Development and psychometric evaluation of the Primary Health Care Engagement (PHCE) Scale: a pilot survey of rural and remote nurses

AimTo report the development and psychometric evaluation of a scale to measure rural and remote (rural/remote) nurses’ perceptions of the engagement of their workplaces in key dimensions of primary health care (PHC).BackgroundAmidst ongoing PHC reforms, a comprehensive instrument is needed to evaluate the degree to which rural/remote health care settings are involved in the key dimensions that characterize PHC delivery, particularly from the perspective of professionals delivering care.MethodsThis study followed a three-phase process of instrument development and psychometric evaluation. A literature review and expert consultation informed instrument development in the first phase, followed by an iterative process of content evaluation in the second phase. In the final phase, a pilot survey was undertaken and item discrimination analysis employed to evaluate the internal consistency reliability of each subscale in the preliminary 60-item Primary Health Care Engagement (PHCE) Scale. The 60-item scale was subsequently refined to a 40-item instrument.FindingsThe pilot survey sample included 89 nurses in current practice who had experience in rural/remote practice settings. Participants completed either a web-based or paper survey from September to December, 2013. Following item discrimination analysis, the 60-item instrument was refined to a 40-item PHCE Scale consisting of 10 subscales, each including three to five items. Alpha estimates of the 10 refined subscales ranged from 0.61 to 0.83, with seven of the subscales demonstrating acceptable reliability (α⩾0.70). The refined 40-item instrument exhibited good internal consistency reliability (α=0.91). The 40-item PHCE Scale may be considered for use in future studies regardless of locale, to measure the extent to which health care professionals perceive their workplaces to be engaged in key dimensions of PHC.

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Psychometric Evaluation of the Nurse Practitioner Satisfaction Survey (NPSS)

Journal of Nursing Measurement ◽

10.1891/1061-3749.17.2.114 ◽

2009 ◽

Vol 17 (2) ◽

pp. 114-133 ◽

Cited By ~ 11

Author(s):

Lucie J. Agosta

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Primary Health Care ◽

Nurse Practitioner ◽

Health Care Services ◽

Factor Model ◽

Psychometric Evaluation ◽

Internal Consistency Reliability ◽

Satisfaction Survey ◽

Primary Health

The purpose of this study was to identify and define underlying latent constructs within the concept of patient satisfaction with nurse practitioner delivered primary health care. The Nurse Practitioner Satisfaction Survey (NPSS), a 28-item, Likert-type, researcher developed instrument was completed by 300 clients presenting for primary health care visits in a hospital outpatient clinic. Factor analysis with promax rotation resulted in a three factor model explaining 70.77% of the variance. Eighteen items loaded on general satisfaction. Six items loaded on communication, and four items loaded on accessibility and convenience. Cronbach’s alpha internal consistency reliability coefficients were .98, .83, and .76 for the three factors, respectively. The NPSS was found to be reliable and valid for measuring patient satisfaction with nurse practitioner delivered primary health care services.

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Exploratory factor analysis and reliability of the Primary Health Care Engagement (PHCE) Scale in rural and remote nurses: findings from a national survey

Primary Health Care Research & Development ◽

10.1017/s146342361700038x ◽

2017 ◽

Vol 18 (06) ◽

pp. 608-622 ◽

Cited By ~ 2

Author(s):

Julie G. Kosteniuk ◽

Norma J. Stewart ◽

Chandima P. Karunanayake ◽

Erin C. Wilson ◽

Kelly L. Penz ◽

...

Keyword(s):

Health Care ◽

Factor Analysis ◽

Primary Health Care ◽

Exploratory Factor Analysis ◽

Internal Consistency ◽

Internal Consistency Reliability ◽

Rural And Remote ◽

Community Based ◽

Primary Health ◽

Contemporary Approach

Aim The study purpose was to provide evidence of validity for the Primary Health Care Engagement (PHCE) Scale, based on exploratory factor analysis and reliability findings from a large national survey of regulated nurses residing and working in rural and remote Canadian communities. Background There are currently no published provider-level instruments to adequately assess delivery of community-based primary health care, relevant to ongoing primary health care (PHC) reform strategies across Canada and elsewhere. The PHCE Scale reflects a contemporary approach that emphasizes community-oriented and community-based elements of PHC delivery. Methods Data from the pan-Canadian Nursing Practice in Rural and Remote Canada II (RRNII) survey were used to conduct an exploratory factor analysis and evaluate the internal consistency reliability of the final PHCE Scale. Findings The RRNII survey sample included 1587 registered nurses, nurse practitioners, licensed practical nurses, and registered psychiatric nurses residing and working in rural and remote Canada. Exploratory factor analysis identified an eight-factor structure across 28 items overall, and good internal consistency reliability was indicated by an α estimate of 0.89 for the final scale. The final 28-item PHCE Scale includes three of four elements in a contemporary approach to PHC (accessibility/availability, community participation, and intersectoral team) and most community-oriented/based elements of PHC (interdisciplinary collaboration, person-centred, continuity, population orientation, and quality improvement). We recommend additional psychometric testing in a range of health care providers and settings, as the PHCE Scale shows promise as a tool for health care planners and researchers to test interventions and track progress in primary health care reform.

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Disaster Management in Rural and Remote Primary Health Care: A Scoping Review

Prehospital and Disaster Medicine ◽

10.1017/s1049023x21000200 ◽

2021 ◽

Vol 36 (3) ◽

pp. 362-369

Author(s):

Katie A. Willson ◽

Gerard J. FitzGerald ◽

David Lim

Keyword(s):

Mental Health ◽

Health Care ◽

Primary Health Care ◽

Mental Health Care ◽

Disaster Management ◽

Scoping Review ◽

Health Care Professionals ◽

Disaster Preparedness ◽

Rural And Remote ◽

Primary Health

AbstractObjective:This scoping review aims to map the roles of rural and remote primary health care professionals (PHCPs) during disasters.Introduction:Disasters can have catastrophic impacts on society and are broadly classified into natural events, man-made incidents, or a mixture of both. The PHCPs working in rural and remote communities face additional challenges when dealing with disasters and have significant roles during the Prevention, Preparedness, Response, and Recovery (PPRR) stages of disaster management.Methods:A Johanna Briggs Institute (JBI) scoping review methodology was utilized, and the search was conducted over seven electronic databases according to a priori protocol.Results:Forty-one papers were included and sixty-one roles were identified across the four stages of disaster management. The majority of disasters described within the literature were natural events and pandemics. Before a disaster occurs, PHCPs can build individual resilience through education. As recognized and respected leaders within their community, PHCPs are invaluable in assisting with disaster preparedness through being involved in organizations’ planning policies and contributing to natural disaster and pandemic surveillance. Key roles during the response stage include accommodating patient surge, triage, maintaining the health of the remaining population, instituting infection control, and ensuring a team-based approach to mental health care during the disaster. In the aftermath and recovery stage, rural and remote PHCPs provide long-term follow up, assisting patients in accessing post-disaster support including delivery of mental health care.Conclusion:Rural and remote PHCPs play significant roles within their community throughout the continuum of disaster management. As a consequence of their flexible scope of practice, PHCPs are well-placed to be involved during all stages of disaster, from building of community resilience and contributing to early alert of pandemics, to participating in the direct response when a disaster occurs and leading the way to recovery.

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Antimicrobial stewardship in rural and remote primary health care: a narrative review

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-00964-1 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Jun Wern Yau ◽

Sze Mun Thor ◽

Danny Tsai ◽

Tobias Speare ◽

Chris Rissel

Keyword(s):

Health Care ◽

Primary Health Care ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Inappropriate Prescribing ◽

Narrative Review ◽

Rural And Remote ◽

Antimicrobial Prescribing ◽

Primary Health ◽

Resistance Rates

Abstract Background Antimicrobial resistance is an emerging problem worldwide and poses a significant threat to human health. Antimicrobial stewardship programmes are being implemented in health systems globally, primarily in hospitals, to address the growing threat of antimicrobial resistance. Despite the significance of primary health care services in providing health care to communities, antimicrobial stewardship programmes are not well established in this sector, especially in rural and remote settings. This narrative review aims to identify in rural and remote primary health care settings the (1) correlation of antimicrobial resistance with antibiotic prescribing and volume of antibiotic use, (2) appropriateness of antimicrobial prescribing, (3) risk factors associated with inappropriate use/prescribing of antibiotics, and (4) effective antimicrobial stewardship strategies. Methods The international literature was searched for English only articles between 2000 and 2020 using specified keywords. Seven electronic databases were searched: Scopus, Cochrane, Embase, CINAHL, PubMed, Ovid Medline and Ovid Emcare. Publication screening and analysis were conducted using Joanna Briggs Institute systematic review tools. Results Fifty-one eligible articles were identified. Inappropriate and excessive antimicrobial prescribing and use directly led to increases in antimicrobial resistance. Increasing rurality of practice is associated with disproportionally higher rates of inappropriate prescribing compared to those in metropolitan areas. Physician knowledge, attitude and behaviour play important roles in mediating antimicrobial prescribing, with strong intrinsic and extrinsic influences including patient factors. Antimicrobial stewardship strategies in rural and remote primary health care settings focus on health care provider and patient education, clinician support systems, utility of antimicrobial resistance surveillance, and policy changes. Results of these interventions were generally positive with decreased antimicrobial resistance rates and improved appropriateness of antimicrobial prescribing. Conclusions Inappropriate prescribing and excessive use of antimicrobials are an important contributor to the increasing resistance towards antimicrobial agents particularly in rural and remote primary health care. Antimicrobial stewardship programmes in the form of education, clinical support, surveillance, and policies have been mostly successful in reducing prescribing rates and inappropriate prescriptions. The narrative review highlighted the need for longer interventions to assess changes in antimicrobial resistance rates. The review also identified a lack of differentiation between rural and remote contexts and Indigenous health was inadequately addressed. Future research should have a greater focus on effective interventional components and patient perspectives.

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