Development and psychometric testing of the quality of care for trauma patients scale using exploratory and confirmatory factor analysis

Ehsan  Sarbazi; Homayoun  Sadeghi-Bazargani; Mostafa  farahbakhsh; Alireza  Ala; Amirhesam  Pouraghaei; Hassan  Soleimanpour

doi:10.18502/fem.v9i4.20865

Ehsan Sarbazi Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Homayoun Sadeghi-Bazargani Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Mostafa farahbakhsh Research center of psychiatry and behavioral sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
Alireza Ala Emergency and Trauma Care Research Center, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
Amirhesam Pouraghaei Faculty of Science, York University, Toronto, Ontario, Canada.
Hassan Soleimanpour Emergency and Trauma Care Research Center, Imam Reza General Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.

DOI: https://doi.org/10.18502/fem.v9i4.20865

Keywords: Validation; Structural Equation Modeling (SEM); Quality of Health Care; Questionnaire

Abstract

Objective: Identifying trauma care quality from the trauma victims' viewpoints is key to patient-centered care, identifying service gaps, developing effective protocols, and building trust in medicine. The current study aims to establish a new quality of trauma care questionnaire and to assess its psychometric characteristics within the hospital context in Iran.

Methods: First, items were developed through a combination of literature review and interviews. Then, the validity of the items, including content, face, and internal consistency, was evaluated. Construct validity was assessed using exploratory factor analysis (EFA) on a sample of 220 patients, followed by confirmatory factor analysis (CFA) with a separate group of 253 patients from August to October 2022.

Results: Content validity, as measured using modified Kappa, was 0.95. Cronbach's alpha for internal consistency was 0.91, and test-retest reliability over two weeks was 0.94. The EFA revealed four factors: interpersonal quality, technical quality, outcome quality, and non-medical quality, which collectively accounted for 67% of the total variance in measuring the quality of care in trauma victims. Using CFA, researchers validated the final version of the trauma quality scale from patients' perspective (TQS-PP), which includes 22 items across four dimensions. The CFA model of the TQS-PP demonstrated an acceptable fit, with χ2/df = 2.064, RMSEA=0.058, CFI=0.912, and NNFI=0.920.

Conclusion: Psychometric evaluations demonstrated sufficient validity and reliability for TQS-PP application in quality research involving trauma victims in Iran. The developed and evaluated TQS-PP serves as a reliable measure of health care quality from the perspective of trauma victims. The new tool could assist public health researchers in assessing the quality of care in emergency departments (EDs) and similar contexts.