School of Public Health, Makerere University, Kampala, Uganda.
Trinity Centre for Global Health, Trinity College Dublin, 7-9 Leinster Street South, Dublin 2, Dublin, Ireland.
BMC Health Serv Res. 2024 Mar 25;24(1):371. doi: 10.1186/s12913-024-10781-y.
The increased recognition of governance, leadership, and management as determinants of health system performance has prompted calls for research focusing on the nature, quality, and measurement of this key health system building block. In low- or middle-income contexts (LMIC), where facility-level management and performance remain a challenge, valid tools to measure management have the potential to boost performance and accelerate improvements. We, therefore, sought to develop a Facility-level Management Scale (FMS) and test its reliability in the psychometric properties in three African contexts.
The FMS was administered to 881 health workers in; Ghana (n = 287; 32.6%), Malawi (n = 66; 7.5%) and Uganda (n = 528; 59.9%). Half of the sample data was randomly subjected to exploratory factor analysis (EFA) and Monte Carlo Parallel Component Analysis to explore the FMS' latent structure. The construct validity of this structure was then tested on the remaining half of the sample using confirmatory factor analysis (CFA). The FMS' convergent and divergent validity, as well as internal consistency, were also tested.
Findings from the EFA and Monte Carlo PCA suggested the retention of three factors (labelled 'Supportive Management', 'Resource Management' and 'Time management'). The 3-factor solution explained 51% of the variance in perceived facility management. These results were supported by the results of the CFA (N = 381; χ2 = 256.8, df = 61, p < 0.001; CFI = 0.94; TLI = 0.92; RMSEA [95% CI] = 0.065 [0.057-0.074]; SRMR = 0.047).
The FMS is an open-access, short, easy-to-administer scale that can be used to assess how health workers perceive facility-level management in LMICs. When used as a regular monitoring tool, the FMS can identify key strengths or challenges pertaining to time, resources, and supportive management functions at the health facility level.
人们越来越认识到治理、领导和管理是影响卫生系统绩效的决定因素，因此呼吁开展研究，重点关注这一关键卫生系统组成部分的性质、质量和衡量标准。在设施层面的管理和绩效仍然是一个挑战的中低收入国家（LMIC），有效的管理工具有可能提高绩效并加速改善。因此，我们试图开发一种设施层面管理量表（FMS），并在三个非洲国家的背景下测试其在心理测量特性中的可靠性。
在加纳（n=287；32.6%）、马拉维（n=66；7.5%）和乌干达（n=528；59.9%），881 名卫生工作者接受了 FMS 的测试。半样本数据被随机进行探索性因素分析（EFA）和蒙特卡罗并行成分分析，以探索 FMS 的潜在结构。然后，使用验证性因素分析（CFA）对半样本数据的结构进行了构建效度测试。还测试了 FMS 的收敛和发散效度以及内部一致性。
EFA 和蒙特卡罗 PCA 的结果表明保留了三个因素（分别标记为“支持性管理”、“资源管理”和“时间管理”）。3 因素解决方案解释了感知设施管理中 51%的方差。这些结果得到了 CFA 的支持（n=381；χ2=256.8，df=61，p<0.001；CFI=0.94；TLI=0.92；RMSEA[95%CI]=0.065[0.057-0.074]；SRMR=0.047）。
FMS 是一种开放获取的、简短的、易于管理的量表，可用于评估卫生工作者如何在中低收入国家感知设施层面的管理。作为一种常规监测工具，FMS 可以识别与时间、资源和支持性管理功能相关的关键优势或挑战。
