An Exploratory Factor Analysis for Developing and Validating a Scale of Long-Term Care Competencies among Care Managers in Long-Term Care System

Abstract

Background: Care managers (CMs) play a crucial role in delivering long-term care (LTC) services for dependent older adults in the district health system (DHS). However, there are limitations of the instrument for assessing LTC competency of CMs in the DHS. Objective: To develop and validate an LTC competency instrument for CMs in the DHS in Thailand. Materials and Methods: An exploratory mixed methods study was conducted. In the qualitative phase, eight participants took part in in-depth interviews and 26 participants took part in focus group discussions, all of them were stakeholders in LTC. The participants included policymakers, practitioners, and academics covering the national, regional, provincial, and district levels. They were invited to determine the LTC competency of CMs. Data were analyzed by content analysis. Trustworthiness was confirmed by triangulation. From the qualitative data, an item pool of 109 items was developed. In the quantitative phase, the validity and reliability of the instrument were assessed with exploratory factor analysis and internal consistency. The content validity index was examined. A pilot test of 30 CMs confirmed the reliability. The exploratory factor analysis was conducted with 378 CMs, and the internal consistency of Cronbach’s alpha and corrected item-to-total correlation was investigated. Results: The LTC competency instrument comprised of four dimensions with 24 items. The four dimensions included 1) management, 2) caring for dependent older persons, 3) intersectoral collaboration, and 4) resilience. They explained 34.217%, 16.803%, 13.229%, and 9.035% of the total variance, respectively. Therefore, these four dimensions together explained 73.284% of the total variance. All subscales showed a Cronbach’s alpha ranging from 0.912 to 0.944, with an overall value of 0.917. Conclusion: The developed LTC competencies scale for CMs in providing LTC services in the DHS is a valid and reliable instrument and can be applicable as a tool to tailor a training program to promote the LTC competency of CMs. Keywords: Long-term care competencies; Care manager; Older adult; Long-term Care System; Exploratory mixed methods