Psychometrics of the Computer-Based Relationships with Health Care Provider Scale in Older Adults

By Anderson, Elizabeth H.; Neafsey, Patricia J. et al. | Journal of Nursing Measurement, April 1, 2011 | Go to article overview

Psychometrics of the Computer-Based Relationships with Health Care Provider Scale in Older Adults


Anderson, Elizabeth H., Neafsey, Patricia J., Peabody, Sheri, Journal of Nursing Measurement


The type and quality of the provider-patient health care relationship impacts patient adherence. The study purpose was to convert the 5-item paper and pencil Relationships With Health Care Provider Scale (RHCPS) to a reliable and valid computer-based scale for use with older adults. Outpatient adults (N = 121) older than 59 years were recruited. The RHCPS underwent several iterations documenting internal consistency reliability, content and factorial validity, and scale usability in a computer tablet format. A total of 5 expert judges rated all 5 items as valid, which resulted in a scale content validity index of 1. Cronbach's standardized alpha was .81. Principal components analysis extracted 1 factor (eigenvalue > 1; confirmed by scree plot) as anticipated. Computer-based RHCPS has the potential to reveal valuable clinical and scientific data on patient-provider relationships among older adults.

Keywords: computerized scale development; health care providers; content validity; hypertension; older adults

It is critical to address medication adherence among older adults to improve the health of the nation and reduce health care costs. To this end, a touch screen Personal Education Program (PEP) has been designed to assess the medication taking behaviors of older adults (Neafsey et al., 2008). To test the PEP and to control for the impact of health care relationships on patient reported behaviors, a computer-based scale measuring health care relationships between providers and patients was developed. The specific purpose of this study was to convert the five-item paper and pencil Relationships With Health Care Provider Scale (RHCPS) (Anderson, Fishman, Tummillo, & Spencer, 2006) to a reliable and valid computer-based scale that could be used by older adults.

BACKGROUND AND CONCEPTUAL FRAMEWORK

Background

It is well established that the type and quality of provider-patient health care relationship impacts patient adherence to recommended care in general (Pignone & McPhee, 2006; Stoeckle, 2009), in persons with HIV or with AIDS (Mikky, Anderson, Fishman, Tummillo, & Spencer, 2007; Molassiotis, Morris, & Trueman, 2007; Schneider, Kaplan, Greenfield, Li, & Wilson, 2004) and in persons with hypertension (Cho, Voils, Yancy, Oddone, & Bosworth, 2007). Delays between diagnosis and treatment in persons with hepatitis C have been linked to physician-patient relationships (Enel, Minell, Jooste, Pinoit, & Hillon, 2009). Adherence is improved with a trusting provider-patient relationship (Pignone & Salazar, 2010) in which patients are empowered and accepted as partners in care (Apollo, Golub, Wainberg, & Indyk, 2006; Bader et al., 2006).

Conceptual Framework

Relationships among humans are the connections, bonds, associations, or interactions between two or more persons. Human relationships and their consequences can be either positive or negative and interpreted differently by either or both participants in the dyad. The conceptual basis of the RHCPS is patients' perceptions of their relationships with their health care providers.

Relationship with health care provider is an abstract concept or mental image of the phenomenon that occurs between a patient and a health care provider while a patient is receiving care (Powers & Knapp, 2006; Walker & Avant, 2005). Patients' relationships with health care providers are indirectly reflected in patients' level and comfort in communication, participation in decision making, and sense of trust in the provider. Within the holistic model of patient care, providers underscore the value of the whole person so that social and emotional aspects of the patient are equally considered with medical or clinical representations (Fortin, Alvarez, Bibeau, & Laudy, 2008; van der Ploeg, Winthereik, & Bal, 2006). This is mirrored in a patient's sense of feeling known as a person and believing that specific concerns are being heard or understood (Williams & Irurita, 2004). …

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