Study On The Development And Reliability And Validity Of Premature Infant Care Competency Scale(PICCS) For Narents In Transition

Objective:1.To explore the cognitive experience of parents,newborn pediatricians and nurses of preterm infants in the transitional period from hospital to family,and to provide references for the development of the scale of parents' care competency assessment in the transitional period.2.In view of the shortage of the tools for assessing the parental care competency of premature infants in the transitional period from hospital to family,a scale for assessing the parents' care competency of premature infants in the transitional period suitable for China's national conditions was developed,and its reliability and validity were tested preliminarily.Methods:1.Qualitative research:on the basis of literature review,the interview outline was drawn up,and 14 premature parents,doctors and nurses of NICU in a third class maternal and child health care hospital in Shenzhen from June 2019 to August 2019 were selected for semi-structured interview.The 7-step analysis method of Colaizzi phenomenological data was used to process the interview data,extract the topics,and provide reference for the development of the item pool of the premature infant care competency scale for parents in transition.2.To establish item pool of scale:Through reviewing the literatures and using qualitative research method,on the basis of the theory of knowledge,attitude and practice(KAP),establish scale item pool3.Delphi expert inquiry method:using Delphi expert inquiry method,21 experts in medical,nursing,child health care,nursing education and other disciplines related to premature infant nursing were invited to evaluate the items of the scale.By using the method of boundary value,the items were screened according to the boundary value of average value of item importance assignment,coefficient of variation and full score frequency.4.Reliability and validity test:Using convenient sampling method,411 parents of premature infants who were discharged or about to be discharged from NICU of a third class maternal and child health care hospital in Shenzhen from October 2019 to May 2020 were selected as the objects of investigation,and the items analysis,content validity,structure validity,internal consistency reliability,external stability reliability and other methods were used to preliminarily test the reliability and validity of the premature infants care competency scale for parents in transiton..Results:1.Eight preterm parents,three neonatal intensive care unit(NICU)doctors and three neonatal intensive care unit(NICU)nurses were interviewed.Through analysis and refinement,five themes were condensed,including cognitive experience,emotional experience,discharge readiness,social support,and the status quo of care competency.The theme cognitive experience includes two sub themes:there are differences between caring for preterm infants and full term infants,and parents' care competency affects the growth of premature infants.The emotional experience includes two sub themes:the expectation to welcome the premature home and the anxiety and tension to care for the premature independently.Discharge readiness includes four sub themes:environment and goods preparation,care attitude,care knowledge and care skills.Social support includes four sub themes:family support can help parents of premature infants cope better,social resources can help parents learn knowledge and skills,hospital continued medical support plays a major role,and community medical support function is lack.2.Based on the qualitative interview and literature review,a total of 40 item pools were obtained.The two rounds of Delphi experts questionnaire returns-ratio were 95.2%and 90%respectively,and the two rounds of expert authority coefficient were 0.904 and 0.903 respectively.The boundary value of the first round of item screening is the mean value of item importance assignment:3.49,coefficient of variation:0.20,and the full score rate of item assignment:58%.The boundary value of the second round of item screening is the mean value of item importance assignment:3.35,coefficient of variation:0.18,and the full score rate of item assignment;55%.In the first round.3 items were deleted,combined with expert opinions,the items were merged and added,and a second round of expert correspondence form with 37 items was formed.In the second round,two items were deleted and two item were modified to form the first draft of the scale with four dimensions and 35 items.At the end of two rounds of expert correspondence,the average value of the importance of each item was 3.39?4.00,and the coefficient of variation was 0.00?0.17.In the first round,Kendall' W is 0.190,and in the second round,Kendall' Wis 0.302.3.In the item analysis,items 1,30 and 34 respectively have one non-comforming item in 6 items analysis(critical ration,item and total score correlation,sub scale correction item and total score correlation,a coefficient after deleting item,commonality and factor load).They fail to meet the deletion standard(delete items with two or more non-comforming items),and they are temporarily reserved,with a total of 35 items.4.The content validity of the scale was evaluated by calculating item level content validity index(I-CVI)and scale level content validity index(S-CVI).The value of I-CVI in this scale ranges from 0.88 to 1.00,all of which are more than 0.78,it means that all items have high I-CVI;the value of scale level content validity index is 0.975,it means that the identification of all participating experts is high,and the content validity of the scale is good.The construct validity was evaluated by exploratory factor analysis and confirmatory factor analysis.In the first round of exploratory factor analysis,extraction factors and orthogonal rotation were found to have commonality among factors.Four factors were obtained by direct obliquity rotation method,and the cumulative explanatory variation was 72.48%,which was basically consistent with the preset dimensions of the scale.According to the previous theoretical basis and item content,four common factors were named as "care knowledge","care attitude","care skills" and "social support".Finally,the final version of premature infant care competence scale for parents in transition was formed,which included four dimensions and 35 items.Confirmatory factor analysis showed that in the modified model,?2/df is 2.13,CFI is 0.927,TLI is 0.922,SRMR is 0.073,RMSEA is 0.061,the model fit well.The scale has good content validity and structure validity.5.To evaluate the scale's reliability,in this study,we used the internal consistency reliability(Cronbach's a reliability,split-half reliability)and external stability reliability(test-retest reliability).The scale's total Cronbach's a reliability coefficient is 0.955,and four dimensions' Cronbach's a reliability coefficient ranges from 0.926 to 0.957.The scale's total split-half reliability coefficient is 0.978,and the four dimensions'split-half reliability coefficient ranges from 0.863 to 0.934.The the total scale' test-retest reliability coefficient is 0.889,and the four dimensions' test-retest reliability coefficient ranges from 0.715 to 0.821.It shows that the scale has good reliability.Conclusions:1.There are differences between caring for preterm infants and caring for full term infants.During the transition period from hospital to family,the care competency of parents of preterm infants can affect the growth of preterm infants.At present,there is a lack of assessment on the preterm infants care competency of parents when they leave hospital in China,and the parents care competency of preterm infants generally fails to meet the requirements.Medical institutions and medical staff should pay more attention to the education and training of parents of premature infants,provide resources and support,strengthen the assessment of parents'care competency,and promote the smooth transition of premature infants.2.In this study,we completed the development of Premature Infant Care Competency Scale(PICCS)for parents in transition.The scale finally includes 35 items in four dimensions:care knowledge,care attitude,care skills and social support.The preliminary reliability and validity test confirmed that the scale has good reliability and validity,and it can be used as an objective tool to evaluate the care competency of premature infants parents in transition.