Validation and psychometric properties of the commitment to hip protectors (C-HiP) index in long-term care providers of British Columbia, Canada: a cross-sectional survey

Abstract

BackgroundIf worn during a fall, hip protectors substantially reduce risk for hip fracture. However, a major barrier to their clinical efficacy is poor user adherence. In long-term care, adherence likely depends on how committed care providers are to hip protectors, but empirical evidence is lacking due to the absence of a psychometrically valid assessment tool.MethodsWe conducted a cross-sectional survey in a convenience sample of 529 paid care providers. We developed the 15-item C-HiP Index to measure commitment, comprised of three subscales: affective, cognitive and behavioural. Responses were subjected to hierarchical factor analysis and internal consistency testing. Eleven experts rated the relevance and clarity of items on 4-point Likert scales. We performed simple linear regression to determine whether C-HiP Index scores were positively related to the question, “Do you think of yourself as a champion of hip protectors”, rated on a 5-point Likert scale. We examined whether the C-HiP Index could differentiate respondents: (i) who were aware of a protected fall causing hip fracture from those who were unaware; (ii) who agreed in the existence of a champion of hip protectors within their home from those who didn’t.ResultsHierarchical factor analysis yielded two lower-order factors and a single higher-order factor, representing the overarching concept of commitment to hip protectors. Items from affective and cognitive subscales loaded highest on the first lower-order factor, while items from the behavioural subscale loaded highest on the second. We eliminated one item due to low factor matrix coefficients, and poor expert evaluation. The C-HiP Index had a Cronbach’s alpha of 0.96. A one-unit increase in championing was associated with a 5.2-point (p < 0.01) increase in C-HiP Index score. Median C-HiP Index scores were 4.3-points lower (p < 0.01) among respondents aware of a protected fall causing hip fracture, and 7.0-points higher (p < 0.01) among respondents who agreed in the existence of a champion of hip protectors within their home.ConclusionsWe offer evidence of the psychometric properties of the C-HiP Index. The development of a valid and reliable assessment tool is crucial to understanding the factors that govern adherence to hip protectors in long-term care.

The effectiveness of champions in implementing innovations in health care: a systematic review

“…Outcome variables include physician reported personal and facility-level change in preference regarding unrelated donor graft use from peripheral blood source to bone marrow. These survey items were scored on a 5 -point Likert scale from very important to very unimportant Reliability: Not reported; Validity: Not reported Korall, 2017, 2018 [ 64 , 65 ] One study—two reports Canada 13 long-term care homes Cross-sectional study Paid care providers = 529 Age in years ( n (%)): 20–29 = 42 (7.9%); 30–39 = 87 (16.4%); 40–49 = 149 (28.2%); 50–59 = 187 (35.3%); 60–69 = 46 (8.7%); Missing/unknown = 18 (3.4%) Reported Gender: Female = 474 (89.6%); Male = 40 (7.6%); Missing/unknown = 15 (2.8%) Interpreted as: Sex Professions: Health care assistant/resident care aide = 290 (54.8%); Licensed practical nurse = 84 (15.9%); Registered nurse = 40 (7.6%) Resident care coordinator = 13 (2.4%); Manager = 14 (2.6%); Recreational/occupational/ physiotherapist = 24 (4.5%); Unit/program clerk = 18 (3.4%); Missing/unknown = 49 (9.3%) Innovation: Hip protectors are protective undergarments with either a hard shield or soft pads sewn into its sides to cover the skin over the lateral aspects of the proximal femur. The purpose of hip protectors is to minimize the injury to the hip resulting from a fall Study outcome measurement Measures: A 15-item questionnaire titled as C-Hip Index, developed and tested for psychometric properties by authors [ 64 ] to measure affective and cognitive, behavioural and overall hip protector commitment Reliability: α (range) = 0.87–0.97 Validity: (1) Construct validity: Authors reported a two-factor structure as the result of an exploratory factor analysis: Factor 1 (affective and cognitive commitment) and Factor 2 (behavioural commitment) which loaded to a higher order factor called "commitment to hip protectors" with an eigen value of 1.386.…”

“…Measures: A 15-item questionnaire titled as C-Hip Index, developed and tested for psychometric properties by authors [ 64 ] to measure affective and cognitive, behavioural and overall hip protector commitment…”

“…H (Adherence to adult vaccination standards) Hsia, 2019 [ 59 ] ( +) S (Hospital medical services and processes performed using E-health technology) Hung, 2008 [ 60 ] ( +) P (Quality of life measures) Kabukye, 2020 [ 61 ] ( +) H (Attitudes towards implementing electronic health record) Kenny, 2005 [ 62 ] ( +) H (Instrumental research use) Khera, 2018 [ 63 ] (?) H (Preferred unrelated graft source for hematologic malignancies) One study, two reports: Korall, 2017, 2018 [ 64 , 65 ] ( +) H (Commitment to hip protectors) Lago, 2013 [ 66 ] (?) H (Non-pharmacological and pharmacological interventions during invasive procedures) Papadakis, 2014 [ 67 ] ( +) H (Delivery of evidence-based smoking cessation treatments) Paré, 2011 [ 68 ] (?)…”

“…Twenty-nine studies evaluated the effectiveness of champions in increasing innovation use: five studies evaluated the effectiveness of champions in increasing conceptual innovation use [ 61 , 64 , 65 , 68 , 75 , 77 , 78 ], and 25 studies evaluated the effectiveness of champions in increasing instrumental innovation use [ 39 – 41 , 47 – 50 , 52 , 54 , 55 , 57 – 59 , 62 , 63 , 66 , 67 , 70 – 76 , 80 ]. One study evaluated both conceptual and instrumental innovation use [ 75 ].…”

“…Four studies evaluated the effectiveness of champions in improving providers’ attitudes and awareness of new technology or equipment (conceptual innovation use) [ 61 , 64 , 65 , 68 , 77 , 78 ]. One of the 4 studies used a quasi-experimental design [ 77 , 78 ], while the other three studies were cross-sectional observational studies [ 61 , 68 , 77 , 78 ].…”