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      Results From a Multimethod Exploratory Scale Development Process to Measure Authoritarian Provider Attitudes in Democratic Republic of Congo and Togo

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          Abstract

          Provider attitudes are a recognized driver of provider behaviors that may influence client behaviors & outcomes–the authors present a scale development & validation process resulting in survey items measuring authoritarian provider attitudes.

          Abstract

          Key Findings

          • There is growing interest in understanding what drives providers' behaviors and attitudes toward clients and how these behaviors and attitudes are important to client health outcomes.

          • Iteration and testing with target populations were key elements of the scale development process, starting with testing 23 items and retaining 14 items in the scale that measures authoritarian provider attitudes.

          • Measuring provider attitudes using validated scales such as the scale presented in this article can identify areas for programmatic improvement by helping stakeholders understand drivers of provider behavior.

          Key Implications

          • Public health practitioners working to measure and improve provider behavior may consider expanding their scope to broader attitudes that may influence behavioral drivers relevant to multiple health areas.

          • Designers of provider behavior change programs should consider how authoritarian provider attitudes interact and affect the quality of health services.

          ABSTRACT

          Background:

          Health care providers' actions can significantly influence clients' experiences of care, adherence to recommendations, and likelihood of re-engaging with health services. There are currently no validated scales that measure provider attitudes that could affect service delivery in multiple health areas.

          Methods:

          We developed provider attitude measures in 3 phases. In phase 1 (2019), survey items were developed based on literature reviews, and quantitative items were tested through a health facility survey conducted in the Democratic Republic of the Congo (DRC). Health care providers (N=1,143) completed a 23-question survey focused on 3 subdomains: provider perceptions of clients, provider roles, and gender roles. In phase 2 (2021), cognitive interviews were administered to 17 health care providers in DRC to assess and improve respondents' understanding and interpretation of questionnaire items and response options. In phase 3 (2021), 52 family planning providers were sampled from urban health facilities in Togo to retest and validate the improved measures.

          Results:

          Phase 1 showed the provider attitude items had low scale reliability, and 8 survey items had low variability. In phase 2, results from the cognitive interviews of the 21 items retained from phase 1 found 16 questions were not well understood or had low response variability and thus modified, and 4 survey items were added to test different iterations of specific survey items. In phase 3, exploratory factor analysis resulted in 1 provider attitude scale of 14 items reflecting authoritarian attitudes related to the 3 initial subdomains.

          Conclusion:

          This research highlights the importance of iteration and testing during scale development, implementable even across geographic locations. Provider behavior change programming should consider how authoritarian provider attitudes pertaining to professional roles, their clients, and gender norms may interact and influence the quality of health services provided.

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          Most cited references41

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          Best Practices for Developing and Validating Scales for Health, Social, and Behavioral Research: A Primer

          Scale development and validation are critical to much of the work in the health, social, and behavioral sciences. However, the constellation of techniques required for scale development and evaluation can be onerous, jargon-filled, unfamiliar, and resource-intensive. Further, it is often not a part of graduate training. Therefore, our goal was to concisely review the process of scale development in as straightforward a manner as possible, both to facilitate the development of new, valid, and reliable scales, and to help improve existing ones. To do this, we have created a primer for best practices for scale development in measuring complex phenomena. This is not a systematic review, but rather the amalgamation of technical literature and lessons learned from our experiences spent creating or adapting a number of scales over the past several decades. We identified three phases that span nine steps. In the first phase, items are generated and the validity of their content is assessed. In the second phase, the scale is constructed. Steps in scale construction include pre-testing the questions, administering the survey, reducing the number of items, and understanding how many factors the scale captures. In the third phase, scale evaluation, the number of dimensions is tested, reliability is tested, and validity is assessed. We have also added examples of best practices to each step. In sum, this primer will equip both scientists and practitioners to understand the ontology and methodology of scale development and validation, thereby facilitating the advancement of our understanding of a range of health, social, and behavioral outcomes.
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            Evaluating the quality of medical care. 1966.

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              Measuring Attitudes toward Gender Norms among Young Men in Brazil: Development and Psychometric Evaluation of the GEM Scale

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                Author and article information

                Journal
                Glob Health Sci Pract
                Glob Health Sci Pract
                ghsp
                ghsp
                Global Health: Science and Practice
                Global Health: Science and Practice
                2169-575X
                30 November 2023
                30 November 2023
                : 11
                : Suppl 1
                : e2200421
                Affiliations
                [a ]Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University , New Orleans, LA, USA.
                [b ]Population Council , Washington, DC, USA.
                [c ]Department of International Health, Johns Hopkins Bloomberg School of Public Health , Baltimore, MD, USA.
                [d ]Cera Group , Lomé, Togo.
                Author notes
                Correspondence to Martha Silva ( msilva3@ 123456tulane.edu ).
                Article
                GHSP-D-22-00421
                10.9745/GHSP-D-22-00421
                10698232
                38035720
                2f482f67-d46b-4bab-81e5-2a044de8d43f
                © Silva et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-22-00421

                History
                : 22 September 2022
                : 17 July 2023
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