Hospital survey on patient safety culture (HSOPSC): a multi-method approach for target-language instrument translation, adaptation, and validation to improve the equivalence of meaning for cross-cultural research.

BACKGROUND: The Hospital Survey on Patient Safety Culture (HSOPSC) is widely utilized in multiple languages across the world. Despite culture and language variations, research studies from Latin America use the Spanish language HSOPSC validated for Spain and the United States. Yet, these studies fail to report the translation method, cultural adaptation process, and the equivalence assessment strategy. As such, the psychometric properties of the HSOPSC are not well demonstrated for cross-cultural research in Latin America, including Peru. The purpose of this study was to develop a target-language HSOPSC for cross-cultural research in Peru that asks the same questions, in the same manner, with the same intended meaning, as the source instrument. METHODS: This study used a mixed-methods approach adapted from the translation guideline recommended by Agency for Healthcare Research and Quality. The 3-phase, 7-step process incorporated translation techniques, pilot testing, cognitive interviews, clinical participant review, and subject matter expert evaluation. RESULTS: The instrument was translated and evaluated in 3 rounds of cognitive interview (CI). There were 37 problem items identified in round 1 (14 clarity, 12 cultural, 11 mixed); and resolved to 4 problems by round 3. The pilot-testing language clarity inter-rater reliability was S-CVI/Avg = 0.97 and S-CVI/UA = 0.86; and S-CVI/Avg = 0.96 and S-CVI/UA = 0.83 for cultural relevance. Subject matter expert agreement in matching items to the correct dimensions was substantially equivalent (Kappa = 0.72). Only 1 of 12 dimensions had a low Kappa (0.39), borderline fair to moderate. The remaining dimensions performed well (7 = almost perfect, 2 = substantial, and 2 = moderate). CONCLUSIONS: The HSOPSC instrument developed for Peru was markedly different from the other Spanish-language versions. The resulting items were equivalent in meaning to the source, despite the new language and different cultural context. The analysis identified negatively worded items were problematic for target-language translation. With the limited literature about negatively worded items in the context of cross-cultural research, further research is necessary to evaluate this finding and the recommendation to include negatively worded items in instruments. This study demonstrates cross-cultural research with translated instruments should adhere to established guidelines, with cognitive interviews, based on evidence-based strategies.

Perceptions of Gastrostomy Buttons Among Caregivers of Children With Special Health Care Needs.

INTRODUCTION: Children with special health care needs (CSHCN) have chronic conditions that generally are classified as developmental disabilities. Children with developmental disabilities are at high risk of malnutrition. Gastrostomy buttons are frequently used to provide enteral nutrition for children with developmental disabilities. OBJECTIVE: This study aimed to understand caregivers' perceptions regarding gastrostomy button placement for CSHCN. METHODS: Caregivers (N = 257) were recruited from CSHCN peer support groups to complete an online survey regarding perceptions of gastrostomy button placement. Kolmogorov-Smirnov testing found that results were not normally distributed. Nonparametric testing with Spearman rank correlation was used to determine the relationship between Overall Satisfaction With Choice and all other perception variables. RESULTS: The findings suggested overall satisfaction and willingness to accept gastrostomy button placement earlier. CONCLUSION: Gastrostomy button placement has diverse effects for children with developmental disabilities and their families. Health care professionals must be knowledgeable about the positive and negative outcomes to effectively educate families as they consider gastrostomy placement.

Access to Digital Communication Technology and Perceptions of Telemedicine for Patient Education among American Indian Patients with Diabetes.

INTRODUCTION: Health care access for medically underserved patients managing chronic conditions is challenging. While telemedicine can support patient education and engagement, the "digital divide" may be particularly problematic among the medically underserved. This study evaluated physical access to digital devices, use of e-mail and social media tools, and perceptions of telemedicine among American Indian (AI) patients with diabetes mellitus (DM). METHODS: Survey data were collected from AI patients with DM during teleophthalmology exams. RESULTS: Eighty-eight percent of patients had access to digital device(s), 70% used e-mail, and 56% used social media. Younger age and greater education were positively associated with e-mail and social media use (p < .05). Most (60%) considered telemedicine an excellent medium for health-related patient education. DISCUSSION: American Indian patients with DM had access enabling patient education via telemedicine. Future work should examine patient technology preferences and effectiveness of technology-based education in improving outcomes among medically underserved populations.

Addressing the Cost, Value, And Student Debt in Nursing Education.

The current initiatives to improve the academic preparation of nurses have added emphasis to the presence or prediction of thousands of dollars of debt, which may influence personal decisions about returning to school. In this study, nearly 40% of survey respondents reported less than $25,000 in college debt and 23.5% reported greater than $25,000 of prior college debt. Slightly less than a third of respondents reported no plans to return to school for more education but of those who did have an educational plan, the influence of prior college debt on their plans for academic progression was significant. Debt and the influence of debt on education planning for nurses was confirmed as a concern that will impede achievement of the baccalaureate education benchmark for nurses unless steps are taken to address prior college debt and the cost of further education. Nurse executives should take nurses' debt load into account when planning academic advancement initiatives.

The Effect of Blood Glucose Self-Monitoring Among Inmates With Diabetes.

The increasing prevalence and risk of complications from diabetes necessitate patient participation and attentiveness to select appropriate foods, perform regular physical activity, and be active in diabetes management and self-maintenance. Diabetes is often largely asymptomatic; consequently, early diagnosis and treatment are necessary. Inmates are a unique population challenged by the increased prevalence of chronic conditions including diabetes. Diabetes standards for inmates contain diagnostic and treatment management guidelines that incorporate personal glucose monitoring for insulin users. In December 2009, the Federal Bureau of Prisons initiated a program to distribute glucose meters to insulin-dependent inmates to facilitate self-monitoring blood glucose. The purpose of this study was to evaluate the effect of these glucose meters on hemoglobin A1c levels.

Cancer Information-Seeking Practices Among the Hispanic Population: Data From the Health Information National Trends Survey 2007.

Hispanic people are less likely to seek cancer information and experience more health care barriers than non-Hispanic people. The purpose of this work was to identify cancer information-seeking practices among U. S. Hispanic adults and identify demographic characteristics associated with information selected. Data from 622 Hispanic participants in the Health Information National Trends Survey 2007 were analyzed. Results of this study indicated that the leading sources of cancer information came from the Internet (47%, n = 105), followed by health care providers (26%, n = 60). As educational level increased, Internet use for cancer information-seeking increased from 20.7% (n = 6) to 60.6% (n = 40). These data indicate a necessity to improve information delivery strategies tailored to this group.

Differences in quality of life between pediatric sickle cell patients who used hydroxyurea and those who did not.

PURPOSE: The purpose of this paper is to examine the differences in quality of life (QoL) between two groups of pediatric sickle cell patients: those who used hydroxyurea and those who chose not to use the medication to treat sickle cell disease. DESIGN/METHODOLOGY/APPROACH: The study was a quantitative, non-randomized, cross-sectional, comparative study. In total, 100 children ages seven to 17 participated in the study. Parents of the patients completed a demographic questionnaire while the participants completed the Pediatric Quality of Life Inventory (Peds QoL) and Sickle Cell Disease Quality of Life Inventory (SCD QoL). FINDINGS: The Ped QoL regression analysis revealed that hydroxyurea use and parental marital status accounted for a significant proportion of the variance in Ped QoL. The SCD QoL regression analysis also revealed that hydroxyurea and age accounted for a significant proportion of the variance in SCD QoL. Finally, the regression analysis revealed that SCD, parental marital status, parental income, sex, age, race and number of siblings did not account for a significant proportion of the variance in SCD crises per year. ORIGINALITY/VALUE: This paper proved a need to study the differences in QoL between those pediatric patients who used hydroxyurea and those who did not use the medication.

Job satisfaction levels of physician assistant faculty in the United States.

PURPOSE: Understanding job satisfaction in academia is important in order to recruit and retain faculty. Faculty members with greater job dissatisfaction are more likely to leave than faculty members who are satisfied. Physician assistant (PA) faculty job satisfaction needs to be assessed to determine which job facets are satisfying or dissatisfying. METHODS: A quantitative descriptive study was done using a Web-based survey sent to PA faculty. The Job Descriptive Index (JDI), a validated survey, was used to measure levels of job satisfaction. The means for each facet were calculated to indicate levels of satisfaction with the job overall, work, supervision, co-workers, pay, promotion, levels of stress, and trustworthiness in management. Correlations were run among demographic factors, salary, and overall job satisfaction. RESULTS: Of the 1,241 PA faculty that received the survey, 239 responses (19.3% response rate) met the criteria for study inclusion. The highest level of satisfaction was with one's co-workers (mean 46.83, range 0 to 54). The promotion facet received the lowest mean level of satisfaction with a 22.2 (range 0 to 54). A small correlation was found between job satisfaction and academic rank (r = -.153, P = .020). CONCLUSION: Job satisfaction is linked to increased productivity and performance. It is important to understand job satisfaction to make improvements in the appropriate areas. Overall, the results indicate that PA faculty are satisfied with their jobs. Further research is needed to understand the factors that contribute to satisfaction among PA faculty.

A descriptive analysis of factors influencing physician assistant specialty selection.

This study assessed factors impacting practice selection among primary care and specialty physician assistants (PAs). Certified PAs randomized by the National Commission on Certification of Physician Assistants (NCCPA) (30,000) were surveyed, with 2,020 responses (RR = 6.7%). Results showed that factors influencing primary care and specialty selection differ. Increasing reimbursements may not increase selection of primary care by PAs.

Factors that influence physician assistant program graduates to choose rural medicine practice.

PURPOSE: A shortage of primary care, rural practitioners exists in the United States. The increasing number of physician assistants (PA) in the workforce could be an important resource in improving access to primary care services for rural patients, yet little is known about the specific factors influencing a PA to choose to practice rural medicine. The purpose of this study is to examine the factors that influence PA program graduates to choose rural medicine. METHODS: This descriptive study was conducted by electronic survey. Participants were recruited from the membership of the Texas Academy of Physician Assistants (TAPA). Main outcome measures were the correlations between rural clerkships, rural background, and rural practice. Participants were also queried regarding 16 additional factors that might influence practice choice. RESULTS: A relationship exists between rural background and rural practice choice (chi2(4) = 16.08, P = .003). Correlation also was identified between completion of rural clerkships and rural practice choice (chi2(1) = 10.67, P= .001). Factors found to have the most influence on PAs to choose rural practice were (1) desire to serve the needs of the community; (2) type of practice; and (3) supervising physician characteristics. CONCLUSIONS: PAs with a rural background and those that completed rural clerkships have a greater propensity toward rural practice after graduation. It is possible, for programs with an interest or a mission of increasing the number of their graduates who choose rural practice, that knowledge of factors that influence their graduates' practice choices may prove beneficial.

Using pictograms for communication.

The U.S. Navy sponsors annual Pacific Partnership deployments to provide humanitarian and disaster relief training for the U.S. military, partner nations, nongovernmental organizations, and host nations. Communication between these groups and the local populations receiving medical care is problematic in that sufficient numbers of capable translators are often unavailable or vastly undertrained with respect to medical terminology and practice. In addition, should Pacific Partnership respond to a real disaster, adequate numbers of translators will likely be unavailable as a result of the disaster itself. Consequently, medical providers will require alternate methods of communication previously tested for efficacy and validity. One such method is the use of pictograms designed to represent common medical maladies. To determine whether pictograms meet the 85% congruence level required by the American National Standards Institute, 36 images were provided to English-speaking physician assistants and nurse practitioners for interpretation with three images repeated within the array to assess internal validity of the questionnaire. Of the 33 distinct images, 26 (79%) reached 85% congruence showing that validated images may be a method of communication in circumstances where medical providers and patients speak discordant languages.

Level of stress and common coping strategies among physician assistant students.

PURPOSE: This study assessed levels of stress and coping strategies in physician assistant (PA) students. METHODS: The study used a descriptive, cross-sectional design. Data were collected through an electronic survey that was sent to all current student members of the Texas Academy of Physician Assistants (N = 560). The Perceived Stress Scale was used to measure level of stress, and the Brief COPE Inventory was used to measure coping strategies. RESULTS: A total of 146 (26.3%) students participated in the study. Most respondents were female, young, single, and Caucasian/non-Hispanic. The mean stress score was 33.3, higher than that reported in the overall general US population. Areas of most concern included feeling nervous and stressed, feeling upset about unexpected happenings, and an inability to control life's irritations and manage personal problems. Self-distraction, venting, and self-blame were the most frequently used unhealthy coping strategies. Acceptance, active coping, and emotional support were the most frequently used positive coping strategies. CONCLUSION: The results of this study indicated that students in PA training experience higher levels of stress than the general population in the United States, making healthy coping strategies among PA students particularly important. The results of this study can inform future research, curriculum design, teaching methods, and educational intervention in PA training programs.