Context Matters:
Development of a scale to measure self-efficacy toward interprofessional competencies (IP)
Lisa M Guirguis, Sharla King, Teresa Paslawski , University of Alberta
Background:
• Challenge to quantify impact of early IPE in health sciences students as part of a mixed methods approach to evaluation. • Self-efficacy is a robust construct directly related to behaviour and could be used as a surrogate for behavior change analogous to using blood pressure as a surrogate for mortality in people with hypertension. • We sought to measure the impact of the IP Launch workshop (i.e., large scale IP education event) on first year students’ self-efficacy toward the University of Alberta IP competencies on communication, role collaboration, role clarification, and reflection as outlined in the IP Learning Pathway.
Role Clarification
INTEGRATION: Entry to Practice Role Clarification
• Self-efficacy should be measured relevant to the specific task and generalized scales are weak measures of changes. Prior scales did not capture these competencies • This required us to create a IP self-efficacy scale specific to our competency model.
www.hserc.ualberta.ca
Learning Objectives:
1. discover the psychometric properties of a context specific IP self-efficacy scale, 2. describe students’ self-efficacy toward IP competencies 3. reflect on opportunities to create context specific IP selfefficacy scales.
Methods:
• A scale was created to measure self-efficacy toward IP competencies on communication, collaboration, role clarification, and reflection using the format of a prior selfefficacy scale. • Using the University of Alberta IP Learning Pathway, we wrote one question for each level (i.e., exposure, immersion, and integration) for each competency (i.e., communication, collaboration, role clarification, and reflection). • Experts reviewed these questions for readability and face validity. • First year students from all health science programs completed the IP self-efficacy scale, as well as the RIPLS and The UWE Interprofessional Questionnaire before the IP Launch (time 1) and spring 2012 (time 2). • Descriptive analyses were used to characterize the scales responses. • Evidence for reliability was established with the Cronbach’s alpha. • Evidence for validity was established with - 1) an exploratory factor analysis using principal components analysis with varimax rotation and - 2) correlations with other existing IP scales: Readiness for Interprofessional Learning Scale (RIPLS) Questionnaire which measures IP beliefs and the UWE Interprofessional Questionnaire (IPQ).
Table 2. Means, Standard Deviations, and ANOVA results for Self-Efficacy by Item, Subscale, and Total
Table 1. Demographics for Student Participants n=390 Value Discipline Undeclared Nursing Nursing Bilingual Physiotherapy Nursing (After Degree) Pharmacy Speech Language Pathology Occupational Therapy Medicine Nutrition Physical Education Dentistry Medical Laboratory Science Other Gender Female Male Year of University 1 2 3 4 5 6
Frequency 5 10 2 44 25 70 54 78 11 9 19 15 27 21 291 82 122 27 45 24 109 61
Percent 1.3 2.6 .5 11.3 6.4 17.9 13.8 20.0 2.8 2.3 4.9 3.8 6.9 5.4 74.6 21.0 31.3 6.9 11.5 6.2 27.9 15.6
• Repeated measures ANOVA were used to examine changes between time 1 and time 2.
Results:
• Expert review resulted in simplified wording and 2 questions on reflection (11 total) as we did not anticipate students employ reflection at an integration level. • Participating students were from 10 disciplines and 75% female (Table 1) • The mean total IP self-efficacy score was 51.16 (standard deviation =10.48) and 53.69 (10.07) (Table 2). • As anticipated, questions at an integration level had lower selfefficacy score than less complex competencies for all subscales
Subscale
Question
A) Effectively talk with other health care professionals about a patient issue B) Avoid using discipline-specific language when talking to other health Communication sciences students/professionals C) Give feedback to another health science student/professional in a difficult situation Subscale: Communication D) Make sure that other health science students/professionals feel they are a respected member of the team E) Work with other health sciences students/professionals to complete a group project Collaboration F) Speak with a health science student/professional who failed to show respect for a team member Subscale: Collaboration G) Explain your professional role to another health science student and professional H) Ask another health science student/professional for help with a paRole Clarification tient issue I) Talk with health science student/professional about stereotypes of health care professionals Subscale: Role Clarification J) Ask another health science student/professional about your strengths and weaknesses Reflection K) Ask a team of health sciences students/professionals to talk about how well their team is working together Subscale: Reflection TOTAL
Table 3: Correlations of SE IP Scale with other IP Scales
390
Time 1 [Mean (SD)] 4.24 (1.461)
Time 2 [Mean (SD)] 4.77 (1.314)
388
4.08 (1.366)
390 390 388
N
389
F-value
p-value
η²
39.027
0.000**
0.091
4.39 (1.312)
13.619
0.001**
0.034
3.93 (1.45)
4.29 (1.369)
19.753
0.000**
0.048
12.23 (3.566) 5.59 (1.128)
13.45 (3.333) 5.68 (1.029)
35.415 2.345
0.000** 0.127
0.083 0.006
5.16 (1.322)
5.38 (1.226)
6.603
0.011*
0.017
The UWE IPQ Scale Score Communication and Teamwork Subscale** Interprofessional Learning Subscale
389
3.95 (1.514)
4.07 (1.408)
2.195
0.139
0.006
Interprofessional Interaction Subscale
390 387
14.69 (3.164) 4.85 (1.340)
15.09 (2.871) 5.22 (1.273)
4.827 20.799
0.029* 0.000**
0.012 0.051
Interprofessional Relationships Subscale**
388
5.38 (1.192)
5.56 (1.058)
6.628
0.010*
0.017
387
4.76 (1.436)
4.83 (1.397)
0.534
.466
0.001
390 390
14.98 (3.292) 4.55 (1.398)
15.53 (3.194) 4.71 (1.376)
8.580 3.550
0.004* 0.060
0.022 0.009
390
4.72 (1.327)
4.91 (1.306)
5.811
0.016*
0.015
390 390
9.26 (2.456) 9.61 (2.477) 51.16 (10.481) 53.69 (10.065)
5.811 18.293
0.016* 0.000**
0.015 0.045
* p < .05 ** p < .005
except reflection. • Chronbach’s alpha was 0.89 (n=390) at time 1 and 0.90 (n=390) at time 2 with subscale scores between 0.69 and 0.79. • Factor analysis with all scale items from all scales (RIPLS and UWS) resulted in all self-efficacy items loading on one factor alone. The communication subscale also loaded on a separate factor with similar loading values. • The self-efficacy IP scale was significantly correlated with the RIPLS and UWE IPQ demonstrating for criterion validity. The
RIPLS Scale Score
strongest correlations were found with two subscales of the UWE IPQ which focused on self-efficacy toward Communication and Teamwork and IP relationships. (e.g., I feel comfortable, I am able to, I feel confident and I lack confidence). (Table 3) • The results indicate that students’ IP self-efficacy total scores significantly increased over time [F(1, 389) = 18.29, p = 0.00]. Four of the 11 items were not found to be significant: Item D, Item I, and Item J. However, it is important to note that all three of these items had positive changes over time. (Table 2)
Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N Pearson Correlation Sig. (2-tailed) N
SE IP Scale Score .180** .000 380 -.456** .000 380 -.489** .000 379 -.302** .000 378 -.092 .075 378 -.509** .000 380
**Correlation is significant at the 0.01 level (2-tailed). **Questions similar to SE scale with items on comfort and confidence in beliefs.
Future Directions:
• The scale was written before the inaugural IP Launch. For the third IP Launch, we will plan to revise the scale to ensure questions assess the competencies of the current activities. • This scale will be used to evaluate future IPE at the University of Alberta. Individual questions will be developed using our IP Learning Pathway with items written at the exposure, immersion, and integration level for each competency.
Conclusion:
• Evidence is provided for validity and reliability of an IP selfefficacy scale relevant to our IP competencies which was able to measure a small improvement in IP self-efficacy after a large scale IPE activity. • Other researchers could use this process to develop their own context specific self-efficacy scale.
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