Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study

Karolin M E Nettelrodt; Ivonne Tomsic; Maike Stolz; Christian Krauth; Iris F Chaberny; Thomas von Lengerke

doi:10.2147/PRBM.S464335

Psychometric Properties of Scales Assessing Psychosocial Determinants of Staff Compliance with Surgical Site Infection Prevention: The WACH-Study

Psychol Res Behav Manag. 2024 Jul 23:17:2757-2767. doi: 10.2147/PRBM.S464335. eCollection 2024.

Authors

Karolin M E Nettelrodt¹, Ivonne Tomsic¹, Maike Stolz², Christian Krauth², Iris F Chaberny^{3

4}, Thomas von Lengerke¹

Affiliations

¹ Department of Medical Psychology, Center of Public Health, Hannover Medical School, Hannover, Germany.
² Institute of Epidemiology, Social Medicine and Health Systems Research, Center of Public Health, Hannover Medical School, Hannover, Germany.
³ Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany.
⁴ Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany.

Abstract

Purpose: Psychosocial determinants influence healthcare workers' compliance with surgical site infection (SSI) preventive interventions. In order to design needs-based interventions promoting compliance, such determinants must first be assessed using valid and reliable questionnaire scales. To compare professional groups without bias, the scales must also be measurement-equivalent. We examine the validity/reliability and measurement equivalence of four scales using data from physicians and nurses from outside the university sector. Additionally, we explore associations with self-reported SSI preventive compliance.

Participants and methods: N = 90 physicians and N = 193 nurses (response rate: 31.5%) from nine general/visceral or orthopedic/trauma surgery departments in six non-university hospitals in Germany participated. A written questionnaire was used to assess the compliance with SSI preventive interventions and the determinants of compliance based on the Capability-Opportunity-Motivation-Behavior-Model. Psychometric testing involved single- and multiple-group confirmatory factor analyses, and explorative analyses used t-tests and multiple linear regression.

Results: The scales assessing individual determinants of compliance (capability, motivation, and planning) were found to be reliable (each Cronbach's α ≥ 0.85) and valid (each Root-Mean-Square-Error of Approximation ≤ 0.065, each Comparative-Fit-Index = 0.95) and revealed measurement equivalence for physicians and nurses. The scale assessing external determinants (opportunity) did not demonstrate validity, reliability, or measurement equivalence. Group differences were found neither in compliance (p = 0.627) nor determinants (p = 0.192; p = 0.866; p = 0.964). Capability (β = 0.301) and planning (β = 0.201) showed associations with compliance for nurses only.

Conclusion: The scales assessing motivation, capability, and planning regarding SSI preventive compliance provided reliable and valid scores for physicians and nurses in surgery. Measurement equivalence allows group comparisons of scale means to be interpreted without bias.

Keywords: capability-opportunity-motivation-behavior (COM-B) model; compliance; infection prevention and control; measurement equivalence; nurses; physicians; surgical site infections.

Grants and funding

This research was conducted as part of the research project WACH (“Wundinfektionen und Antibiotikaverbrauch in der Chirurgie” [“Wound Infections and Antibiotic Use in Surgery”]), which was funded by the German Federal Ministry of Health from January 15, 2017 to February 11, 2021, within its program “Antibiotic Resistance and Nosocomial Infections” (Grant ID: ANNIE2016-55-038). WACH was registered in the German Clinical Trial Register (DRKS; https://www.bfarm.de/EN/BfArM/Tasks/German-Clinical-Trials-Register/_node.html/). The funding body had no other roles than the funding itself (ie, the authors were independent in the design of the study and collection, analysis, and interpretation of data and writing the manuscript).