Halek Margareta, Holle Daniela, Bartholomeyczik Sabine
German Center for Neurodegenerative Diseases (DZNE), Stockumer Str. 12, 58453, Witten, Germany.
School of Nursing Science, Witten/Herdecke University, Witten, Germany.
BMC Health Serv Res. 2017 Aug 14;17(1):554. doi: 10.1186/s12913-017-2469-8.
One of the most difficult issues for care staff is the manifestation of challenging behaviour among residents with dementia. The first step in managing this type of behaviour is analysing its triggers. A structured assessment instrument can facilitate this process and may improve carers' management of the situation. This paper describes the development of an instrument designed for this purpose and an evaluation of its content validity and its feasibility and practicability in nursing homes.
The development process and evaluation of the content validity were based on Lynn's methodology (1998). A literature review (steps 1 + 2) provided the theoretical framework for the instrument and for item formation. Ten experts (step 3) evaluated the first version of the instrument (the Innovative dementia-oriented Assessment (IdA®)) regarding its relevance, clarity, meaningfulness and completeness; content validity indices at the scale-level (S-CVI) and item-level (I-CVI) were calculated. Health care workers (step 4) evaluated the second version in a workshop. Finally, the instrument was introduced to 17 units in 11 nursing homes in a field study (step 5), and 60 care staff members assessed its practicability and feasibility.
The IdA® used the need-driven dementia-compromised behaviour (NDB) model as a theoretical framework. The literature review and expert-based panel supported the content validity of the IdA®. At the item level, 77% of the ratings had a CVI greater than or equal to 0.78. The majority of the question-ratings (84%, n = 154) and answer-ratings (69%, n = 122) showed valid results, with none below 0.50. The health care workers confirmed the understandability, completeness and plausibility of the IdA®. Steps 3 and 4 led to further item clarification. The carers in the study considered the instrument helpful for reflecting challenging behaviour and beneficial for the care of residents with dementia. Negative ratings referred to the time required and the lack of effect on residents´ behaviour.
There was strong evidence supporting the content validity of the IdA®. Despite the substantial length and time requirement, the instrument was considered helpful for analysing challenging behaviour. Thus, further research on the psychometric qualities, implementation aspects and effectiveness of the IdA® in understanding challenging behaviour is needed.
护理人员面临的最困难问题之一是痴呆症患者出现具有挑战性的行为。管理这类行为的第一步是分析其触发因素。一种结构化的评估工具可以促进这一过程，并可能改善护理人员对这种情况的管理。本文描述了为此目的设计的一种工具的开发过程，以及对其内容效度、在养老院中的可行性和实用性的评估。
开发过程和内容效度评估基于林恩的方法（1998年）。文献综述（第1步+第2步）为该工具和项目形成提供了理论框架。十位专家（第3步）对该工具的第一个版本（创新型痴呆症导向评估（IdA®））的相关性、清晰度、意义和完整性进行了评估；计算了量表层面（S-CVI）和项目层面（I-CVI）的内容效度指数。医护人员（第4步）在一次研讨会上对第二个版本进行了评估。最后，在一项实地研究中（第5步），该工具被引入11家养老院的17个单元，60名护理人员评估了其实用性和可行性。
IdA®以需求驱动的痴呆症受损行为（NDB）模型为理论框架。文献综述和专家小组支持了IdA®的内容效度。在项目层面，77%的评级CVI大于或等于0.78。大多数问题评级（84%，n = 154）和答案评级（69%，n = 122）显示有效结果，没有低于0.50的。医护人员证实了IdA®的可理解性、完整性和合理性。第3步和第4步导致了项目的进一步澄清。研究中的护理人员认为该工具有助于反映具有挑战性的行为，对痴呆症患者的护理有益。负面评级提到了所需时间以及对患者行为缺乏影响。
有强有力的证据支持IdA®的内容效度。尽管篇幅较长且需要时间，但该工具被认为有助于分析具有挑战性的行为。因此，需要进一步研究IdA®在理解具有挑战性的行为方面的心理测量质量、实施方面和有效性。
