Expert adaptation and validation of a verbal autopsy instrument in Chile using the Delphi method

Abstract

Background In Chile, despite high obstetric coverage and consolidated registration systems, there has been a stagnation in the reduction of maternal mortality, reflecting the need to identify social factors and determinants. These are often overlooked by traditional surveillance systems. Objective To adapt and validate, through expert consensus, a verbal autopsy instrument based on the three delays model, with a gender and intercultural approach. Methods Expert validation study using the Delphi method in three phases, carried out between June and October 2024. Forty experts in maternal health, epidemiological surveillance, gender, and interculturality participated. Seven criteria were evaluated: clarity, relevance, cultural relevance, socio-health relevance, regulatory relevance, and the incorporation of gender and intercultural approaches. The process sought to reach consensus to ensure the methodological and contextual quality of the instrument. Results The final instrument includes 95 items organized into six thematic blocks. An overall consensus of 85% was achieved on the evaluated criteria. The adaptation incorporated variables such as mental health, gender-based violence, ethnic identity, and perceived quality of care. Operational validation identified implementation, logistical, and ethical challenges, leading to a gradual implementation plan in regulatory, pilot, and national expansion phases. Conclusions The instrument adapted and validated by experts offers a complementary tool for monitoring maternal mortality in Chile. Its comprehensive approach would allow identifying social and structural factors associated with maternal deaths, favoring more equitable and culturally relevant interventions aimed at preventing avoidable maternal deaths. Field validation is essential to assess the impact of its application.

Keywords

• verbal autopsy
• maternal mortality
• gender
• interculturality