Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 North Broadway, Baltimore, MD, USA.
Int J Qual Health Care. 2019 Jul 1;31(6):411-418. doi: 10.1093/intqhc/mzy132.
Self-report instruments have been widely used to better understand variations in patient safety climate between physicians and nurses. Research is needed to determine whether differences in patient safety climate reflect true differences in the underlying concepts. This is known as measurement equivalence, which is a prerequisite for meaningful group comparisons. This study aims to examine the degree of measurement equivalence of the responses to a patient safety climate survey of Chinese hospitals and to demonstrate how the measurement equivalence method can be applied to self-report climate surveys for patient safety research.
Using data from the Chinese Hospital Survey of Patient Safety Climate from six Chinese hospitals in 2011, we constructed two groups: physicians and nurses (346 per group). We used multiple-group confirmatory factor analyses to examine progressively more stringent restrictions for measurement equivalence.
We identified weak factorial equivalence across the two groups. Strong factorial equivalence was found for Organizational Learning, Unit Management Support for Safety, Adequacy of Safety Arrangements, Institutional Commitment to Safety, Error Reporting and Teamwork. Strong factorial equivalence, however, was not found for Safety System, Communication and Peer Support and Staffing. Nevertheless, further analyses suggested that nonequivalence did not meaningfully affect the conclusions regarding physician-nurse differences in patient safety climate.
Our results provide evidence of at least partial equivalence of the survey responses between nurses and physicians, supporting mean comparisons of its constructs between the two groups. The measurement equivalence approach is essential to ensure that conclusions about group differences are valid.
自陈式量表已被广泛用于更好地理解医生和护士之间的患者安全氛围差异。需要研究确定患者安全氛围的差异是否反映了潜在概念的真实差异。这被称为测量等效性，这是进行有意义的组间比较的前提。本研究旨在检验中国医院患者安全氛围调查中对回答的测量等效程度，并展示如何将测量等效性方法应用于患者安全研究的自陈式气候调查。
使用 2011 年来自中国六家医院的中国医院患者安全氛围调查的数据，我们构建了两组：医生和护士（每组 346 人）。我们使用多组验证性因素分析来检验测量等效性的更严格限制。
我们发现两组之间存在微弱的因子等效性。在组织学习、单位管理对安全的支持、安全安排的充分性、机构对安全的承诺、错误报告和团队合作方面发现了强有力的因子等效性。然而，在安全系统、沟通和同伴支持以及人员配备方面没有发现强有力的因子等效性。尽管如此，进一步的分析表明，不等效并没有对医生和护士之间患者安全氛围的差异的结论产生有意义的影响。
我们的结果提供了证据表明，护士和医生对调查回答至少有部分等效性，支持了两组之间其结构的均值比较。测量等效性方法对于确保关于组间差异的结论是有效的至关重要。
