Tina Pedersen1, Eva Cignacco2, Simon Fischer1, Jonas Meuli1, Robert Greif1
1Department of Anaesthesiology and Pain Medicine, Bern University Hospital, University of Bern , Switzerland; 2University of Applied Sciences, Health Department, Bern, Switzerland; firstname.lastname@example.org
Background: Interprofessional collaborative practice is an unavoidable and significant factor in today’s health care provision. To assess interprofessional attitudes among health professional students, the Interprofessional Attitudes Scale (IPAS) was developed in the USA(1). This scale consists of 27 items with five subscales: teamwork, roles and responsibilities; patient-centeredness; interprofessional biases; diversity and ethics; and community centeredness. Unfortunately no such scale was available in German.
Research question: The aim of this study was to translate the IPAS into German and thereafter validate the German version of IPAS.
Methods: The first step was to translate the IPAS from English to German according to the ISPOR guidelines, with forward and backward translations(2).
Secondly, cognitive interviews with midwifery students, anaesthesia nurses, and physicians were conducted according to the method of G. B. Willis(4). The goal of these interviews was to rephrase or delete items in the German version, if they did not make sense or were unclear to potential users.
The cognitive interviews were followed by the calculation of the Content Validity Index (CVI) for each item (item-CVI) and for the whole scale (scale-CVI) (4).
To uncover the underlying structure of the items and create meaningful subscales, we performed an explanatory factor analysis following the recommendations by Osborne et al.(5).
Finally, a homogeneity testing calculating Cronbach’s α for single items, for subscales, and for the whole scale was performed.
Results: After the forward and backward translation, the study group discussed the wording of all items until consensus was found. The cognitive interviews resulted in minor rewriting of the translated items to improve understanding. The first item-CVI’s ranged from 0.33 and up to 1.00, while the Scale-CVI achieved a satisfactory result of 0.79. The explanatory factor analysis revealed that three items did not fit in the German version, and the German IPAS was rearranged within three subscales; 1) teamwork, roles and responsibilities; 2) patient-centeredness and 3) health care provision. The subscale interprofessional biases with three items was deleted due to low factor loadings and cross-loadings, and the items of the subscale diversity and ethics were re-arranged into other subscales.
After factor analysis and re-arrangement of the items, the S-CVI reached an index of 0.82. Cronbach’s α was 0.88 for the subscale teamwork, roles and responsibilities; 0.78 for the subscale patient-centeredness; and 0.85 for the subscale health care provision. The Cronbach’s α for the overall scale was finally 0.87.
Discussion: After proper translation of the original English version into German, we found a low Cronbach’s α for the subscale interprofessional biases, which was a comparable finding with the validation trajectory of the English scale (1). Furthermore, this subscale achieved low CVI scores and in the explanatory factor analysis the items in this subscale loaded on a variety of different other factors. For that reason we decided to delete the entire subscale. This resulted in the final German version containing 24 items to assess interprofessional attitudes in health care.
Conclusion: Based on a rigorous validation process the German Scale “Haltung zur Interprofessionalität” (IPAS_German Version) provides a tool to reliably assess attitudes towards interprofessionalism among different health care professions in the German speaking countries.
1. Norris J, Carpenter JG, Eaton J, Guo JW, Lassche M, Pett MA, et al. The Development and Validation of the Interprofessional Attitudes Scale: Assessing the Interprofessional Attitudes of Students in the Health Professions. Academic medicine : journal of the Association of American Medical Colleges. 2015;90(10):1394-400.
2. Wild D, Grove A, Martin M, Eremenco S, McElroy S, Verjee-Lorenz A, et al. Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes (PRO) Measures: report of the ISPOR Task Force for Translation and Cultural Adaptation. Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research. 2005;8(2):94-104.
3. Willis GB. Cognitive Interviewing: A Tool for Improving Questionnaire Design. Thousand Oaks, California: Sage Publications; 2005.
4. Polit DF, Beck CT, Owen SV. Is the CVI an acceptable indicator of content validity? Appraisal and recommendations. Research in nursing & health. 2007;30(4):459-67.
5. Osborne J. C, A. Best practices in exploratory factor analysis: Four recommendations for getting the most from your analysis. Practical Assessment, Research & Evaluation. 2005;10(7).