Development and psychometric testing of the clinical networks engagement tool

BackgroundClinical networks are being used widely to facilitate large system transformation in healthcare, by engagement of stakeholders throughout the health system. However, there are no available instruments that measure engagement in these networks.MethodsThe study purpose was to develop and assess the measurement properties of a multiprofessional tool to measure engagement in clinical network initiatives. Based on components of the International Association of Public Participation Spectrum and expert panel review, we developed 40 items for testing. The draft instrument was distributed to 1,668 network stakeholders across different governance levels (leaders, members, support, frontline stakeholders) in 9 strategic clinical networks in Alberta (January to July 2014). With data from 424 completed surveys (25.4% response rate), descriptive statistics, exploratory and confirmatory factor analysis, Pearson correlations, linear regression, multivariate analysis, and Cronbach alpha were conducted to assess reliability and validity of the scores.ResultsSixteen items were retained in the instrument. Exploratory factor analysis indicated a four-factor solution and accounted for 85.7% of the total variance in engagement with clinical network initiatives: global engagement, inform (provided with information), involve (worked together to address concerns), and empower (given final decision-making authority). All subscales demonstrated acceptable reliability (Cronbach alpha 0.87 to 0.99). Both the confirmatory factor analysis and regression analysis confirmed that inform, involve, and empower were all significant predictors of global engagement, with involve as the strongest predictor. Leaders had higher mean scores than frontline stakeholders, while members and support staff did not differ in mean scores.ConclusionsThis study provided foundational evidence for the use of this tool for assessing engagement in clinical networks. Further work is necessary to evaluate engagement in broader network functions and activities; to assess barriers and facilitators of engagement; and, to elucidate how the maturity of networks and other factors influence engagement.

背景：临床网络（Clinical networks）目前已被广泛应用于推动医疗领域的大规模系统变革，通过动员全医疗系统内的利益相关方参与其中以达成目标。然而，当前尚无可用工具可用于衡量此类网络中的参与度。

方法：本研究旨在开发一款多专业工具，并评估其用于衡量临床网络项目参与度的测量学性能。研究基于国际公众参与协会量表（International Association of Public Participation Spectrum）的核心要素，并结合专家小组评审意见，初步开发了包含40个测试条目的问卷。2014年1月至7月，研究团队将该初稿问卷发放给加拿大阿尔伯塔省9个战略临床网络内、覆盖不同治理层级（领导者、成员、支持人员、一线利益相关方）的1668名网络利益相关方。最终回收有效问卷424份，有效回收率为25.4%。基于该调研数据，我们采用描述性统计、探索性因子分析与验证性因子分析、皮尔逊相关分析、线性回归、多变量分析以及克朗巴赫α系数（Cronbach alpha）等方法，对问卷得分的信度与效度进行评估。

结果：最终保留了16个测试条目。探索性因子分析显示四因子结构模型，该模型可解释临床网络项目参与度总方差的85.7%，四个因子分别为：整体参与度（global engagement）、信息告知（被提供相关信息）、协同参与（协作解决相关议题）以及赋权（被授予最终决策权）。所有子量表均表现出可接受的信度（克朗巴赫α系数为0.87至0.99）。验证性因子分析与回归分析均证实，信息告知、协同参与与赋权均为整体参与度的显著预测因子，其中协同参与的预测效力最强。不同层级群体的得分存在显著差异：领导者的平均得分高于一线利益相关方，而成员与支持人员的平均得分无明显差异。

结论：本研究为使用该工具评估临床网络中的参与度提供了基础性证据。未来仍需开展进一步研究，以评估更广泛网络功能与活动中的参与度、剖析参与度的阻碍因素与促进路径，同时阐明网络成熟度等其他因素对参与度的影响机制。