Korall Alexandra M B, Godin Judith, Feldman Fabio, Cameron Ian D, Leung Pet-Ming, Sims-Gould Joanie, Robinovitch Stephen N
Injury Prevention and Mobility Laboratory (IPML), Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada.
Centre for Hip Health and Mobility, 7th Floor, 2635 Laurel Street, Vancouver, V5Z 1M9, BC, Canada.
BMC Geriatr. 2017 May 3;17(1):103. doi: 10.1186/s12877-017-0493-5.
If worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool.
We conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, "Do you think of yourself as a champion of hip protectors", rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn't.
Hierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach's alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p < 0.01) increase in C-HiP Index score. Median C-HiP Index scores were 4.3-points lower (p < 0.01) among respondents aware of a protected fall causing hip fracture, and 7.0-points higher (p < 0.01) among respondents who agreed in the existence of a champion of hip protectors within their home.
We offer evidence of the psychometric properties of the C-HiP Index. The development of a valid and reliable assessment tool is crucial to understanding the factors that govern adherence to hip protectors in long-term care.
如果在跌倒时佩戴，髋部保护器可大幅降低髋部骨折风险。然而，其临床疗效的一个主要障碍是使用者依从性差。在长期护理中，依从性可能取决于护理人员对髋部保护器的重视程度，但由于缺乏心理测量学上有效的评估工具，尚无实证依据。
我们对529名付费护理人员的便利样本进行了横断面调查。我们开发了包含15个条目的C-HiP指数来衡量重视程度，该指数由三个子量表组成：情感、认知和行为。对回答进行了层次因子分析和内部一致性测试。11位专家用4点李克特量表对条目的相关性和清晰度进行评分。我们进行了简单线性回归，以确定C-HiP指数得分是否与“你认为自己是髋部保护器的倡导者吗”这一问题呈正相关，该问题用5点李克特量表评分。我们研究了C-HiP指数是否能够区分受访者：（i）知晓因佩戴髋部保护器而避免髋部骨折的人与不知晓的人；（ii）同意其住所内存在髋部保护器倡导者的人与不同意的人。
层次因子分析产生了两个低阶因子和一个高阶因子，代表了对髋部保护器重视程度的总体概念。情感和认知子量表的条目在第一个低阶因子上的载荷最高，而行为子量表的条目在第二个低阶因子上的载荷最高。由于因子矩阵系数低和专家评价差，我们删除了一个条目。C-HiP指数的克朗巴哈系数为0.96。倡导程度每增加一个单位，C-HiP指数得分增加5.2分（p<0.01）。知晓因佩戴髋部保护器而避免髋部骨折的受访者的C-HiP指数中位数得分低4.3分（p<0.01），同意其住所内存在髋部保护器倡导者的受访者的C-HiP指数中位数得分高7.0分（p<0.01）。
我们提供了C-HiP指数心理测量特性的证据。开发一个有效且可靠的评估工具对于理解长期护理中影响髋部保护器依从性的因素至关重要。
