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

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:

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

Abbreviations

COM-B, Capability-Opportunity-Motivation-Behavior Model; CFI, Comparative-Fit-Index; CFA, confirmatory factor analysis; EFA, exploratory factor analysis; HCW, healthcare workers; HH, hand hygiene; IPC, infection prevention and control; ME, measurement equivalence; MGCFA, multiple group confirmatory factor analysis; RMSEA, Root-Mean-Square-Error of Approximation; SD, standard deviation; SRMR, Standardized Root Mean Square Residual; SSI, surgical site infection; WACH, Wundinfektionen und Antibiotikaverbrauch in der Chirurgie (Surgical Site Infections and Antibiotic Use in Surgery) = acronym and name of the study.

Data Sharing Statement

The data is available from the corresponding author upon reasonable request.

Acknowledgments

Preliminary results were presented as a poster on September 6, 2022, at the 74th Annual Meeting of the German Society for Hygiene and Microbiology in Berlin, Germany, and on September 13, 2023, at the 7th International Conference on Prevention & Infection Control (ICPIC) in Geneva, Switzerland. A previous version of this paper has been uploaded to Research Square as a preprint: https://www.researchsquare.com/article/rs-3199535/v2.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising, or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare no conflicts of interest regarding this work.

Additional information

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).