Psychometric properties of the Health Professionals and Aphasia Questionnaire (HPAQ): a new self-assessment tool for evaluating health communication with people with aphasia

Figures & data

Table 1. The 16 HPAQ questions in English translation, grouped according to their conceptual association with different aspects of professional competence

Knowledge How well do you think you understand what aphasia is? How much knowledge do you have about how to communicate best with people with aphasia? How much knowledge do you have about how people with aphasia experience not being able to communicate?

Skills (4)If people with aphasia cannot say what they want, I have some strategies to help them express themselves in other ways (5)If people with aphasia do not understand what I am saying, I have some strategies to help their understanding (6)If I am not certain that a person with aphasia and I have understood each other correctly, I have some strategies to check this (7)If communication with a person with aphasia is unsuccessful, I have some strategies to end the conversation in a good way for the person

Attitudes and emotions (8)I am confident that I can communicate with people with aphasia (9)As health professional, I have a responsibility to make an extra effort when communicating with people with aphasia (10)I experience the situation as frustrating if communication with people with aphasia is unsuccessful

Practice (11)In my daily work with people with aphasia, I communicate about complex topics to the same extent as when communicating with people without aphasia (12)In my daily communication with people with aphasia, I always use strategies to ensure we understand each other (13)When planning my work, I always take into consideration the communicative problems of people with aphasia

Environment (14)At my workplace there are materials readily available for me to support communication with people with aphasia (15)At my workplace there are colleagues who will help me with communication with people with aphasia if I need it (16)At my workplace there is support from my closest management to take special considerations when working with people with aphasia

Table 2. Respondent characteristics at four weeks before and on the morning of the day of their scheduled course

	Respondents four weeks before the course		Respondents on the morning of the day of their course
	n	%	n	%
Gender
Female	192	91	190	90
Male	19	9	19	9
Other	1	0	1	0
Total	212		210
Missing	0		20
Age
< 34	59	28	66	31
35–44	52	25	45	21
45–54	51	24	57	27
> 54	50	24	42	20
Total	212		210
Missing	0		20
Profession
Nurse	32	15	30	14
Nursing assistant	60	28	56	27
Physio/occupational therapist	85	40	84	40
Other	35	17	40	19
Total	212		210
Missing	0		20
Current work setting
Acute	23	11	28	13
Rehabilitation	126	59	112	53
Both	25	12	32	15
Other	38	18	38	18
Total	212		210
Missing	0		20
Years of work experience
0–5	48	23	52	25
6–10	46	22	45	21
11–20	59	28	56	27
> 20	59	28	57	27
Total	212		210
Missing	0		20
Years of work experience within stroke care/rehabilitation
0–5	96	45	101	48
6–10	26	12	24	11
11–20	57	27	54	26
> 20	33	16	31	15
Total	212		210
Missing	0		20
How often are you in touch with people with aphasia per week?
0 times	16	8	13	6
1–10 times	140	66	146	70
11–20 times	38	18	32	15
21–30 times	9	4	8	4
> 30 times	9	4	11	5
Total	212		210
Missing	0		20

Table 3. Floor and ceiling effect in the questions given by prevalence of respondents, who achieved the lowest or highest possible score in each questionnaire

	Questionnaire four weeks before the course		Questionnaire on the morning zof the course day
Question	Minimum	Maximum	Minimum	Maximum
1	0.47	8.49	0.44	4.80
2	0.47	2.83	0.44	1.31
3	1.89	1.42	0.44	0.87
4	0.48	4.35	0.44	2.21
5	2.93	3.41	0.45	2.25
6	2.40	4.81	0.89	2.22
7	1.92	3.37	1.33	0.88
8	0.50	5.53	0.43	2.61
9	0.50	41.71	0.44	20.09
10	1.51	14.57	0.88	8.77
11	5.61	3.57	5.83	0.45
12	1.02	12.76	0.44	4.85
13	1.02	18.88	0.44	8.00
14	2.55	13.27	2.73	5.45
15	0.51	29.44	0.44	11.95
16	0.51	26.02	0.46	11.42

Table 4. ICC comparing the HPAQ responses four weeks before with responses on the morning of the day of the course for each question separately; health professionals at two units of hospital of Sourthwest Jutland and four surrounding municipalities, Denmark, 2019

Question		ICC	95% CI		Interpretation^a
1	How well do you think you understand what aphasia is?	0.71	0.64	0.78	Good
2	How much knowledge do you have about how to communicate best with people with aphasia?	0.80	0.75	0.85	Excellent
3	How much knowledge do you have about how people with aphasia experience not being able to communicate?	0.68	0.61	0.76	Good
4	If people with aphasia cannot say what they want, I have some strategies to help them express themselves in other ways	0.74	0.68	0.81	Good
5	If people with aphasia do not understand what I am saying, I have some strategies to help their understanding	0.76	0.70	0.82	Excellent
6	If I am not certain that a person with aphasia and I have understood each other correctly, I have some strategies to check this	0.76	0.70	0.82	Excellent
7	If communication with a person with aphasia is unsuccessful, I have some strategies to end the conversation in a good way for the person	0.74	0.68	0.81	Good
8	I am confident that I can communicate with people with aphasia	0.70	0.62	0.77	Good
9	As health professional, I have a responsibility to make an extra effort when communicating with people with aphasia	0.54	0.43	0.64	Moderate
10	I experience the situation as frustrating if communication with people with aphasia is unsuccessful	0.48	0.36	0.59	Moderate
11	In my daily work with people with aphasia, I communicate about complex topics to the same extent as when communicating with people without aphasia	0.73	0.66	0.80	Good
12	In my daily communication with people with aphasia, I always use strategies to ensure we understand each other	0.62	0.53	0.71	Good
13	When planning my work, I always take into consideration the communicative problems of people with aphasia	0.48	0.36	0.60	Moderate
14	At my workplace there are materials readily available for me to support communication with people with aphasia	0.79	0.74	0.85	Excellent
15	At my workplace there are colleagues who will help me with communication with people with aphasia if I need it	0.76	0.70	0.82	Excellent
16	At my workplace there is support from my closest management to take special considerations when working with people with aphasia	0.67	0.58	0.75	Good

^aCicchetti and Sparrow (1981).

Table 5. Factor loadings on the 16 questions of the HPAQ

		Factor loading
Question		Factor 1:	Factor 2:	Factor 3:
		Knowledge and skill	Environmental	Expecting extra effort
1	How well do you think you understand what aphasia is?	0.7380
2	How much knowledge do you have about how to communicate best with people with aphasia?	0.8771
3	How much knowledge do you have about how people with aphasia experience not being able to communicate?	0.7748
4	If people with aphasia cannot say what they want, I have some strategies to help them express themselves in other ways	0.8902
5	If people with aphasia do not understand what I am saying, I have some strategies to help their understanding	0.8539
6	If I am not certain that a person with aphasia and I have understood each other correctly, I have some strategies to check this	0.8684
7	If communication with a person with aphasia is unsuccessful, I have some strategies to end the conversation in a good way for the person	0.8109
8	I am confident that I can communicate with people with aphasia	0.8716
9	As health professional, I have a responsibility to make an extra effort when communicating with people with aphasia	0.4863		0.7054
10	I experience the situation as frustrating if communication with people with aphasia is unsuccessful		0.4268	0.3368
11	In my daily work with people with aphasia, I communicate about complex topics to the same extent as when communicating with people without aphasia	0.3923
12	In my daily communication with people with aphasia, I always use strategies to ensure we understand each other	0.7492
13	When planning my work, I always take into consideration the communicative problems of people with aphasia	0.4509	0.3136	0.4513
14	At my workplace there are materials readily available for me to support communication with people with aphasia	0.5400	0.4451	−0.4778
15	At my workplace there are colleagues who will help me with communication with people with aphasia if I need it	0.4233	0.7062
16	At my workplace there is support from my closest management to take special considerations when working with people with aphasia	0.3286	0.7645

Blanks represent abs(loading) < .30.

Table 6. Test–retest reliability of the overall HPAQ and each of the three underlying factors split by profession and years of experience within stroke care/rehabilitation

	Complete questionnaire		Knowledge and skill		Environmental		Expecting extra effort
	ICC	95% CI	ICC	95% CI	ICC	95% CI	ICC	95% CI
Overall	0.86	0.82–0.90	0.86	0.83–0.90	0.76	0.69–0.82	0.65	0.56–0.74
Profession
Nurse	0.77	0.71–0.83	0.77	0.71–0.83	0.74	0.68–0.81	0.66	0.58–0.74
Nursing assistant	0.73	0.66–0.79	0.74	0.67–0.80	0.71	0.64–0.78	0.60	0.51–0.68
Physio/occupational therapist	0.59	0.50–0.68	0.59	0.50–0.68	0.65	0.57–0.72	0.57	0.49–0.66
Other	0.73	0.66–0.79	0.73	0.66–0.80	0.69	0.62–0.76	0.57	0.48–0.67
Years of work experience within stroke care/rehabilitation
0–5	0.49	0.39–0.59	0.49	0.39–0.59	0.64	0.56–0.71	0.52	0.43–0.62
6–10	0.82	0.77–0.86	0.82	0.77–0.87	0.74	0.67–0.80	0.64	0.56–0.73
11–20	0.74	0.67–0.80	0.74	0.67–0.80	0.71	0.64–0.77	0.62	0.53–0.70
> 20	0.81	0.76–0.86	0.81	0.76–0.86	0.71	0.64–0.78	0.63	0.55–0.72

Cicchetti, D. V., & Sparrow, S. A. (1981). Developing criteria for establishing interrater reliability of specific items: Applications to assessment of adaptive behavior. American Journal of Mental Deficiency, 86(2), 127–137.

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