Psychometric properties of questionnaire scales to assess psychosocial determinants that influence compliance with surgical site infection prevention measures: results of the WACH-study

Abstract

Abstract Objective: Psychosocial determinants influence healthcare workers’ compliance with infection prevention and control measures. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. This study examines these psychometric properties of four questionnaire scales that assess determinants influencing compliance with surgical site infection (SSI) prevention measures. Exploratively, associations with self-reported compliance are reported. Design: Cross-sectional survey. Setting: Nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany. Participants: N=90 physicians and N=193 nurses (response rate: 31.5%). Methods: A written questionnaire was used to assess the compliance with SSI prevention measures and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. For psychometric testing, single- and multiple-group confirmatory factor analyses were performed, and t-tests and multiple linear regressions for explorative analyses. Results: The scales assessing individual determinants of compliance (capability, motivation, planning) were found to be reliable (Cronbach’s αs≥.85) and valid (Root-Mean-Square-Error of Approximation=.065, Comparative-Fit-Index=.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p=.627) nor determinants (p=.129; p=.866; p=.964). Capability (β=.301) and planning (β=.201) showed theory-conform associations with compliance for nurses only. Conclusions: The scales assessing motivation, capability, and planning regarding SSI prevention compliance provided reliable and valid scores for physicians and nurses in surgery. Measurementequivalence allows group comparisons of scale means to be interpreted without bias.