Professor Wake Forest School of Medicine Wake Forest School of Medicine Winston-Salem, North Carolina, United States
Background: A subgroup of children with medical complexity (CMC) receive home health nursing (HHN) services. There are gaps in the quality of HHN services received by CMC. However, instruments to evaluate parent/caregiver satisfaction with pediatric HHN are not available.
Objective: The goal of this project is to describe the development and initial psychometric evaluation of a new measure of caregiver satisfaction with pediatric HHN quality, called Caregiver Assessment of Pediatric Home Health Nurse Quality (CAPHONQ).
Design/Methods: CAPHONQ was developed by: (1) generating items from literature review of existing measures of satisfaction with home health services; and (2) qualitative data from 20 interviews of caregivers of CMC and 4 focus groups of home health nurses. Initial psychometric evaluation included: (1) content validity, (2) internal consistency, (3) test-retest reliability, and (4) convergence validity. For content validity, four caregivers of CMC receiving HHN, and 2 complex care physicians (from other institutions) evaluated the instrument. For the other psychometric evaluation, 22 caregivers of CMC evaluated 68 nurses involved in their children’s care. CAPHONQ was administered (15 English and 7 Spanish) by a study team member. Reliability was evaluated by retest within about one week of initial administration. Intraclass correlation (ICC) treated ratings as nested within caregiver. Convergence validity was evaluated by comparing CAPHONQ items with global measures of satisfaction with HHN.
Results: The initial instrument had 24 items (including 4 global items). Based on the review of caregivers and providers for content validity, one item was added, one deleted, and one revised. The final version of CAPHONQ has 20 items under four domains – skills, communication, relationship, and professionalism (Table 1), with a score of 1 (worst) to 10 (best) for each item. Test-retest ICC and Pearson correlations were generally high (Table 2). Internal consistency for CAPHONQ as measured by Cronbach’s alpha was also high, but lowest for ‘communication’ domain (Table 3). When compared to the 4 global measures, the overall measure and the domains showed good convergent validity (Table 4). Conclusion(s): CAPHONQ is a simple and useful measure to assess caregiver satisfaction with HHN. Preliminary psychometric evaluation of CAPHONQ suggests good test-retest reliability, internal consistency, and content and convergent validity. Further validation of CAPHONQ is necessary.
Table 1. Caregiver Assessment of Pediatric Home Health Nurse Quality (CAPHONQ) Items
Table 2. Test-retest reliability of CAPHONQ
Table 3. Internal Consistency of CAPHONQ Domains
Table 4. Convergent Validity of CAPHONQ Domains
Authors/Institutions: Savithri Nageswaran, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States; Douglas Easterling, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States; Cobi Ingram, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States; Jamie Skaar, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States; Anna Miller Fitzwater, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States; Edward Ip, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States