Development of an Instrument to Measure Community Acceptance of Nurse Practictioners and Physician Assistants

Abstract

The purpose of this study was to identify the significant dimensions of the concept of community acceptance of nurse practitioners/physician’s assistants and to construct areliable and valid instrument which would reflect these dimensions. The methodological approach included: conceptualization of categories, development of items for each category, development of the tool, administration of the tool, and psychometric analysis of results. Community input through focus-group interviews and post-administration questions provided qualitative data. The survey tool, consisting of items in four conceptualized categories (knowledge, access, competence, and trust), was administered in five rural communities. The responses of 967 residents were analyzed through factor analysis. The criterion, eigenvalue > 1.0, resulted in seven factors. Oblique rotation was applied to the seven factors and marker variables (loadings > .70) facilitated the identification of the underlying dimensions of each factor. Overall, 98% of the items assigned to the original categories were maintained after factor analysis. The identification of these dimensions helped to simplify the description and understanding of community acceptance of nurse practitioners and physicians’ assistants. Community acceptance of these advanced health care providers is a necessary precursor to use of services.

Patient satisfaction with nurse practitioner‐delivered primary healthcare services

“…An exhaustive review of the literature indicated that no existing instrument entirely and satisfactorily demonstrated promise or pertinence to the specific objective of the study. Therefore, the Nurse Practitioner Satisfaction Survey (NPSS), a 5‐point Likert‐type survey, was created specifically for the purposes of this study from a compilation of numerous satisfaction scales reviewed, a review of related literature, and professional opinion (Alexander, 2001; Baer, et al, 1999; Bear & Bowers, 1998; Cole, Mackey, & Lindenberg, 1999; Courtney & Rice, 1997; DiTomasso &Willard, 1991; Marsh, 1999). The NPSS (Agosta, 2005) is composed of 28 Likert‐type items compiled with the intent of including concepts viewed as relevant and instrumental in influencing overall patient satisfaction with care.…”

Higher‐order factor analysis of an instrument with dichotomous data

“…In the first-order analysis, items specific to trust and access loaded on three distinct factors (Baer et al, 1999); however, in the second-order analysis these three factors converged into a single factor. The methodological question raised by this analysis is: ''Does the clustering of the trust and access related factors correspond with the elimination of difficulty factors that might occur when using factor analysis on dichotomous data?''…”

“…This instrument was developed based on focus group analysis, extensive literature review, and expert opinion. Through this process, items for the instrument were constructed to reflect four underlying concepts of acceptance: trust, knowledge, competence, and access (Baer et al, 1999). The 40 items that comprised this instrument assessed community acceptance of NPs and PAs in a rural setting.…”

“…The cumulative percent of all seven factors accounted for 49.8% of the common factor variance. An analysis of these seven factors with respect to the four hypothesized dimensions of the concept of acceptance indicated that ''competence'' and ''access'' were multidimensional (Baer et al, 1999). Distinct from an orthogonal rotation method, oblique rotation results in a factor correlation matrix that allows each factor to correlate with others (Gorsuch, 1983).…”

“…Two of the second-order factors clearly corresponded with the underlying concepts of knowledge and competence. Original items representing the concepts of access and trust combined to form the third higher-order factor, which theoretically is most representative of the concept of access as it is represented in the literature (Baer et al, 1999).…”