09.52%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eSpecialization/Residency (75.00%)\u003c/p\u003e\n \u003cp\u003eMaster\u0026apos;s (12.50%)\u003c/p\u003e\n \u003cp\u003eDoctorate (12.50%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 109px;\"\u003e\n \u003cp\u003eSpecialized training (Supported Decision-Making and Advance Planning; Recovery Practices for Mental Health and Well-Being)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEquivalences\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn the evaluation carried out by the experts in the different modules, variations in item approval rates were observed. In the Human Rights Module, most items received 100% approval, with the exception of one item that recorded 83% approval, resulting in an overall approval rate of 99%. In the Mental Health, Disability and Human Rights Module, most items achieved 100% approval, with some specific items recording 83% approval, culminating in a total rate of 96%. In the Recovery and the Right to Health Module, most items were fully approved, with only one item recording 83% approval, totaling 99% overall approval. In the Legal Capacity and the Right to Decide Module, although most items reached 100% approval, some recorded rates between 50% and 83%, resulting in variable total approval. In the Freedom from Coercion, Violence and Abuse Module, the vast majority of items were approved, except for a single item that recorded 83% approval, culminating in a total rate of 99%. In the Supported Decision-Making and Advance Planning Module, most items were approved, but some recorded approval rates of 83% and 67%, resulting in variable overall approval rates. Finally, in the Recovery Practices for Mental Health and Well-Being Module, although most items achieved 100% approval, some recorded 83% approval, resulting in a total rate of 96%. The details are summarized in Table 4.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eValidation Results of Each Module According to Expert Opinion\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"609\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eModule\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 345px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal Approval of Each Module\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eContent Validity Index (CVI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eApproval Percentage\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cem\u003eHuman rights\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0,99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cem\u003eMental health, disability and human rights\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0,96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cem\u003eRecovery and the right to health\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0,99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cem\u003eLegal capacity and the right to decide\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e93%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cem\u003eFreedom from coercion, violence and abuse\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0,99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e99%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cem\u003eSupported decision-making and advance planning\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0,96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 264px;\"\u003e\n \u003cp\u003e\u003cem\u003eRecovery practices for mental health and well-being\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0,96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e96%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eIn addition to the evaluation via the Likert scale, the experts could provide suggestions for each item. To improve any item that did not achieve maximum approval (100%), all the suggestions were accepted, and modifications were made to the module before the pretesting stage. The suggestions focused on enhancing the clarity and detail of the texts, with topics that facilitate reading and comprehension. Adjustments were recommended for the language, particularly replacing foreign and academic terms with simpler equivalents, as well as defining technical terms. The inclusion of more illustrations was also suggested to enhance visual communication, and there was a reinforced need to create an interactive environment to encourage participation from those involved.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eTarget population evaluation\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAccording to the skill and knowledge level of the participants, 68% considered the content level advanced, 12% basic, 8% very basic, and 12% reasonable. The majority of the content agreed that it was relevant (82.6%), as was its flow and corresponding activities (82.6%), with clarity in communication (73.9%), participant engagement (69.6%), useful scenarios (69.6%) and discussions (73.9%), and sufficient information (82.6%). Concerning the individuals who facilitated the training, a large majority agreed or strongly agreed that the communication was clear (52%; 32%), with participant engagement (56%; 32%), useful questions answered (52%; 36%), creating a participatory environment (56%; 32%), and respecting participants\u0026apos; viewpoints (52%; 40%). The participants agreed that, overall, the training met their learning needs (72%) and expectations (69.6%) and was useful in their work/life (60.9%). Furthermore, they agreed that the training changed attitudes toward individuals with psychosocial, intellectual, and cognitive disabilities (78.3%) or would alter personal practices/aspects (78.3%). All these data are detailed in Table 5.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e Distribution of Responses Obtained from the QualityRights Training Evaluation Tool Applied to the Target Population in the Pretest Stage.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"606\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEvaluation Tool Items\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWithout Response (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDisagree (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisagree (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNeutral (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAgree (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrongly\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAgree (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 606px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbout the Training Content\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe content presented was relevant.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e82,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e13,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe flow of the content and activities worked\u003c/p\u003e\n \u003cp\u003ewell.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e82,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e13,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe content was clearly communicated.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e73,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e21,7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe training engaged participants.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e69,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e26,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe case scenarios were helpful.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e69,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e26,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe discussions during the training were useful.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e73,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e26,1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe amount of information was sufficient.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e-\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e82,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e13,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 606px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAbout people delivering the training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eClearly, communicated the content\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e8,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e52,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e32,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eEngaged the participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e56,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;32,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eResponded to questions in a helpful way\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e52,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;36,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eCreated a participatory environment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e56,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;32,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eRespected the participants\u0026rsquo; point of view\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e52,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e40,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\" valign=\"top\" style=\"width: 606px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegarding Learning, Expectations, and Utility of the Training\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eOverall, this training met my learning needs.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e4,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e72,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e12,0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe training met my expectations.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e8,7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e69,6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e17,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThe training experience will be useful in my\u003c/p\u003e\n \u003cp\u003ework/life.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e60,9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e30,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThis course changed my attitude toward\u003c/p\u003e\n \u003cp\u003epeople with psychosocial, intellectual and\u003c/p\u003e\n \u003cp\u003ecognitive disabilities.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e78,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e17,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 159px;\"\u003e\n \u003cp\u003eThis course will alter my practice/aspects of\u003c/p\u003e\n \u003cp\u003emy life.\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 68px;\"\u003e\n \u003cp\u003e4,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 94px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e78,3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e17,4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe responses to the open-ended questions from the training evaluation tool revealed three themes: \u003cem\u003emore empathetic and humanized attitudes and practices; additional benefits and impacts on professional careers; positive impacts on the Facilitators; and teaching methodology\u0026nbsp;\u003c/em\u003e.\u003c/p\u003e\n\u003cp\u003eIn the first theme, the comments from healthcare professionals reflect an acknowledgment of the need to enhance their practices with greater sensitivity and empathy in care. There is a self-critique and a commitment to humanizing care, as they emphasize the adoption of an attentive and empathetic perspective toward others. The training ignited in them a desire to transform their professional approaches, leading them to value understanding and closeness to individuals with disabilities more.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;(...) I tested a much more humane perspective than I previously had.\u0026rdquo; (ACS9)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I will look at others with more love.\u0026rdquo; (ACS24)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I will strive to be more empathetic.\u0026rdquo; (ACS26)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I believe this will change my practices toward a more empathetic view of people with psychosocial disabilities.\u0026rdquo; (ENF16)\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the second theme, the accounts indicate an enhancement in the analysis of situations and a more conscious and critical approach to patient care. Additionally, the training was perceived as highly relevant to daily practice, especially in the context of home visits, reinforcing the direct application of the knowledge acquired.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;(...) we began to analyze each situation better.\u0026rdquo; ACS7\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I learned a lot in practice and in how to care for individuals with mental health issues.\u0026rdquo; ACS25\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;My attitude changed for the better, I mean, after the course.\u0026rdquo; ENF16\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;This training has been and will be of great value for my home visits.\u0026rdquo; ACS1\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eIn the third theme, the comments highlight the quality and effectiveness of the training, with particular emphasis on the performance of the team responsible for the training. There is an appreciation for the engagement and clarity of the explanations. The interaction between the facilitators and the professionals was a central point, creating a welcoming and conducive environment for the sharing of experiences and opinions, which contributed to making the training dynamics more interesting and participatory. This involvement facilitated learning, promoted an atmosphere of trust and open dialog among all participants.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The professionals who delivered the course deserve congratulations.\u0026rdquo; ACS1\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;The team engaged the participants, making the dynamics more interesting.\u0026rdquo; ACS7\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I liked the explanations; they were very clear regarding how to interact with people with disabilities.\u0026rdquo; ACS6\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I was struck by the interaction of the facilitators with the team, making us feel comfortable sharing our experiences and opinions.\u0026rdquo; TECENF13\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThese testimonies reflect the transformation in the professionals\u0026apos; approach, the enrichment of their practices, and the quality of the training provided.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFigure 2 illustrates the interconnected elements that contribute to fostering empathy, commitment, and professional transformation in healthcare practices.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe methodological rigor of our study follows standards similar to those of other methodological studies, such as Santos et al.(36). The experts conducted a critical reading of the material and filled out an adapted assessment instrument, the suitability assessment of materials (SAM)(36). We ensured that the validation was accessible and appropriate for the target audience by organizing the information in a simple and objective manner(37). As in other studies in the literature, the majority of the experts were women and held a master\u0026apos;s degree(38). Like other studies in the literature, each training module was validated by six judges(39).\u003c/p\u003e\n\u003cp\u003eThe evaluation of the educational material by the judges, using the SAM, was validated as superior, reflecting similar findings in the literature. For example, a study validated a series album, achieving 92.7% agreement among content judges. Items assessed across the six domains achieved over 70% agreement, being considered superior, although some technical items had lower evaluations, and one item was classified as inadequate in the layout and typography domain. After suggestions for modifications, the album was deemed adequate(40).\u003c/p\u003e\n\u003cp\u003eLike in the aforementioned study, we made modifications on the basis of the specialists\u0026apos; suggestions, ensuring that the modules were appropriate and effective for the target audience. The results of our study align with the literature, demonstrating the validity and suitability of the modules adapted for the Brazilian context.\u003c/p\u003e\n\u003cp\u003eA relevant study for comparison with our results is the one conducted by Santos et al.(36). In this validation process, 12 judges/experts participated, obtaining the following content validity index (CVI) results for the categories: content (0.91), writing (0.84), illustrations (0.87), presentation (0.62), motivation (0.93), and cultural appropriateness (0.91). Subitem 4.2, regarding the size and type of font in the presentation category, received a score of 0.6, necessitating the required alteration. The educational material achieved an overall CVI of 0.85, which was considered validated(36).\u003c/p\u003e\n\u003cp\u003eSimilar results were found in our study. In Module 1, the majority of items received 100% approval, with the exception of one item that recorded 83%, resulting in a total approval rate of 99%. In the Mental Health, Disability and Human Rights Module, most items achieved 100% approval, with some specific items recording 83%, culminating in a total rate of 96%. In the Recovery and the Right to Health Module, the majority of items were fully approved, with only one item recording 83%, totaling 99% overall approval. In the Legal Capacity and the Right-to-Decide Module, although most items achieved 100% approval, some recorded rates between 50% and 83%, resulting in variable total approval. In the Freedom from Coercion, Violence and Abuse Module, the vast majority of the items were approved, except for a single item that recorded 83%, culminating in a total rate of 99%. In the Supported Decision-Making and Advance Planning Module, most items were approved, but some recorded approval rates of 83% and 67%, resulting in variable overall approval rates. Finally, in the Recovery Practices for Mental Health and Well-Being Module, although most items achieved 100% approval, some recorded 83%, resulting in a total rate of 96%.\u003c/p\u003e\n\u003cp\u003eIn the study by Costa et al.(37), the average CVI across the three analyzed dimensions was above 0.8, validating the contents of the educational booklet. With a global CVI of 0.96, the result was quite satisfactory, validating the content of the booklet. Additionally, the judges suggested replacing technical terms, reformulating and adding illustrations, simplifying sentences for greater clarity, defining necessary acronyms and technical terms, and including additional information. These results are comparable to those of our study, where the average CVI per item was above 0.8 and the minimum overall CVI was 0.93.\u003c/p\u003e\n\u003cp\u003eIn the study by Santos et al.(38), the agreement among the judges regarding the educational material resulted in a global CVI of 0.92 in the first evaluation, validating the content(38). Another study, which developed an educational booklet and used SAM analysis, reported that all the items were individually rated as superior. The overall evaluation of the booklet, which was based on the average scores among the items, revealed that the material was considered superior, with a percentage of 85.2%(41).\u003c/p\u003e\n\u003cp\u003eIn addition to the evaluation percentages, it is important to highlight the relevance of the comments and suggestions from the experts, which enriched the educational material, enhancing its ability to achieve the outlined objectives(36), as well as the suggestions made in our study, which were fundamental for improving each evaluated category.\u003c/p\u003e\n\u003cp\u003eThe formative process in health, especially in the area of mental health and the construction and validation of educational technologies, aims to enhance practices and care, strengthening the National Mental Health Policy(42). The use of evidence-based educational materials subjected to content and semantic validation processes is crucial for mediating health education practices and raising awareness among university students, promoting effective dialog with the target audience(43). Educational activities that employ technologies and aim for behavioral changes are an integral part of the health education process(41). The use of these technologies in health education is significantly growing, as they have the potential to empower individuals both individually and collectively, providing pertinent information and knowledge on the subject(36).\u003c/p\u003e\n\u003cp\u003eThe results of this research, in line with the findings of Morrissey(9), reinforce the positive impact of training on changing the attitudes and practices of healthcare professionals. In the pretest of this research, 82.6% of the participants considered the training content relevant, and 82.6% also believed that the information provided was sufficient to promote a mindset change regarding care. This is complemented by the responses to the open-ended questions explored in the first and second themes, where participants highlighted the practical relevance of the content addressed, reinforcing the finding that the training not only enhanced technical knowledge but also positively influenced personal attitudes, promoting greater empathy and sensitivity in their daily practices.\u003c/p\u003e\n\u003cp\u003eThis recognition of relevance is similar to that observed in the study by Morrissey(9), in which 92% of the participants believed that the training would be useful in their professional and personal lives. Additionally, the engagement of participants and the clarity in the application of content (73.9%) were also highlighted in this research, reflecting the effectiveness of active methodologies, such as scenarios and discussions, which were used to make learning more practical and applicable. The study by Morrissey(9) also emphasized the personal impact of the training, highlighting how it sensitized participants to the importance of human rights and the realities experienced by individuals with disabilities, resulting in 89% of participants stating that their practices would change directly through learning.\u003c/p\u003e\n\u003cp\u003eThe results indicate that the majority of participants positively evaluated the clarity in communication and the engagement of the facilitators, with 84% of the respondents agreeing or strongly agreeing about the clarity of the information conveyed and 88% recognizing a high level of engagement from the facilitators. Additionally, the participants highlighted that their questions were adequately answered (88%) and that the environment promoted during the training was participatory and respectful, with 84% stating that different viewpoints were considered. The expertise of the facilitating team was widely explored in the comments that constitute the third theme of the qualitative analysis, recognized as an important factor for the validation of the training. The literature reinforces that the technical and interpersonal competence of course facilitators generates trust among participants and facilitates the assimilation of content and involvement in proposed activities(44).\u003c/p\u003e\n\u003cp\u003eThe study by Morrissey(9) also pointed to a positive perception regarding the facilitators of the QualityRights training, with participants emphasizing that their expertise and knowledge were crucial for understanding the concepts presented, particularly regarding human rights and mental health practices. The quality of facilitation was identified as a key factor for the success of the training, promoting not only the absorption of theoretical content but also the practical application of the discussed principles.\u003c/p\u003e\n\u003cp\u003eRegarding the expectations and utility of the training, the majority of participants (60.9%) highlighted the practical applicability of the content, whereas 78.3% reported expected changes in their attitudes and practices toward individuals with psychosocial disabilities. These results align with studies conducted in India and Tunisia, where health professionals also rated the training as useful or extremely useful, with emphasis on the content and feedback mechanisms. They also showed a significant improvement in knowledge and attitudes after the training, indicating that the training applied by the facilitators and with active participation from professionals enhanced the understanding and approach to mental health care on the basis of human rights(45,46).\u003c/p\u003e\n\u003cp\u003eThe participatory approach to learning, which uses personal stories and group discussions, is highlighted in the literature as a powerful tool to promote empowerment and critical reflection on human rights in the context of mental health across different countries(9,45,46. Therefore, these findings align with the global objectives of implementing QualityRights training(47), which are based on the principles of the CRPD(48).\u003c/p\u003e\n\u003cp\u003eHowever, it is worth noting that the Czech Republic demonstrated difficulties in the translation and cultural adaptation of training, such as the course\u0026apos;s length and the consequent loss of participants, with the COVID-19 pandemic being the main reason(49). These challenges highlight the importance of ensuring that the training content is relevant and accessible to the local context to maximize its utility, as well as specific transformation plans to implement ongoing training and promote effective changes in practice(45).\u003c/p\u003e\n\u003cp\u003eTherefore, the validation of the QualityRights training modules significantly influences the practices of mental health professionals in Brazil, as well as the routines of other professionals who may encounter demands related to mental health, as it enables more humanized care that provides autonomy and a safe environment for individuals with mental disorders, thereby increasing access to health services, guaranteeing the human rights of these users, and fulfilling the principles outlined in the Convention on the Rights of Persons with Disabilities (CRPD)(9,48).\u003c/p\u003e\n\u003cp\u003eThe open-ended questions provided a deeper understanding of the content by the target audience and the manner in which the training was delivered. This was also significant in a study with healthcare professionals from China, Ethiopia, India, Nepal, and Tunisia, who participated in training on experienced and anticipated discrimination related to mental health. They considered the content highly relevant and useful for their professional practices, emphasizing the direct applicability of the topics addressed in their daily work. They also praised the competence and accessibility of the team that delivered the course, appreciating the instructors\u0026apos; experience, knowledge, and willingness to clarify doubts and offer additional support, recognized as important facilitators(50).\u003c/p\u003e\n\u003cp\u003eMoreover, it is important to emphasize that, in light of the professional attitude changes following training, there is a goal to eliminate barriers such as discrimination, rights violations, and other disparities, not only through the recognition of the aforementioned factors but also through the joint advocacy of user autonomy. Through respect, dignified treatment, and the importance given to the issues reported by these individuals, holistic care and recognition of the subject beyond the biomedical approach are achieved, thereby ensuring continuity of care by promoting an equitable and comprehensible environment(9).\u003c/p\u003e\n\u003cp\u003eThe aforementioned individual changes favor the implementation of a system that guarantees individuals with mental disorders not only access to health services, which will have trained teams but also professionals who are willing to intervene in specific needs and the community at large. Given that mental health is interconnected with social and economic factors and represents a collective responsibility involving health institutions, families, communities, governments, and other civil society organizations, trained professionals will have mediation tools between different institutions and the means to act comprehensively in the treatment and recovery of users, ensuring the success of assistance(9).\u003c/p\u003e\n\u003cp\u003eIn summary, the validation of educational technologies and the use of evidence-based materials are fundamental to improving practices in mental health and health education. Our results indicate significant progress in the cultural adaptation of the modules, which will contribute to the effective implementation and strengthening of mental health policies in Brazil.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe cultural adaptation and validation of the WHO QualityRights training modules to Brazilian Portuguese represent important steps forward in enhancing mental health practices in Brazil. By aligning the training content with the specific cultural and contextual needs of Brazilian healthcare professionals, this initiative facilitates the integration of human rights principles into mental health care, promoting more humane, dignified, and person-centered approaches.\u003c/p\u003e\n\u003cp\u003eThe results of this study reinforce the importance of rigorous validation of educational technologies in the mental health field aimed at improving the practices and care provided to patients. By adopting a consistent methodological approach aligned with established standards in the literature, we demonstrated the effectiveness of educational materials adapted for the Brazilian context.\u003c/p\u003e\n\u003cp\u003eThe active participation of experts provided valuable insights that enriched the validation process, confirming not only the relevance of the adopted approach but also offering robust support for the effective implementation of mental health policies. This, in turn, promotes the well-being of the Brazilian population and facilitates the continuous improvement of health services.\u003c/p\u003e\n\u003cp\u003eThe participants expressed a strong commitment to applying the knowledge gained in their professional practice, anticipating improvements in their attitudes toward individuals with psychosocial disabilities. The study demonstrated that the training modules were well received by participants, as evidenced by high approval rates and positive feedback on the clarity, relevance, and applicability of the content.\u003c/p\u003e\n\u003cp\u003eFurthermore, the engagement of facilitators and the interactive nature of the training contributed to a supportive learning environment, fostering trust and open dialog. This aligns with global efforts to improve mental health services and highlights the importance of training that empowers professionals to challenge existing biases and adopt a more empathetic approach to care.\u003c/p\u003e\n\u003cp\u003eIn summary, the successful adaptation and validation of these training modules not only enhance the capacity of healthcare professionals in Brazil but also contribute to the broader objective of promoting human rights and improving mental health outcomes for individuals with mental disorders. This initiative underscores the need for ongoing training and support to ensure that mental health practices remain aligned with international human rights standards.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003e\u003cem\u003eEthics approval and consent to participate\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe research was approved by the Ethics Committee of the School of Nursing of Ribeir\u0026atilde;o Preto at the University of S\u0026atilde;o Paulo (Opinion Number: 6.257.303/2021). The free and informed consent term was read and signed by the participants (experts and healthcare professionals) in two copies, with one kept by them and the other by the research team. To preserve the anonymity of the responses from the open-ended questions, codes were assigned to the healthcare professional participants (ACS, ENF, TEC-ENF). The study followed the recommendations of Brazilian Resolution No. 466, of 2012, on research involving human beings (Brazil, 2012).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eClinical trial number\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by the National Council for Scientific and Technological Development (CNPq)-Brazil (process n\u0026deg; 408399/2021-0).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAuthors\u0026apos; contributions\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eESB and ABZM wrote the main manuscript, with input from IOR and CAAV. IOR and AMS prepared the tables and figures. ESB and ABZM coordinated the expert committee stage, with contributions from AMS. ESB, ABZM, and IOR conducted the pretesting stage. ABZM conducted the analysis. ESB obtained ethical consent for the study. IOR, ABZM and CAAV contributed to data interpretation. ESB, IOR and CAAV revised the manuscript. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMahdanian AA, Laporta M, Drew Bold N, Funk M, Puras D. Human rights in mental healthcare; A review of current global situation. International Review of Psychiatry [Internet]. 2023 [cited 2024 Nov 26];35(2):150\u0026ndash;62. Available from: https://www.tandfonline.com/doi/abs/10.1080/09540261.2022.2027348\u003c/li\u003e\n\u003cli\u003ePuras D, Gooding P. Mental health and human rights in the 21st century. World Psychiatry [Internet]. 2019 Feb 1 [cited 2024 Nov 26];18(1):42\u0026ndash;3. Available from: https://pubmed.ncbi.nlm.nih.gov/30600633/\u003c/li\u003e\n\u003cli\u003eHughes K, Bellis MA, Jones L, Wood S, Bates G, Eckley L, et al. Prevalence and risk of violence against adults with disabilities: a systematic review and meta-analysis of observational studies. The Lancet. 2012 Apr;379(9826):1621\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eMann SP, Bradley VJ, Sahakian BJ. Human Rights-Based Approaches to Mental Health: A Review of Programs \u0026ndash; Health and Human Rights Journal. Health Numan Rights [Internet]. 2016 Jun [cited 2024 Oct 2];1(18):263\u0026ndash;76. Available from: https://www.hhrjournal.org/2016/05/human-rights-based-approaches-to-mental-health-a-review-of-programs/\u003c/li\u003e\n\u003cli\u003eJacob K. Recovery Model of Mental Illness: A Complementary Approach to Psychiatric Care. Indian J Psychol Med [Internet]. 2015 Apr 1 [cited 2024 Oct 2];37(2):117. Available from:/pmc/articles/PMC4418239/\u003c/li\u003e\n\u003cli\u003ePatel V, Saxena S, Lund C, Thornicroft G, Baingana F, Bolton P, et al. The Lancet Commission on global mental health and sustainable development. Lancet [Internet]. 2018 Oct 27 [cited 2024 Nov 26];392(10157):1553\u0026ndash;98. Available from: https://pubmed.ncbi.nlm.nih.gov/30314863/\u003c/li\u003e\n\u003cli\u003eUnited Nations. Convention on the Rights of Persons with Disabilities. New York; Dec 13, 2006.\u003c/li\u003e\n\u003cli\u003eBhugra D, Tribe R, Poulter D. Social justice, health equity, and mental health. https://doi.org/101177/00812463211070921 [Internet]. 2022 Jan 8 [cited 2024 Nov 26];52(1):3\u0026ndash;10. Available from: https://journals.sagepub.com/doi/full/10.1177/00812463211070921\u003c/li\u003e\n\u003cli\u003eMorrissey FE. An evaluation of attitudinal change toward CRPD rights following delivery of the WHO QualityRights training programme. Ethics Med Public Health. 2020 Apr 1;13:100410.\u003c/li\u003e\n\u003cli\u003eMuhia J, Jaguga F, Wamukhoma V, Aloo J, Njuguna S. A human rights assessment of a large mental hospital in Kenya. Pan Afr Med J [Internet]. 2021 [cited 2024 Nov 26];40. Available from: https://pubmed.ncbi.nlm.nih.gov/35096226/\u003c/li\u003e\n\u003cli\u003eMoro MF, Kola L, Fadahunsi O, Jah EM, Kofie H, Samba D, et al. Quality of care and respect of human rights in mental health services in four West African countries: collaboration between the mental health leadership and advocacy programme and the World Health Organization QualityRights initiative. BJPsych Open [Internet]. 2022 Jan [cited 2024 Nov 26];8(1). Available from: https://pubmed.ncbi.nlm.nih.gov/35076357/\u003c/li\u003e\n\u003cli\u003ePitta AMF, Coutinho DM, Rocha CCM. Direitos humanos nos Centros de Aten\u0026ccedil;\u0026atilde;o Psicossocial do Nordeste do Brasil: um estudo avaliativo, tendo como refer\u0026ecirc;ncia o QualityRights - WHO. Sa\u0026uacute;de em Debate [Internet]. 2015 Sep [cited 2024 Oct 2];39(106):760\u0026ndash;71. Available from: https://www.scielo.br/j/sdeb/a/zqy4dxc8v5Qm8T5SvTk9PrP/\u003c/li\u003e\n\u003cli\u003eOsei AO, Amissah C, Hanu SC, Tawiah PE, Brobbey KA, Arthur YA, et al. Implementation of the World Health Organization\u0026rsquo;s QualityRights initiative in Ghana: an overview. BJPsych Open [Internet]. 2024 May;10(3):e111. Available from: https://www.cambridge.org/core/product/identifier/S2056472424000115/type/journal_article\u003c/li\u003e\n\u003cli\u003eWHO WHO. QualityRights materials for training, guidance and transformation [Internet]. World Health Organization. 2019. Available from: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools\u003c/li\u003e\n\u003cli\u003eCarta MG, Ghacem R, Milka M, Moula O, Staali N, Uali U, et al. Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital. Clin Pract Epidemiol Ment Health [Internet]. 2020 Aug 2 [cited 2022 Sep 15];16(Suppl-1):125. Available from:/pmc/articles/PMC7431701/\u003c/li\u003e\n\u003cli\u003ePathare S, Funk M, Drew Bold N, Chauhan A, Kalha J, Krishnamoorthy S, et al. Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India. The British Journal of Psychiatry [Internet]. 2021 Apr 1 [cited 2024 Nov 26];218(4):196\u0026ndash;203. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/systematic-evaluation-of-the-qualityrights-programme-in-public-mental-health-facilities-in-gujarat-india/0D467F4768D9D08725AE9F0056A3B929\u003c/li\u003e\n\u003cli\u003eMelo RMDSB de, Morais GB, Morais JB, Leite SN. Conception of the Right to Health of Mid-Level Technical Professionals of Unified Health System In Brazil. Journal of Human Growth and Development. 2018 Mar 12;28(1):95.\u003c/li\u003e\n\u003cli\u003eOrtega F, M\u0026uuml;ller MR. Rethinking structural competency: Continuing education in mental health and practices of territorialization in Brazil. Glob Public Health [Internet]. 2023 Jan 2 [cited 2024 Nov 26];18(1). Available from: https://www.tandfonline.com/doi/abs/10.1080/17441692.2022.2157034\u003c/li\u003e\n\u003cli\u003eNewham R, Hewison A, Graves J, Boyal A. Human rights education in patient care: A literature review and critical discussion. Nurs Ethics [Internet]. 2021 Mar 1 [cited 2024 Nov 26];28(2):190\u0026ndash;209. Available from: https://journals.sagepub.com/doi/10.1177/0969733020921512\u003c/li\u003e\n\u003cli\u003eZanardo ABR, Ventura CAA. Cultural adaptation and validation of the Strategies to end seclusion restraint module of the QualityRights ToolKit*. Rev Lat Am Enfermagem. 2022;30.\u003c/li\u003e\n\u003cli\u003eLobiondo-Wood G, Haber J. Desenhos n\u0026atilde;o experimentais. In: Pesquisa em enfermagem: m\u0026eacute;todos, avalia\u0026ccedil;\u0026atilde;o cr\u0026iacute;tica e utiliza\u0026ccedil;\u0026atilde;o. 4th ed. Guanabara-Koogan; 2001.\u003c/li\u003e\n\u003cli\u003ePolit DF, Beck CT. Fundamentos da pesquisa em enfermagem: avalia\u0026ccedil;\u0026atilde;o de evid\u0026ecirc;ncias para a pr\u0026aacute;tica de enfermagem. . 7th ed. Artmed; 2011.\u003c/li\u003e\n\u003cli\u003eBeaton DE, Bombardier C, Guillemin F, Ferraz MB. Guidelines for the Process of Cross-Cultural Adaptation of Self-Report Measures. Spine (Phila Pa 1976). 2000 Dec;25(24):3186\u0026ndash;91.\u003c/li\u003e\n\u003cli\u003ePasquali L. Princ\u0026iacute;pios de elabora\u0026ccedil;\u0026atilde;o de escalas psicol\u0026oacute;gicas. Rev Psiquiatr Clín. 1998;25(5):206\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003eOliveira MS de, Fernandes AFC, Sawada NO. Manual educativo para o autocuidado da mulher mastectomizada: um estudo de valida\u0026ccedil;\u0026atilde;o. Texto \u0026amp; Contexto - Enfermagem. 2008 Mar;17(1):115\u0026ndash;23.\u003c/li\u003e\n\u003cli\u003ePasquali L. Princ\u0026iacute;pios de elabora\u0026ccedil;\u0026atilde;o de escalas psicol\u0026oacute;gicas. Rev Psiquiatr Clín. 1998;25(5):206\u0026ndash;13.\u003c/li\u003e\n\u003cli\u003ePolit DF, Beck CT. The content validity index: Are you sure you know what\u0026rsquo;s being reported? critique and recommendations. Res Nurs Health. 2006 Oct;29(5):489\u0026ndash;97.\u003c/li\u003e\n\u003cli\u003eLobiondo-Wood G, Haber J. Desenhos n\u0026atilde;o experimentais. In: Pesquisa em enfermagem: m\u0026eacute;todos, avalia\u0026ccedil;\u0026atilde;o cr\u0026iacute;tica e utiliza\u0026ccedil;\u0026atilde;o. 4th ed. Guanabara-Koogan; 2001.\u003c/li\u003e\n\u003cli\u003ePolit DF, Beck CT. Fundamentos da pesquisa em enfermagem: avalia\u0026ccedil;\u0026atilde;o de evid\u0026ecirc;ncias para a pr\u0026aacute;tica de enfermagem. . 7th ed. Artmed; 2011.\u003c/li\u003e\n\u003cli\u003eSousa CS, Turrini RNT, Poveda VB. Tradu\u0026ccedil;\u0026atilde;o e adapta\u0026ccedil;\u0026atilde;o do instrumento \u0026ldquo;suitability assessment of materials\u0026rdquo; (sam) para o portugu\u0026ecirc;s. Revista de Enfermagem UFPE on line [Internet]. 2015 Apr 12 [cited 2024 Nov 26];9(5):7854\u0026ndash;61. Available from: https://periodicos.ufpe.br/revistas/index.php/revistaenfermagem/article/view/10534\u003c/li\u003e\n\u003cli\u003eAguiar B, Correia W, Campos F. Uso da Escala Likert na An\u0026aacute;lise de Jogos. In: Proceedings of SBGames. 2011.\u003c/li\u003e\n\u003cli\u003eParo BA. Escala Likert: coisas que todo pesquisador deveria saber. NetQuest; 2012.\u003c/li\u003e\n\u003cli\u003eArag\u0026atilde;o J da S, de Fran\u0026ccedil;a ISX, Coura AS, de Sousa FS, Batista JDL, Magalh\u0026atilde;es IM de O. A content validity study of signs, symptoms and diseases/health problems expressed in LIBRAS. Rev Lat Am Enfermagem [Internet]. 2015 Nov 1 [cited 2024 Nov 27];23(6):1014\u0026ndash;23. Available from: https://www.scielo.br/j/rlae/a/q4fPCn9RTfczrvYDQCgWcct/?lang=en\u003c/li\u003e\n\u003cli\u003eBraun V, Clarke V. Conceptual and Design Thinking for Thematic Analysis. Qualitative Psychology. 2021 May 13;9(1):3\u0026ndash;26.\u003c/li\u003e\n\u003cli\u003eBrasil. Resolu\u0026ccedil;\u0026atilde;o n\u003csup\u003eo\u003c/sup\u003e 466. Minist\u0026eacute;rio da Sa\u0026uacute;de; Dec 12, 2012.\u003c/li\u003e\n\u003cli\u003eSantos IL, Nascimento L de CN, Coelho MP, Freitas P de SS, Moraes-Partelli AN. Produ\u0026ccedil;\u0026atilde;o e valida\u0026ccedil;\u0026atilde;o de material educativo: instrumento educativo para o cuidado domiciliar ao rec\u0026eacute;m-nascido prematuro. Rev Bras Enferm. 2023;76(1).\u003c/li\u003e\n\u003cli\u003eCosta CC da, Gomes LF de S, Teles LMR, Mendes IC, Ori\u0026aacute; MOB, Damascen AK de C. Constru\u0026ccedil;\u0026atilde;o e valida\u0026ccedil;\u0026atilde;o de uma tecnologia educacional para preven\u0026ccedil;\u0026atilde;o da s\u0026iacute;filis cong\u0026ecirc;nita. Acta Paulista de Enfermagem. 2020 Oct 20;33.\u003c/li\u003e\n\u003cli\u003eSantos A da S, Rodrigues L do N, Andrade KC, Santos MSN dos, Viana MCA, Chaves EMC. Construction and validation of an educational technology for mother-child bond in the neonatal intensive care unit. Rev Bras Enferm. 2020;73(4).\u003c/li\u003e\n\u003cli\u003eLins MLR, Evangelista CB, Gomes GLL, Macedo JQ de. Autocuidado domiciliar ap\u0026oacute;s cirurgias ginecol\u0026oacute;gicas: elabora\u0026ccedil;\u0026atilde;o e valida\u0026ccedil;\u0026atilde;o de material educativo. Acta Paulista de Enfermagem. 2021 Nov 5;34.\u003c/li\u003e\n\u003cli\u003eVasconcelos FX, Barbosa LP, Lima FET, Sabino LMM de, Lima KF, Mendes ER da R. \u0026Aacute;lbum seriado para promo\u0026ccedil;\u0026atilde;o da autoefic\u0026aacute;cia na asma infantil: constru\u0026ccedil;\u0026atilde;o e valida\u0026ccedil;\u0026atilde;o. Revista da Escola de Enfermagem da USP. 2023;57.\u003c/li\u003e\n\u003cli\u003eBalsells MMD, Silveira GEL, Aquino P de S, Barbosa LP, Damasceno AK de C, Lima TM. Desenvolvimento de cartilha como tecnologia educacional para al\u0026iacute;vio da dor do parto. Acta Paulista de Enfermagem. 2023 Jan 20;36.\u003c/li\u003e\n\u003cli\u003eSilva FP da, Alves BMM, Silva DMR da, Fraz\u0026atilde;o I da S, Brand\u0026atilde;o Neto W, Pinto ID da S, et al. VALIDA\u0026Ccedil;\u0026Atilde;O DE TECNOLOGIA EDUCACIONAL COMO RECURSO DID\u0026Aacute;TICO NO ENSINO DE ENFERMAGEM EM SA\u0026Uacute;DE MENTAL. Texto \u0026amp; Contexto - Enfermagem. 2024;33.\u003c/li\u003e\n\u003cli\u003eGigante VCG, Oliveira RC de, Ferreira DS, Teixeira E, Monteiro WF, Martins AL de O, et al. CONSTRU\u0026Ccedil;\u0026Atilde;O E VALIDA\u0026Ccedil;\u0026Atilde;O DE TECNOLOGIA EDUCACIONAL SOBRE CONSUMO DE \u0026Aacute;LCOOL ENTRE UNIVERSIT\u0026Aacute;RIOS. Cogitare Enfermagem. 2021 Feb 22;26.\u003c/li\u003e\n\u003cli\u003eKuske S, Icks A, Zaletel J, Rothe U, Lindstrom J, Sorensen M, et al. Education and health professionals training programs for people with type 2 diabetes: a review of quality criteria. Ann Ist Super Sanit\u0026agrave;. 2015;51(3):199\u0026ndash;205.\u003c/li\u003e\n\u003cli\u003eCarta MG, Ghacem R, Milka M, Moula O, Staali N, Uali U, et al. Implementing WHO-Quality Rights Project in Tunisia: Results of an Intervention at Razi Hospital. Clin Pract Epidemiol Ment Health [Internet]. 2020 Aug 2 [cited 2022 Sep 15];16(Suppl-1):125. Available from:/pmc/articles/PMC7431701/\u003c/li\u003e\n\u003cli\u003ePathare S, Funk M, Drew Bold N, Chauhan A, Kalha J, Krishnamoorthy S, et al. Systematic evaluation of the QualityRights programme in public mental health facilities in Gujarat, India. The British Journal of Psychiatry [Internet]. 2021 Apr 1 [cited 2024 Nov 26];218(4):196\u0026ndash;203. Available from: https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/systematic-evaluation-of-the-qualityrights-programme-in-public-mental-health-facilities-in-gujarat-india/0D467F4768D9D08725AE9F0056A3B929\u003c/li\u003e\n\u003cli\u003eWHO WHO. QualityRights materials for training, guidance and transformation [Internet]. World Health Organization. 2019. Available from: https://www.who.int/publications/i/item/who-qualityrights-guidance-and-training-tools\u003c/li\u003e\n\u003cli\u003eUnited Nations. Convention on the Rights of Persons with Disabilities. New York; Dec 13, 2006.\u003c/li\u003e\n\u003cli\u003eMion ABZ, Ventura CAA. The WHO QualityRights Initiative and its use worldwide: A literature review. International Journal of Social Psychiatry [Internet]. 2023 Dec; Available from: http://journals.sagepub.com/doi/10.1177/00207640231207580\u003c/li\u003e\n\u003cli\u003eHenderson C, Ouali U, Bakolis I, Berbeche N, Bhattarai K, Brohan E, et al. Training for mental health professionals in responding to experienced and anticipated mental health related discrimination (READ-MH): protocol for an international multisite feasibility study. 2022.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Human Rights, Mental Health, People with disability, CRPD, Training, QualityRights, Rights-based care, World Health Organization, Validation Study","lastPublishedDoi":"10.21203/rs.3.rs-5753746/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5753746/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e: Human rights violations in mental health care can worsen conditions, while their protection fosters recovery and dignity. The WHO QualityRights training is an important educational tool for empowering health professionals and driving institutional change. Recognizing the need for culturally relevant mental health training materials in Brazil, this study aimed to adapt and validate the WHO QualityRights training modules into Brazilian Portuguese.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e: Seven modules were translated and validated through four stages (translation, synthesis, expert committee review, and pretesting), following models by Beaton et al. (2000) and Pasquali (1998). A total of 42 experts evaluated semantic, idiomatic, and conceptual equivalence using the Content Validation Index (CVI). The pretest involved 21 primary health care professionals, who assessed the training's relevance through closed and open-ended questions. Quantitative analyses were performed using IBM® SPSS Statistics version 25, while qualitative data were analyzed using Braun \u0026amp; Clarke’s Thematic Analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e: The CVI ranged from 93% to 99% across modules, confirming content validity. During pretesting, 82.6% of participants found the training relevant and applicable to their practice. Responses to open-ended questions revealed three themes, highlighting increased empathy, understanding of human rights-based approaches, and the effectiveness of the training methodology used by facilitators.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e: The training modules were well-received and understood, demonstrating potential to promote human rights-oriented mental health care tailored to Brazil’s cultural and contextual needs. This approach could also serve as a replicable model for other low- and middle-income countries aiming to integrate human rights into health services.\u003c/p\u003e","manuscriptTitle":"Cultural Adaptation and Validation of the WHO QualityRights Training to Brazilian Portuguese","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-03-12 08:13:04","doi":"10.21203/rs.3.rs-5753746/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e629846b-d4c9-4873-81ea-4f429c0fd941","owner":[],"postedDate":"March 12th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-03-12T08:13:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-03-12 08:13:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5753746","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5753746","identity":"rs-5753746","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}