title: Emergency healthcare worker sleep, fatigue, and alertness behavior survey (SFAB): development and content validation of a survey tool.
abstract: BACKGROUND
  Workplace safety is a recognized concern in emergency medical services (EMS). Ambulance crashes are common and injury rates exceed that of the general working public. Fatigue and sleepiness during shift work pose a safety risk for patients and EMS workers. Changing EMS worker behaviors and improving alertness during shift work is hampered by a lack of instruments that reliably and accurately measure multidimensional beliefs and habits that predict alertness behavior.
  
  
  OBJECTIVE
  We sought to test the reliability and validity of a survey tool (the sleep, fatigue, and alertness behavior survey [SFAB]) designed to identify the cognitions of EMS workers concerning sleep, fatigue, and alertness behaviors during shift work.
  
  
  METHODS
  We operationalized the integrative model of behavioral prediction (IMBP) and developed a pool of 97 candidate items and sub-items to measure eight domains of the IMBP. Five sleep scientists judged the content validity of each item and a convenience sample of EMS workers completed a paper-based version of the SFAB. We retained items judged content valid by five sleep scientists and performed exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and tests of reliability and internal consistency. We identified a simple factor structure for each scale and calculated means and standard deviations for each item and scale.
  
  
  RESULTS
  We received 360 completed SFAB surveys from a convenience sample of 800 EMS workers attending two regional continuing education conferences (45% participation rate). Forty-seven candidate items and sub-items/options were removed following content validation, EFA, and CFA testing. Analyses revealed a simple factor structure for seven of eight domains and a final pool of 50 items and sub-items/options. Domains include: attitudes, normative beliefs, knowledge, salience, habits, environmental constraints, and intent. EFA tests of self-efficacy items failed to identify a simple factor structure. We retained two self-efficacy items based on Spearman-Brown correlation of 0.23 (p<0.0001).
  
  
  CONCLUSIONS
  Measurement of sleep, fatigue, and alertness behavior among EMS workers is challenging. We describe the development and psychometric testing of a survey tool that may be useful in a variety of applications addressing sleep, fatigue, and alertness behavior among EMS workers.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. Electronic address: pattersond@upmc.edu.
authors.forename: P Daniel
authors.initials: PD
authors.lastname: Patterson
authors.affiliation: Department of Psychiatry and Clinical Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Buysse
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Weaver
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Suffoletto
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Kyle L
authors.initials: KL
authors.lastname: McManigle
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Donald M
authors.initials: DM
authors.lastname: Yealy
mesh_terms: D000328:Adult; D003625:Data Collection; D004632:Emergency Medical Services; D005163:Factor Analysis, Statistical; D005221:Fatigue / Q000175:diagnosis*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D011594:Psychometrics; D015203:Reproducibility of Results; D012890:Sleep; D012894:Sleep Stages; D014940:Work Schedule Tolerance; D017132:Workplace
keywords: Alertness; Emergency workers; Fatigue; Sleep