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Oudshoorn CEM, Frielink N, Riper H, Embregts PJCM. Measuring working alliance and technical alliance from the perspective of healthcare professionals working with people with mild intellectual disabilities: adaptation, factor structure and reliability. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2023; 67:49-63. [PMID: 36320102 PMCID: PMC10092498 DOI: 10.1111/jir.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 10/10/2022] [Accepted: 10/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The establishment of a valuable and meaningful working alliance between people with mild intellectual disabilities (IDs) and healthcare professionals is critically important for improving both the quality of life and impact of therapy for people with mild IDs. Measuring the working alliance as a treatment or support component is therefore of utmost relevance. In light of the increased use of eHealth tools, it is also essential to measure the alliance using these tools, which is referred to as technical alliance. There was a lack of validation of these two measurements for healthcare professionals working with people with mild IDs, which this study sought to address. METHOD Both the validated Working Alliance Inventory - Short Form - MID (WAI-SF-MID) and Technical Alliance Inventory - Short Form - MID (TAI-SF-MID) for general patient populations were adapted for healthcare professionals working with people with mild IDs. A two-step approach was conducted to systematically adapt both measurements with an expert group of healthcare professionals. Confirmatory factor analysis was conducted to test a three-factor structure for both the WAI-SF-MID (N = 199) and the TAI-SF-MID (N = 139), and internal consistency was determined for both scales. RESULTS An acceptable-to-good model fit was found for both the WAI-SF-MID and the TAI-SF-MID; confirmatory factor analysis confirmed a three-factor model for both measurements. Cronbach's alpha and McDonald's omega were excellent for both total scales (≥0.90) and acceptable to good for sub-scales of both versions. CONCLUSION Both the WAI-SF-MID and the TAI-SF-MID are promising measurements for determining healthcare professionals' perspective on the (digital) working alliance with people with mild IDs.
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Affiliation(s)
- C. E. M. Oudshoorn
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
- ASVZSliedrechtThe Netherlands
| | - N. Frielink
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
| | - H. Riper
- Department of Clinical, Neuro‐ & Developmental PsychologyVrije Universiteit Amsterdam, Amsterdam Public Health, Mental Health ProgramAmsterdamThe Netherlands
- Department of PsychiatryAmsterdam UMC Location Vrije Universiteit AmsterdamAmsterdamThe Netherlands
| | - P. J. C. M. Embregts
- Tranzo, Tilburg School of Social and Behavioral SciencesTilburg UniversityTilburgThe Netherlands
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Paap D, Karel YHJM, Verhagen AP, Dijkstra PU, Geertzen JHB, Pool G. The Working Alliance Inventory's Measurement Properties: A Systematic Review. Front Psychol 2022; 13:945294. [PMID: 35910993 PMCID: PMC9337219 DOI: 10.3389/fpsyg.2022.945294] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/24/2022] [Indexed: 11/13/2022] Open
Abstract
Measurement properties of the Working Alliance Inventory (WAI) and its various translations and adaptations for specific target groups have been investigated for over 30 years. No systematic review analyzing studies on measurement properties of the WAI has been conducted to date. COnsensus-based Standards for the selection of health Measurements INstruments (COSMIN) were developed for conducting high-quality systematic reviews on measurement properties in a transparent and standardized way. Aim of this study was to systematically review studies on measurement properties of the WAI, and its adapted versions, within psychotherapy, and other healthcare contexts using COSMIN criteria. PsycINFO, Medline, and EMBASE were searched (1989–2021). In all phases of the review procedure, study selection, data extraction, risk of bias assessment, rating of the quality of measurement properties, and rating of the quality of evidence for measurement properties, disagreement between reviewers was resolved by discussion. Results on validity, internal structure, reliability, construct validity, and responsiveness were analyzed. In total 66 studies were included. In most studies, evidence for measurement properties was according to COSMIN criteria, insufficient, lacking, or conflicting. Content validity was rated insufficient because neither patients nor healthcare professionals were involved in the development and validation process. Hence evidence for content validity of the WAI is unknown. Conflicting evidence was found for structural validity. Evidence for internal consistency could not be established. Limited evidence was found for inter-rater reliability and convergent validity. Conflicting evidence was also found for test-retest reliability and divergent validity. COSMIN criteria exposed persistent problems in validation studies of the WAI. These findings may indicate that measurement properties of the WAI are not up to current standards, or that COSMIN criteria may be less appropriate for assessing measurement properties of the WAI, or it could indicate both. The results of this systematic review suggest that WAI outcomes should be interpreted with caution and further research is needed regarding the content validity and hypotheses development. For the future, the theoretical framework underlying the measurement of the working alliance needs to be studied in psychotherapy and other health contexts, and tested in methodologically sound studies.
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Affiliation(s)
- Davy Paap
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Physical Therapy, Saxion University of Applied Science, Enschede, Netherlands
- *Correspondence: Davy Paap
| | - Yasmaine H. J. M. Karel
- Center of Expertise Caring Society 3.0, Avans University of Applied Science, Breda, Netherlands
- Department General Practice, Erasmus Medical Centre University, Rotterdam, Netherlands
| | - Arianne P. Verhagen
- Department General Practice, Erasmus Medical Centre University, Rotterdam, Netherlands
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Pieter U. Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Jan H. B. Geertzen
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Grieteke Pool
- Section Health Psychology, Faculty of Medical Sciences, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
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Ebert KD. Parent perspectives on the clinician-client relationship in speech-language treatment for children. JOURNAL OF COMMUNICATION DISORDERS 2018; 73:25-33. [PMID: 29567464 DOI: 10.1016/j.jcomdis.2018.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 03/12/2018] [Accepted: 03/14/2018] [Indexed: 06/08/2023]
Abstract
Few studies have explored clinician-client relationships in speech-language treatment for children, although evidence indicates that these relationships may be important. Parents play a unique role in clinician-client relationships and their views have yet to be considered in the speech-language pathology literature. This study explored parents' perspectives on the clinician-client relationship in speech-language treatment for children using both quantitative and qualitative information. An online survey collected responses from 159 parents with children enrolled in speech-language services. Respondents were asked to complete a rating of the clinician-client relationship, provide information on length of treatment and treatment setting, and respond to open-ended questions about what enhances the clinician-client relationship. Length of treatment was unrelated to the parent rating of the clinician-client relationship. However, ratings did vary by treatment setting; parents of children enrolled in treatment services in schools provided lower ratings than parents with children enrolled in other settings. Thematic analysis of parent views on what enhances the clinician-client relationship yielded four main themes: qualities of the speech-language pathologist (SLP), session characteristics, the child-SLP bond, and communication. The most frequent subthemes in the analysis related to characteristics of the sessions: the integration of play and fun, and a child-oriented approach to sessions. These results provide insight into the development of clinician-client relationships in children's speech-language treatment, with implications for both clinicians and researchers.
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Affiliation(s)
- Kerry Danahy Ebert
- Rush University, 1016D Armour Academic Center, 600 S. Paulina St., Chicago, IL, 60612, United States.
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