Development and psychometric evaluation of an instrument: Attitudes toward patient advocacy
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The purpose of this study was to develop and test psychometric properties of the instrument of attitudes toward patient advocacy, which measures nurses' views regarding advocating for patients. The study was based on Fishbein and Ajzen's definition of attitude, the advocacy model proposed by the researcher, and classical measurement theory. Content validity was determined by seven experts. Data from the 27 respondents were used for examining test-retest reliability of the instrument. Data from the 459 respondents were used to examine construct validity and internal consistency reliability. Initially, 171 items were generated to measure three dimensions of the instrument: (1) attitudes toward safeguarding patients' autonomy, (2) attitudes toward acting on behalf of patients, and (3) attitudes toward championing social justice in the provision of health care. The item pool was revised according to comments from the dissertation committee. After this revision, 84 items were included in the instrument and were sent to a panel of seven content experts for evaluation. Experts reviewed and commented on the instrument to ensure that items were relevant to the objective of the instrument of attitudes toward patient advocacy and its three dimensions. Content validity of the instrument was determined by the Content Validity Index based on consensus among the seven content experts. The Content Validity Index was 85% for the whole instrument of attitudes toward patient advocacy, 83% for the subscales of attitudes toward safeguarding patients' autonomy and attitudes toward acting on behalf of patients, and 88% for the subscale of championing social justice. Construct validity of the instrument was determined by factor analysis. Exploratory factor analysis indicated that the instrument consisted of two correlated factors. Confirmatory factor analysis indicated that both the emerged 2-factor model from the exploratory factor analysis and the initially hypothesized 3-factor model adequately fit the data. The test-retest reliability coefficient of the instrument and its subscales ranged form .94 to .96. Cronbach's alpha coefficients of the instrument its subscales were all above .8. These results exhibited the instrument of attitudes toward patient advocacy possessed satisfactory psychometric properties and was appropriate to assess nurses' attitudes toward patient advocacy. Understanding nurses' attitudes toward advocating for patients will provide direction to develop interventions (e.g., changing attitudes) to facilitate nurses' advocacy practice.