Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA.
Population Council, Washington, DC, USA.
Glob Health Sci Pract. 2023 Nov 30;11(Suppl 1). doi: 10.9745/GHSP-D-22-00421.
Health care providers' actions can significantly influence clients' experiences of care, adherence to recommendations, and likelihood of re-engaging with health services. There are currently no validated scales that measure provider attitudes that could affect service delivery in multiple health areas.
We developed provider attitude measures in 3 phases. In phase 1 (2019), survey items were developed based on literature reviews, and quantitative items were tested through a health facility survey conducted in the Democratic Republic of the Congo (DRC). Health care providers (N=1,143) completed a 23-question survey focused on 3 subdomains: provider perceptions of clients, provider roles, and gender roles. In phase 2 (2021), cognitive interviews were administered to 17 health care providers in DRC to assess and improve respondents' understanding and interpretation of questionnaire items and response options. In phase 3 (2021), 52 family planning providers were sampled from urban health facilities in Togo to retest and validate the improved measures.
Phase 1 showed the provider attitude items had low scale reliability, and 8 survey items had low variability. In phase 2, results from the cognitive interviews of the 21 items retained from phase 1 found 16 questions were not well understood or had low response variability and thus modified, and 4 survey items were added to test different iterations of specific survey items. In phase 3, exploratory factor analysis resulted in 1 provider attitude scale of 14 items reflecting authoritarian attitudes related to the 3 initial subdomains.
This research highlights the importance of iteration and testing during scale development, implementable even across geographic locations. Provider behavior change programming should consider how authoritarian provider attitudes pertaining to professional roles, their clients, and gender norms may interact and influence the quality of health services provided.
医疗服务提供者的行为可以显著影响客户的护理体验、对建议的依从性以及重新使用卫生服务的可能性。目前，没有经过验证的量表来衡量可能影响多个卫生领域服务提供的提供者态度。
我们分三个阶段制定了提供者态度测量工具。在第 1 阶段（2019 年），根据文献综述制定了调查项目，并通过在刚果民主共和国（DRC）进行的卫生机构调查对定量项目进行了测试。医疗保健提供者（N=1143）完成了一项包含 23 个问题的调查，重点关注 3 个子领域：提供者对客户的看法、提供者角色和性别角色。在第 2 阶段（2021 年），对刚果民主共和国的 17 名医疗保健提供者进行了认知访谈，以评估和改善受访者对问卷项目和响应选项的理解和解释。在第 3 阶段（2021 年），从多哥城市卫生设施中抽取了 52 名计划生育提供者来重新测试和验证改进后的措施。
第 1 阶段显示提供者态度项目的量表信度较低，8 个调查项目的变异性较低。在第 2 阶段，从第 1 阶段保留的 21 个项目的认知访谈结果发现，有 16 个问题理解得不好或响应的变异性较低，因此进行了修改，并增加了 4 个调查项目来测试特定调查项目的不同迭代。在第 3 阶段，探索性因素分析得出了 14 个项目的提供者态度量表，反映了与 3 个初始子领域相关的威权主义态度。
这项研究强调了在量表开发过程中迭代和测试的重要性，即使在地理位置上也是可行的。提供者行为改变方案应考虑与专业角色、其客户和性别规范相关的威权主义提供者态度如何相互作用并影响提供的卫生服务质量。
