Development and psychometric evaluation of triage questionnaire (QTrix): Exploratory factor analysis and item response theory analysis

Abstract

Introduction: Triage errors can occur in all emergency departments, regardless of the type of triage system being used. One way to minimize triaging errors is by enhancing the triage officers’ knowledge and attitude on triage. The assessment of knowledge and attitude can be carried out by questionnaire assessment. This study aims to perform content, face, and construct validation on a newly developed triage questionnaire, QTrix, which is designed for healthcare personnel in a tertiary teaching hospital in Kelantan, Malaysia, that uses the three-tier Malaysian Triage Category system. Methods: This study consisted of two phases: the first phase was the questionnaire development phase, which included the content validity with the expert panel and the face validity using 30 respondents; and the second phase was the psychometric assessment phase, which included the item response theory and the exploratory factor analysis using 139 respondents. Results: The knowledge section with 12 remaining items was considered unidimensional by item response theory after removing items with extreme difficulty coefficients (outside the range of −3 to +3) and items with very low discrimination values (<0.35). After exploratory factor analysis, two items in the attitude section were removed due to low factor loadings (<0.3) and high item complexity. The reliability of the remaining 13 items in the attitude section was very good as shown by Cronbach’s alpha values of more than 0.8. Conclusion: The QTrix questionnaire is a well-validated and reliable tool to assess the knowledge and the attitude on triage. Its use among healthcare personnel can help minimize triaging errors in emergency departments that utilize the Malaysian Triage Category system.