Cross-Level Group Measurement Invariance When Groups Are at Different Levels of Multilevel Data

Development and validation of a rating scale for barriers to and facilitators of nurses' participation intentions in "Internet + Nursing Service"

BACKGROUND

Given increases in China's aging population, the growing demand for public health services and the shortage of human resources among nurses have become more prominent. Under such a background, "Internet + Nursing Services" have received more attention. Thus, exploring the barriers to and facilitators of nurses' willingness to participate in "Internet + Nursing Services" and utilizing internet technology to increase the supply of nursing services has become a key issue.

OBJECTIVE

This study aimed to develop a scale for assessing the barriers to and facilitators of nurses' willingness to participate in "Internet + Nursing Services" and to test the validity and reliability of the scale.

METHODS

A preliminary scale was developed based on a literature review, theoretical research, semistructured qualitative interviews, and two rounds of Delphi expert inquiry. A convenient sampling method was used for the questionnaire survey. A 5-point Likert scale was used to evaluate the importance of the items. The survey data of 659 clinical nurses obtained from February to March 2023 were used for item analysis, exploratory factor analysis (EFA), and reliability and validity tests of the scale. The survey data of 538 clinical nurses obtained in April 2023 were used for confirmatory factor analysis (CFA) of the final scale.

RESULTS

The final scale consists of 25 items and 4 dimensions (performance expectations, perceived risk, need for professional knowledge training, and nonprofessional knowledge training). The scale showed good structural validity and content validity: the Cronbach's α coefficient of the scale was 0.955, the split-half reliability was 0.778, the test-retest reliability was 0.944, the kaiser-meyer-olkin(KMO) value was 0.960, and the cumulative variance contribution rate of the 4 common factors was 83.147%. The scale content validity index(S-CVI) was 0.914. The confirmatory factor analysis model had favorable fit indices: χ2/df = 4.234, RMSEA = 0.078, NFI = 0.940, IFI = 0.953, TLI = 0.947, and CFI = 0.953.

CONCLUSION

The scale for assessing the barriers to and facilitators of nurses' willingness to participate in "Internet + Nursing Services" has good reliability and validity, and provides a reference for evaluating nurses' willingness to participate in "Internet + Nursing Services".

Development and validation of a Decision-Making Ability Scale for postpartum urinary incontinence women engaging in pelvic floor physical therapy

OBJECTIVE

This study aimed to develop and validate a Decision-Making Ability Scale (DMA-S) for postpartum urinary incontinence (PPUI) women engaging in pelvic floor physical therapy (PFPT).

METHODS

Items were created in line with a review of the literature and exploratory qualitative study with 22 women. The items were submitted for expert opinion and a pilot implementation was made with 58 women with PPUI. Furthermore, the construct validity of the scale was tested with exploratory factor analysis (EFA) (n = 220) and confirmatory factor analysis (CFA) (n = 240). Internal consistency for the Chronbach's α and test-retest reliability for the intraclass correlation coefficient (ICC) were also investigated for the DMA-S in the study.

RESULTS

The results of the EFA indicated a Kaiser-Meyer-Olkin value of 0.85 and Bartlett's test of sphericity showed a χ2 value of 8352.101, p < 0.001. After removing one item with factor loading values below 0.50, the resulting factor structure accounted for 83.38% of the total variance. The fit indices of the scale model tested in the CFA were determined as χ2 /df = 1.08 < 3, root mean square error of approximation = 0.018 < 0.08, comparative fit index = 0.996 > 0.90, Tucker-Lewis index = 0.995 > 0.90, goodness-of-fit index (GFI) = 0.933 > 0.90, adjusted GFI = 0.916 > 0.90, and incremental fit index = 0.996 > 0.90. The Cronbach's α values were 0.95-0.97 for the subdimensions of the scale and 0.93 for the total scale. Data also showed a good test-retest stability (ICC = 0.984).

CONCLUSION

The DMA-S is a reliable and valid tool for assessing the decision-making ability for PPUI women engaging in PFPT.

Development, reliability and validity of infectious disease specialist Nurse's Core competence scale

Aim

This study aims to develop an instrument to measure infectious disease specialist nurses’ core competence and examining the scale’s validity and reliability.

Background

With the increase of infectious diseases, more and more attention has been paid to infectious disease nursing care. The core competence of the infectious disease specialist nurses is directly related to the quality of nursing work. In previous researches, infectious disease specialist nurses’ core competence was measured by the tools developed for general nurses instead of specialized tools, which made it difficult to clarify the core competence of nurses in infectious diseases department.

Methods

Preliminary items were developed through literature review, theoretical research, qualitative interview and Delphi method. The confirmed 47 items were applied in the two rounds of data collection. Evaluation data on 516 infectious disease specialist nurses’ core competence in the first round were utilized to preliminarily evaluate and explore the scale’s constrution, while evaluation data on 497 infectious disease specialist nurses’ core competence in the second round were utilized to do reliability analysis and validity analysis. In this study, factor analysis, Cronbach’s α, Pearson correlation coefficients were all adopted.

Results

The final scale is composed of 34 items and 5 factors, and adopted the 5-point scoring method. The factors are Professional Development Abilities, Infection Prevention and Control Abilities, Nursing Abilities for Infectious Diseases, Professionalism and Humanistic Accomplishment, and Responsiveness to Emergency Infectious Diseases. The explanatory variance of the five factors was 75.569%. The reliability and validity of the scale is well validated. The internal consistency, split-half reliability and test-retest reliability were 0.806, 0.966 and 0.831 respectively. The scale has good structural validity and content validity. The content validity was 0.869. Discrimination analysis showed that there were significant differences in the scores of core competence and its five dimensions among infectious disease specialist nurses of different ages, working years in infectious diseases, titles, educational background, marital status and wages (all P < 0.05).

Conclusions

The proposed scale takes on high reliability and validity, and is suitable for assessing the infectious disease specialist nurses’ core competence.

Relevance to clinical practice

This scale provides a reference for clinical assessment of infectious disease nursing.

Combined Approach to Multi-Informant Data Using Latent Factors and Latent Classes: Trifactor Mixture Model

Although collecting data from multiple informants is highly recommended, methods to model the congruence and incongruence between informants are limited. Bauer and colleagues suggested the trifactor model that decomposes the variances into common factor, informant perspective factors, and item-specific factors. This study extends their work to the trifactor mixture model that combines the trifactor model and the mixture model. This combined approach allows researchers to investigate the common and unique perspectives of multiple informants on targets using latent factors and simultaneously take into account potential heterogeneity of targets using latent classes. We demonstrate this model using student self-rated and teacher-rated academic behaviors (N = 24,094). Model specification and testing procedures are explicated in detail. Methodological and practical issues in conducting the trifactor mixture analysis are discussed.