Development of a measure to describe the practice context of Healthcare professionals

Introduction: Healthcare professionals such as nurses, occupational therapists, physicians, and physiotherapists are expected to mobilize knowledge, skills, and attitudes, also referred to as competencies, when providing care and services to patients. Professional competencies are influenced by an interplay of internal (individual characteristics) and external characteristics (contextual characteristics). While individuals’ internal resources have been the focus of research on professional competencies, contextual characteristics have received less attention. Existing measures of context are limited, and those that do exist, primarily focus on a single contextual characteristic, tend to consider the influence of context on one competency or are developed for a single profession.Objective: To initiate the development of a questionnaire documenting the contextual characteristics that might influence the enactment of perceived competencies for four healthcare professions.Methods: The measure was developed following DeVellis’ Scale Development Guidelines: 1) Defining the construct of interest - context; 2) Generating items based on the contextual characteristics identified through a scoping review; 3) Determining the measurement response format; 4) Expert review of the clarity, relevance, and comprehensiveness of the items; 5) Not applicable as it includes validity testing which is not required at this stage of questionnaire development; 6) Pilot-testing the questionnaire with healthcare professionals working in Canada; 7) Evaluating individual items based on Classical Test Theory; and 8) Optimizing the questionnaire length for validity and response time.Results: We identified five themes through a scoping review, namely: 1) Leadership and Agency, 2) Values, 3) Policies, 4) Supports, and 5) Demands including 12 contextual characteristics each. The first theme Leadership and Agency refers to the leaders’ characteristics, their attitudes, and the opportunities they provide to healthcare professionals to be independent and contribute to the decisions made within the organization. The second theme Values refers to the principles and norms that guide the actions of other healthcare professionals and the organization. The third theme Policies refers to the aspects of healthcare that are enforced by regulations of the organization, professional bodies, and legislature on healthcare professionals. The fourth theme Supports describes the organization’s actions and/or initiatives that facilitate healthcare professionals’ work. The final theme Demands refers to the roles and responsibilities that are expected and required of healthcare professionals. The questionnaire subscales and items were based on the themes and the contextual characteristics respectively. A total of 117 items were piloted with a sample of 127 healthcare professionals (n=33 nurses, 32 occupational therapists, 27 physicians, 35 physiotherapists) working primarily in Quebec. Following the removal of items based on item discrimination and item correlation scores, the internal consistency scores on the Cronbach’s alphas for the five subscales (with 12 items each) were 0.9, 0.9, 0.9, 0.9, and 0.7 respectively.Conclusion: With some additional revisions and psychometric testing, the questionnaire will be used to document the characteristics of the context which might influence the enactment of perceived competencies of healthcare professionals. The questionnaire will eventually contribute to our understanding of the influence of context on professional competencies

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