Miniotti Marco, Cuniberti Francesco, Olivero Alberto, Leombruni Paolo
'Rita Levi Montalcini' Department of Neuroscience, University of Turin, Turin, Italy.
Med Sci Educ. 2024 Jul 20;34(6):1391-1399. doi: 10.1007/s40670-024-02119-4. eCollection 2024 Dec.
Patient-centered care is becoming a paradigm in medicine. The Patient-Practitioner Orientation Scale (PPOS) is the only tool that measures the patient-centered attitude of healthcare students and professionals. Despite its spread, PPOS has had a poor process of scale modelling and validation and previous studies raised concerns about its psychometric robustness.
This study aims to investigate the PPOS psychometric properties, factor structure, and construct validity on a large sample of undergraduate medical students.
Participants of this cross-sectional single-center study are 1543 first-year medical students. PPOS item validity (internal consistency, test-retest reliability), factor structure (explorative principal axis factoring), and construct validity (convergent-discriminant validity, between-groups invariance) have been investigated.
A three-factor not clearly defined solution explaining 34.4% of the variance and containing 14 items out of 18 was retained. Internal consistency was questionable for factor 1 ( = 0.657), poor for factor 2 ( = 0.566), and unacceptable for factor 3 ( = 0.399). Item-total correlations for factor 1 and factor 2 were > 0.3, except for item 6 (ITC = 0.218) and item 12 (ITC = 0.283). Item total-correlations for factor 3 were all < 0.3. Test-retest reliability was acceptable for factor 1 (ICC = 0.704) and factor 2 (ICC = 0.789) and questionable for factor 3 (ICC = 0.661). Construct validity and measurement invariance across groups were satisfactory.
Findings in this study corroborate previous evidences about PPOS psychometric limitations and provide new evidence about the multidimensionality of patient-centeredness construct.
以患者为中心的医疗正在成为医学领域的一种范式。患者-从业者导向量表（PPOS）是唯一用于衡量医学生和医疗专业人员以患者为中心态度的工具。尽管该量表已广泛应用，但其量表建模和验证过程不佳，先前的研究对其心理测量稳健性表示担忧。
本研究旨在调查PPOS在大量本科医学生样本中的心理测量特性、因子结构和结构效度。
这项横断面单中心研究的参与者为1543名一年级医学生。研究了PPOS的项目效度（内部一致性、重测信度）、因子结构（探索性主轴因子分析）和结构效度（聚合-区分效度、组间不变性）。
保留了一个未明确界定的三因子解决方案，该方案解释了34.4%的方差，包含18个项目中的14个。因子1的内部一致性存疑（α = 0.657），因子2较差（α = 0.566），因子3不可接受（α = 0.399）。因子1和因子2的项目-总分相关性> 0.3，但项目6（ITC = 0.218）和项目12（ITC = 0.283）除外。因子3的项目总分相关性均< 0.3。因子1（ICC = 0.704）和因子2（ICC = 0.789）的重测信度可接受，因子3（ICC = 0.661）存疑。各组间的结构效度和测量不变性令人满意。
本研究结果证实了先前关于PPOS心理测量局限性的证据，并为以患者为中心的结构的多维性提供了新证据。
